Preprocedural Planning
The patient must be assessed before the splint is applied. Sugar-tong splints cover the elbow, forearm, and wrist and may cause certain injuries (particularly to the skin) to be missed. Before a sugar-tong splint is applied, the entire limb from the shoulder to the fingertips should be examined for tenderness, bruising, and skin injury. A complete neurovascular examination should be performed before and after application of the splint.
Ultimately, the person applying the splint should be sure of the diagnosis, aware of all injuries to the affected limb, and familiar with the risks and benefits of splinting.
The splint and the splinting procedure should be explained to the patient.
Equipment
Equipment used in sugar-tong splinting is as follows (see the image below):
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Splint padding material in rolls (4-6)
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10-cm (4-in.) plaster in rolls (3 or 4)
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Elastic roller bandages in rolls (2 or 3)
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2.5-cm (1-in.) tape (most varieties are effective)
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Room-temperature water
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Hospital gown
Patient Preparation
Anesthesia
Sugar-tong splinting itself is generally well tolerated without anesthesia. Anesthesia, however, is sometimes administered to patients requiring sugar-tong splinting in order to facilitate manipulation of broken bones.
Positioning
The patient should be supine or sitting upright on a hospital bed or stretcher. If possible, the patient’s bed should be adjusted to a height comfortable for the person applying the splint. The patient should be covered with a hospital gown to protect his or her clothes from plaster dust and drips. The patient should be asked to flex the elbow of the injured limb to 90°.
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Sugar-tong forearm splinting. Splinting materials.
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Sugar-tong forearm splinting. Measuring splint.
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Sugar-tong forearm splinting. Two sheets of splint padding placed side by side.
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Sugar-tong forearm splinting. Two additional layers of splint padding.
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Sugar-tong forearm splinting. Ten layers of plaster roll.
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Sugar-tong forearm splinting. Soaking plaster layers.
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Sugar-tong forearm splinting. Laminating plaster layers.
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Sugar-tong forearm splinting. Plaster layers on top of splint padding.
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Sugar-tong forearm splinting. Folding one sheet of splint padding back over plaster layers.
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Sugar-tong forearm splinting. Folding second layer of splint padding back over plaster layers.
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Sugar-tong forearm splinting. Splint extends to midpalm on palm side of hand.
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Sugar-tong forearm splinting. Splint extends to base of fingers on back of hand.
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Sugar-tong forearm splinting. Splint wrapped in elastic roller bandage.
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Applying bandage wrap for sugar-tong forearm splint. Video courtesy of Kenneth R Chuang, MD.
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Sugar-tong forearm splinting. Four sheets of splint padding have been correctly arranged.
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Sugar-tong forearm splinting. Splint padding is folded up and around each side of plaster strip.
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Sugar-tong forearm splinting. Splint is applied in stages (A, B, C) and shown in its final form (D, E).
