Thumb Spica Splinting Periprocedural Care

Updated: May 03, 2017
  • Author: Dinesh Patel, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Preprocedural Planning

On physical examination, injury to the scaphoid can be tested by compression dorsally at the anatomic snuffbox, compression of the wrist volarly directly over the scaphoid, and axial loading of the thumb. Pain upon these compressions is suggestive of scaphoid injury. Flexion of the MCP joint does not transmit pressure or forces to the scaphoid.

An injury or fracture to the scaphoid is difficult to detect by means of radiography. When a radiograph is obtained to rule out fracture but is read as negative, an occult fracture cannot be ruled out. The patient should be advised of this possibility. Such fractures might only be identified on delayed radiographs. A patient who has clinical evidence of a scaphoid injury on physical examination should be placed in a thumb spica splint and should receive close follow-up.

The term gamekeeper's thumb originates from a description of injuries sustained by Scottish rabbit gamekeepers. [4]  Repetitive and sudden valgus forces placed on the gamekeeper’s thumbs, when they killed rabbits by breaking their necks, resulted in injuries to the ulnar collateral ligament (UCL). On physical examination, a UCL injury presents as pain, weakness, and instability during challenge of a pinched grasp between the thumb and fifth digit (see the image below).

Test for ulnar collateral ligament injury (gamekee Test for ulnar collateral ligament injury (gamekeeper's thumb).
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Equipment

Equipment employed in thumb spica splinting includes the following (see the image below):

  • Stockinette
  • Padding (eg, Webril)
  • Plaster of Paris or prefabricated fiberglass (eg, Orthoglass)
  • Bandage or wrap (eg, Bias bandage or Ace wrap)
  • Clean, room-temperature water in a basin
  • Trauma shears or a pair of medical scissors without pointed ends
  • Absorbent underpads (eg, Chux) and bed sheet
  • Tape or bandage clips
Equipment for thumb spica splint. Image courtesy o Equipment for thumb spica splint. Image courtesy of Kenneth R Chuang, MD.

For injuries or reductions that require shorter drying times, faster-setting plaster is available (eg, Specialist Extra Fast Setting Plaster). However, as plaster dries faster, the risk of thermal injury increases. For most splints, regular plaster (eg, Specialist Fast Setting Plaster) is appropriate.

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Patient Preparation

Anesthesia

Splinting is usually tolerated without the use of anesthesia. However, if significant manipulation or reduction of the injury is required during the splinting process, anesthetic techniques may be used. Acceptable techniques include the following:

  • Administration of a hematoma block or nerve block
  • Procedural sedation with appropriate monitoring and administration by an experienced physician
  • Administration of oral or intravenous pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid analgesic agents

With the administration of any analgesic agent or the initiation of a formal sedation protocol, care should be taken to avoid oversedation. A complete neurovascular examination should be performed after the splint has been applied.

Positioning

Place the patient in a comfortable position (eg, seated or reclined). Cover the patient with a sheet to avoid splatter from the wet plaster. (See the video below.)

Thumb spica splinting: appropriate coverage of patient. Video courtesy of Kenneth R Chuang, MD.

Completely expose the injured limb. Jewelry should also be removed. In particular, rings can cause constriction and ischemia of the fingers with delayed swelling of the soft tissues. If a ring cannot be removed, try using soap as a lubricant, or consider a ring cutter. (See the video below.)

Thumb spica splinting: removal of jewelry and rings to avoid ischemia from swelling. Video courtesy of Kenneth R Chuang, MD.
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