Mix & Match: Upper Extremity Splints and Fractures

All right, folks.  Spring Break is over and it's time to get serious.  Rather than a traditional case study for today's post, let's talk more splints.  Last week, I reviewed Splinting 101, explaining the process of splint application.  This week, let's talk about types of splints and which kind of splint is appropriate for various types of fractures.

While splinting is a pretty simple skill, it's important that as a nurse practitioner or physician assistant you are proficient in the process.  A misplaced or ill-applied splint can lead to some serious complications.  Mastering the different varieties of splints and pairing them appropriately to a fracture is essential to your practice.  Which types of splints are used to immobilize upper extremity fratures?

Ulnar Gutter Splint

Indications: 4th and 5th metacarpal fractures, boxer's fractures.

Application: Place splint from the tip of the 5th finger (just beyond the DIP) to about 2 inches from the antecubital.  Apply splint in a gutter formation to the ulnar side of the hand. 

Tips: Asking the patient to hold a can or bandage wrap can help get the hand into proper position.  

Radial Gutter

Indications: Fractures of the 2nd and 3rd metacarpals or phalanges.

Application: Place splint along the radial side of the forearm from just beyond the DIP of the index finger to about 2 inches from the antecubital.  The thumb should be left free.

Tips: Some orthopedic specialists recommend a volar splint rather than a radial gutter splint.  It's a good idea to consult an orthopedist see which type of splint he/she recommends.  Median nerve compression can occur with this type of splint.  If numbness or weakness in the palmar side of the thumb, 2nd, 3rd or 4th digit occurs after splint application, remove the splint promptly. 

Thumb Spica Splint

Indications: Scaphoid injuries, navicular injuries, ligamentous injuries to the thumb, 1st metacarpal fracture

Application: Place splint from the tip of the thumb to about 2 inches from the antecubital. As you apply the splint, smooth it over the dorsal side of the hand and forearm. 

Tips: Asking the patient to hold a can or bandage wrap may help achieve proper positioning of the hand and wrist. Scaphoid fractures can be difficult to diagnose on X-Ray.  If the patient has tenderness over the anatomical snuffbox, this is suggestive of scaphoid injury and should be splinted. 

Volar Splint

Indications: Fractures of 2nd, 3rd and 4th metacarpals, fractures of 2nd, 3rd and 4th phalanges, soft tissue injuries of wrist and hand. 

Application: Place splint from the base of the fingers to about 2 inches from the antecubital.  

Tips: Holding a can or bandage roll can assist in proper positioning of the hand.  Volar splints are not recommended for fractures of the radius and ulna as they do not limit forearm supination and pronation. 

Sugar-Tong

Indications: Initial treatment of fractures of the radius or ulna. 

Application: Place splint from the palmar crease, along the forearm.  Continue wrapping the splint around the elbow to the MCP joints creating a "U" shape. 

Tips: Sugar-tong splints can be difficult to apply by yourself.  Having another person assist will result in better splint placement.  Measuring splint length on the patient's uninjured limb will be easier than using the injured extremity as a guide. 

Double Sugar-Tong

Indications: Elbow and forearm fractures, Colles fractures

Application: Start by placing a single sugar-tong splint.  Then, apply a second sugar-tong extending from the deltoid, extending down the upper arm, around the elbow and back up the arm to a few inches below the axilla. 

Tips: The double sugar-tong is effective for unstable or complex fractures.  It can be difficult to apply alone.  Seek assistance for easier splint application. 

Long Arm Posterior Splint

Indications: Elbow, proximal and mid-shaft forearm, and wrist fractures. 

Application: Place splint from the base of the 5th metacarpal to about 3 inches away from the axilla.

Tips: Long arm splints are not recommended for unstable fractures.  Having the patient hold a can or bandage wrap will assist in proper positioning of the hand and wrist. 

Always check your splints after application to make sure the patient is neurovascularly intact and that the extremity is immobilized in the proper position.  Complications of splinting range from joint stiffness to more serious complications like compartment syndrome.  Applying the appropriate splint for the fracture with the proper technique is essential in preventing complications and promoting healing of the injured extremity. 

You Might Also Like: Forearm Fractures: Beyond Transverse, Oblique and Comminuted

 

Sources:

Schraga, E. and Do, T. (2013, December 19). Splinting. Medscape. Retrieved March 23, 2014 from http://emedicine.medscape.com/article/1997864-overview. 

Boyd, A, Benjamin, H. and Asplund, C. (2009, September 1). Splints and Casts: Indications and Methods. AAFP. Retrieved March 23, 2014 from http://www.aafp.org/afp/2009/0901/p491.html.