Volar Splinting

Volar splinting of the upper extremity can be employed to immobilize hard and soft tissue injuries in addition to painful atraumatic conditions. Hard tissue skeletal injuries that may benefit from volar splinting include distal radius fractures, Colles fractures, and metacarpal or carpal fractures, excluding fractures of the first metacarpal and trapezium. Basic splinting guidelines of skeletal pathology require immobilization of the joint above and below the lesion. Exceptions to this rule include metaphyseal fractures, such as Colles or Smith fractures; metaphyseal fractures behave like injuries within the joint. For more proximal shaft fractures, the principle of volar splinting expands into sugar-tong or Muenster-type splinting, extending above the elbow. Other conditions amenable to volar splinting include acute gouty arthritis, carpal tunnel syndrome, and radial nerve palsy. Splinting is an adjunct to elevation and ice. Splinting improves patient comfort, facilitates recovery, and protects from further injury. Splints may be used for comfort as a temporizing measure for wrist and hand dislocations or fracture subluxations while awaiting definitive care. Splints differ from casts in that the noncircumferential bandage allows for some degree of soft tissue swelling without undue constriction. Splints can be easily removed for wound care. Splinting may be the definitive treatment or temporary treatment before casting. Although plaster is considered the traditional splinting material, padded fiberglass or preformed plastic splints are commonly encountered in clinical practice.