Forearm Volar Splint

Other Names

Approximate landmarks for the volar forearm splint

Demonstration of volar forearm splint.

Step-by-step instructions for the volar slab splint

Demonstration of the final splint

• Volar Splint
• Dorsal Splint
• Sandwich splint
• Forearm Volar Slab

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Background

• This page refers to both dorsal and volar splints
  • Typically a volar splint is used
  • A dorsal slab can be applied for increased stability
• Can be used as definitive treatment or temporary treatment before a cast is applied
• Improves patient comfort, facilitates recovery, and protects from further injury
• A forearm volar splint differs from a cast in that it is not circumferential
  • This allows for some swelling without constriction

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Indications

• Soft tissue injuries to the hand and wrist including:
  • Cellulitis
  • Lacerations
• Carpal Tunnel Syndrome
• Second to fifth Metacarpal Fractures
  • Typically for 2nd to 5th metacarpal heads
  • If there is prominent fracture angulation and displacement is present, a closed reduction should be made first
  • Sugar Tong Splint is more appropriate for most metacarpal fractures
• Carpal Bone Fractures
  • Including triquetrum, pisiform, trapezoid, capitate, hamate
• Wrist sprains
• Gouty arthritis
• Radial nerve palsy

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Contraindications

• Distal radius fractures or distal ulnar fractures
  • Forearm volar splint allows for supination and pronation

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Procedure

Equipment

• See: Splinting Materials

Preparation

• Length and application depend on the type of fracture
  • Typically extends from metacarpal heads to mid- or proximal forearm
  • Use about 8-10 layers of plaster of paris

Technique

• Assess and confirm neurovascular status
• Apply stockinette and smooth over the extremity with ~2cm extra proximally and distally
• Wrap cast padding from the metacarpal head circumferential to the antenuptial fossa over stockinette (avoid wrinkles and gaps)
• Supinate the wrist and hold it at ~20 degrees of extension
• Splint application
  • Wet splitting material with lukewarm water and squeeze excessive water
  • Lay most material along the palmar aspect of the hand, wrist, and forearm to ~4cm proximal to the antecubital fossa
• Once plaster takes form, apply cast padding above splinting material
• Apply final layer of ACE bandage
• Reassess neurovascular status and confirm fit patient

Pearls

• Key anatomic positions
  • Forearm in neutral position with thumb up
  • Wrist in slight extension (10–20º)
  • Hand is in "holding a can" position

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Aftercare

• Try to elevate extremity for the first few days to prevent more swelling
• Advise patient to keep cast or splint clean and dry
• Do not insert objects into splint/ cast
• Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
• Seek further care if unable to control pain at home

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Complications

• Thermal injury
  • Plaster/fiberglass and water cause an exothermic reaction
• Skin sores, pressure ulcers, and blisters from excessive pressure
• Ischemic injury if too tight
  • Can also contribute to compartment syndrome
• Nerve palsy
• Vascular compromise
  • Unlikely given splint only covers volar or dorsal surface
• Splint dermatitis
• Joint stiffness

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See Also

• Splinting Main
• Procedures Main

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