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Double Sugar Tong Splint

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Other Names

The double sugar tong splint.jpg
Illustration of the plaster positions in the double sugar tong splint[1]
Completed double sugar tong splint[2]
  • Double Sugar Tong Splint
  • Double Sugar-Tong Splint

Background

  • This page describes the double sugar tong splint
  • So called because it includes the standard sugar tong along the forearm with a second one extending up the humerus
  • Useful in unstable forearm and elbow fractures
    • Eliminates supination and pronation
    • Limits elbow flexion and extension

Indications

  • Unstable elbow fractures
  • Unstable forearm fractures
  • Fractures which require removal of supination/pronation
  • Nondisplaced Colles Fracture

Contraindications

  • Absolute contraindications
    • None
  • Relative contraindications
    • Open fractures
    • Injuries with neurovascular compromise

Procedure

Equipment

Preparation

  • You must prepare plaster for both splints
  • Measure the standard sugar tong splint for the forearm
    • Measure: proximal to the MCP joints extending around the elbow and back to the MCP joints
  • Measure the second sugar tong splint for the humerus
    • Measure from the deltoid insertion distally around the 90° flexed elbow
    • Then up to approximal to 3 inches short of the axilla

Technique

  • Patient positioning
    • Patients elbow is flexed to 90°
    • Forearm is neutral
    • Wrist is in slight extension, 10-20°
  • Apply stockinette
    • This should extend distal to the metacarpals
    • Extend up into the axilla
  • Cast padding
    • Apply cast padding along the same distribution as the stockinette
    • Be sure to place extra padding around the olecranon
  • First sugar tong splint
    • Apply from MCP around elbow and back down to MCP
    • Stabilize this by wrapping some web roll around it
    • Optionally, you can immediately apply the second sugar tong splint if prepared
  • Second sugar tong splint
    • Apply from deltoid insertion along arm, down around elbow and up to about 3 inches short of axilla
  • Apply more web roll
  • Apply ace bandage
  • Confirm neurovascular exam

Pearls and Pitfalls

  • Provides superior pronation and supination control,
  • Preferable with complex or unstable fractures of the distal forearm and elbow.

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

Complications

  • Plaster burn/ thermal injury
  • Pressure sores
    • The epicondyles and olecranon process are particularly vulnerable.
  • Nerve palsy
    • The ulnar nerve is vulnerable to compression at the posterior lateral epicondyle
    • The radial nerve is vulnerable at the anterior medial epicondyle.
  • Vascular compromise
  • Splint dermatitis
  • Permanent joint stiffness

See Also


References

  1. Image courtesy of https://fpnotebook.com/, "double sugar-tong splint"
  2. Image courtesy of Courtesy of Anthony Beutler, MD and Nathaniel Nye, MD; source: uptodate.com
Created by:
Jesse Fodero on 14 July 2019 20:29:47
Authors:
Last edited:
15 June 2023 19:48:04
Category: