Double Sugar Tong Splint

Other Names

Illustration of the plaster positions in the double sugar tong splint

Completed double sugar tong splint

• Double Sugar Tong Splint
• Double Sugar-Tong Splint

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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

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Indications

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

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Contraindications

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

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Procedure

Equipment

• See: Splinting Materials

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.

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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

• 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

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See Also

• Procedures Main
• Splinting Main

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