Intrinsic Plus Splint

Other Names

The intrinsic plus splint

• Intrinsic Plus Splint

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Background

• This page describes the so-called intrinsic plus splint
• The splint is named after the intrinsic plus hand position
  • Characterized by MCP flexion, PIP and DIP extension
  • Caused by an imbalance between spastic intrinsic and weak extrinsic muscles of the hand
  • Etiology is varied widely

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Indications

• Metacarpal Fractures

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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

• Measure plaster
  • Dorsal Slab: Measure from mid forearm to distal fingertips
  • Volar slab: Measure from mid forearm to distal finger tips
  • Each side should be 8-10 layers

Technique

• Patient position (Intrinsic Plus)
  • Wrist extension: 20–30° of wrist extension
  • MCP: 70–80° flexion
  • PIP/DIP in full extension
• Stockinette
  • Apply stockinette slightly longer than desired splint length
• Web roll/ cotton padding
  • Apply cotton padding starting proximally and working distally
• Plaster of Paris
  • Place the dorsal and volar slabs
  • Place the wrist into intrinsic plus.
  • Maintain this position until the plaster reaches the rigid state
• Apply more cast padding if needed
• Flip the stockinette over the edges of the splint
• Apply the ace wrap
• Reassess distal neurovascular status

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Aftercare

• Typically non-weight bearing until re-evaluated
• 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

• Acute Compartment syndrome
• Plaster burn/ thermal injury
• Pressure sores
• Nerve palsy
• Vascular compromise
• Splint dermatitis
• Permanent joint stiffness
• Skin infection
  • Cellulitis from underlying wound, pressure ulcers

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See Also

• Splinting Main
• Procedures Main

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