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Sugar Tong Splint

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Other Names

Illustration of the sugar tong splin[1]
Demonstration of the sugar tong splinting material from the distal volar MCP joint, down around the flexed elbow and back up to the dorsal MCP joint[2]
Final product of the sugar tong splint[3]
  • Sugar Tong Splint

Background

  • This page describes the so-called sugar tong splint
  • Useful for distal wrist injuries/ fractures
  • Removes supination and pronation

Indications


Contraindications

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

Procedure

Equipment

Preparation

  • Measure splint material/ plaster
    • Start from just proximal to MCP joint, extend around the elbow and back to the MCP joints
    • Use approximately 8-10 layers of plaster of Paris
    • Alternatively, you can use prefabricated splints or material

Technique

  • Patient position
    • The wrist is at 10 - 20° extension.
    • The elbow is at 90° flexion.
  • Stockinette
    • Should cover the area from distal to the MCP joints to the mid-humerus.
    • Make a hole in the stockinette to allow protrusion of the thumb.
  • Cast padding
    • Wrap cast padding from MCP joint to the mid-humerus;
    • Smooth the padding as necessary
    • Apply extra padding over the olecranon
    • Tear away any areas of excess padding to prevent areas of increased pressure on the skin.
  • Apply splint material
    • Immerse the splinting material in lukewarm water.
    • Squeeze excess water from the splinting material
    • Apply the splint material from the volar surface of the MCP joints along the volar surface of the forearm
    • Wrap around the elbow, then along the dorsal surface of the forearm back to the dorsal surface of the MCP joints.
  • Apply additional cotton padding as needed
  • Fold the stockinette and extra cast padding over the splinting material
  • Elastic bandage
    • Wrap the elastic wrap over the splinting material distally to proximally
    • Overlap each revolution by half the width of the elastic wrap
  • Smooth out the splinting material
    • Use your palms rather than your fingertips to conform to the contour of the arm to fill in the interstices in the material
  • Maintain the wrist at 10 to 20° extension and the elbow at 90° flexion until the splinting material hardens.
  • Confirm distal neurovascular status

Pearls and Pitfalls

  • If simultaneously reducing, you will need to hold compression at the site of the fracture
    • Typically, this will require two people to apply the splint and maintain the reduction until plaster hardens
  • Do not splint wrist at 0 degrees of flexion/extension or in flexion

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
  • Nerve palsy
  • Vascular compromise
  • Splint dermatitis
  • Permanent joint stiffness

See Also


References

  1. Image courtesy of merckmanuals.com, "How To Apply a Sugar Tong Arm Splint"
  2. Boyd, Anne S., Holly J. Benjamin, and Chad A. Asplund. "Splints and casts: indications and methods." American family physician 80.5 (2009): 491-499.
  3. Jackson, Trevor, et al. "A comparison of sugar-tong and volar–dorsal splints for provisional immobilization of distal radius fractures in the adult population." European Journal of Orthopaedic Surgery & Traumatology 31 (2021): 229-234.
Created by:
Jesse Fodero on 10 July 2019 18:35:24
Last edited:
19 June 2023 17:49:55
Category: