Sugar Tong Splint

Other Names

Illustration of the sugar tong splin

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

Final product of the sugar tong splint

• Sugar Tong Splint

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Background

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

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Indications

• Distal Radius Fracture
• Distal Ulna Fracture
• Ulnar Styloid Fracture
• Lunate Dislocation
• Some Carpal Bone 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 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

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

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See Also

• Procedures Main
• Splinting Main

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