Thumb Spica Cast

Other Names

Mid application of the thumb spica cast

Final product of the thumb spica cast

Illustration of the so-called short thumb spica cast

• Short thumb spica cast
• Thumb Spica Cast

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Background

• This page reviews the thumb spica cast
  • Cast begins on proximal 1/3 of forearm
  • Extends down to thumb, leaving distal phalanx exposed for neurovascular exam
  • Covers approximately half of the hand
• Similar to
  • Thumb spica splint but is circumferential
  • Thumb spica brace but is not as easily removed

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Indications

• Scaphoid Fracture
• First Metacarpal Fracture
  • Non-displaced, non-angulated, extra-articular

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Contraindications

• Most acute fractures
• Open fractures
• Injuries with neurovascular compromise
• Fractures with active swelling

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Procedure

Equipment

• See: Casting materials

Technique

• Patient position
  • Thumb in neutral position (as in holding a beer can)
  • Wrist extended to 20-25°
  • Forearm in neutral position
• Stockinette/ tubular bandage
  • Extend stockinette up forearm to approximately elbow
  • Extend down past thumb/ end of hand
• Cast padding
  • Wrap circumferentially from distal to proximal
  • Typically a single layer of padding is sufficient
• There should be no creases in the stockinette or cast padding
• Cast material
  • Wrap from distal to proximal
  • Trim excess material to accommodate distal thumb and fingers
  • Fold the proximal and distal ends of the stockinette over the cast
  • Apply an additional layer of cast material
• Apply a 3 point fixation at the fracture site until the material hardens
• Consider placement in a shoulder sling
• Confirm neurovascular exam

Pearls and Pitfalls

• Consider a Shoulder Sling for comfort

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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
  • The ability to passively/actively extend fingers without discomfort indicates absence of muscle compartment compression
• 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

• Casting Main
• Procedures Main

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