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Thumb Spica Cast

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Other Names

Mid application of the thumb spica cast[1]
Final product of the thumb spica cast[2]
Illustration of the so-called short thumb spica cast[3]
  • Short thumb spica cast
  • Thumb Spica Cast

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

Indications


Contraindications

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

Procedure

Equipment

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


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

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

See Also


References

  1. Image courtesy of https://www.youtube.com/watch?v=8YzhHlle93k
  2. Boyd, Anne S., Holly J. Benjamin, and Chad Asplund. "Splints and casts: indications and methods." American family physician 80.5 (2009): 491-499.
  3. Carruthers, Katherine H., et al. "Casting and splinting management for hand injuries in the in-season contact sport athlete." Sports Health 9.4 (2017): 364-371.
Created by:
Jesse Fodero on 10 July 2019 17:14:25
Authors:
Last edited:
31 July 2023 15:06:38
Category: