Thumb Spica Splint

Other Names

Cast material shaped into the thumb spica mold.

Plaster thumb spica splint with coban wrapped around it

Prefabricated velcro thumb spica splint

• Thumb Spica Splint
• Thumb Spica Brace
• Plaster Thumb Spica
• Prefab Thumb Spica

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Background

• This page refers to the thumb spica splint
• Splinting technique used to treat injuries of the thumb, carpal, and metacarpal
  • Can be molded from plaster or splinting materials or made pre-fabricated

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Indications

• Scaphoid Fracture
• Extra-articular fracture of first metacarpal
• De Quervain Tenosynovitis
• Lunate Fracture
• Ulnar Collateral Ligament Injury (Skier's/ Gamekeeper's thumb)

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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

• Expose patient's skin where splint will be applied and perform neurovascular examination
• Measure appropriate length of splint with stockinette
  • Splint should run the length of mid distal phalanx of thumb to mid forearm, with small amount of extra stockinette at end (approximately 2 inches on either end)
• Measure appropriate length of plaster/ fiberglass based on stockinette length
• Gather remainder of supplies and tub of warm water

Technique

• Apply stockinette to affected forearm/ hand
• Cut hole in stockinette for thumb with shears
• Wrap two layers of cast padding over stockinette and add liberal amounts of padding over joints
• Maintain patient's forearm in neutral position and wrist at approximately 25- 30° of extension
  • Have patient position hand as though they are holding a can of soda/beer
• Wet plaster/ fiberglass with warm water and squeeze out excess water
• Apply plaster/ fiberglass along radial aspect of forearm from mid distal phalanx of thumb to mid forearm
• Mold plaster/ fiberglass to arm
• Fold over excess stockinette ends over plaster/ fiberglass
• Cut wedges into casting material at base of MCP with shears prior to molding
• Apply Ace wrap over plaster/ fiberglass tightly
• Continue to mold splint to arm until hardened
• Reassess neurovascular exam of affected extremity after splinting completion

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Aftercare

• Arrange for outpatient follow up/ next visit
• Maintain splint at all times
• Keep splint clean and dry
• Monitor for complications

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Complications

• Acute Compartment syndrome
• Thermal burn injury from casting application
• Neurovascular compromise to extremity
• Skin infection
  • Cellulitis from underlying wound, pressure ulcers

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See Also

• Splinting Main
• Procedures Main

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