Often, splinting can be performed by one person. An assistant, however, is generally helpful.

Before the hand is immobilized, it is important to confirm that the fracture has been sufficiently reduced if indicated. This is most commonly done with radiographic verification of reduction. Please place all equipment at the bedside. Again, any open fractures need an orthopedic consultation.  

General Overview

All splints need to be properly placed and dressed. A soft cotton bandage, such as Webril, is placed on the skin to prevent any skin breakdown and to allow room in the splint for any inflammatory processes to complete their course. Separate the digits by placing 4 x 4 gauze between each finger. The plaster, such as ortho-glass, is then placed against the cotton bandage. The plaster should be soaked in water and then excess water removed before application. An elastic band is wrapped around the injured area that will hold that bandage and plaster in place. The elastic band is then secured in place. The splint should be held in the position of best reduction until the plaster hardens. [5][6][7][8]

Dorsal Distal Phalanx Splints

A metallic splint with sponge rubber padding is placed on the dorsal aspect of the digit spanning the fracture site. It is recommended that the digit is splinted in full extension. 

Hairpin Splint

A thin piece of metal is placed covering the distal phalanx. This is not a structurally supportive splint. This splint functions better to protect the distal end of the finger from further injury. 

Dynamic Finger Splinting

Using a metallic splint with sponge rubber padding splint the injured finger side by side with an adjacent uninjured finger. The two digits are taped together for immobilization. 

Ulnar Gutter Splint

A soft cotton bandage is placed from the distal palmar crease extending to the mid-forearm. The first, second, and third digits are generally not immobilized with this splint. Plaster is then cut to the same length and placed on the medial (ulnar nerve distribution) side of the hand. The plaster is placed laterally, extending to the volar and dorsal aspects of the hand. The plaster should extend far enough to immobilize the fourth and fifth digits. The MCP joint should be flexed 50 to 90 degrees. The DIP and PIP joints are splinted in extension. 

Radial Gutter Splint

A soft cotton bandage is placed from the distal palmar crease extending to the mid-forearm. The fourth and fifth digits are not generally immobilized with this splint. Plaster is cut to the same length and placed on the medial side of the hand (median nerve distribution). An opening needs to be made in the plaster for the thumb. The splint is placed laterally extending to the volar and dorsal aspects of the hand. The plaster should extend far enough to immobilize the second and third digits. The MCP joint should be flexed 50 to 90 degrees. The DIP and PIP joints are splinted in extension. 

Dorsal Splint With Extension Hood

A soft cotton bandage is placed from the DIP joint to the mid-forearm, sparing the thumb. In a dorsal forearm splint, plaster is placed to extend and cover the second, third, fourth, and fifth digits. The plaster should extend past the DIP joint. The MCP joint is splinted in in 50 to 90 degrees of flexion. The PIP and DIP joints are splinted in extension. An elastic bandage is placed over the splint. 

Thumb Spica Splint

A soft cotton bandage is placed from the mid-hand to the mid-forearm. A stockinet is placed over the thumb in order to protect from friction due to the plaster. Plaster is placed encompassing the thumb to the mid-forearm. The hand is positioned as if holding a can of soda; this is with the thumb abducted with the first interphalangeal joint in extension. The plaster should extend past the interphalangeal joint in order to fully immobilize the thumb. The wrist is splinted in a neutral position.

There are many complications that are associated with splint application. Inflammation and swelling of injuries can cause compartment syndrome, nerve impingement, pressure sores, skin breakdown, skin infection, and vascular compromise. Soft cotton bandages should also be placed on the skin to prevent any thermal injury from plaster reaction after the plaster has been soaked in water.  

It is imperative that hand injuries are splinted with proper technique.  As the proper technique is followed, the versatile capabilities of the hand are preserved, nerve impingements are avoided, and the full range of motion is retained. In certain settings, evaluation by an orthopedic specialist is not readily available and the hand should be splinted to prevent further injury prior to a proper follow-up appointment.

Hand splints are used to treat many disorders and can be effective for symptom relief. However, all healthcare workers including therapists and nurses who apply hand splints should ensure that the patient has close followu up. Hand splints can be associated with many complications, which if neglected can lead to malpractice litigation. At discharge the patient should be provided with thorough instructions on follow up, symptoms to observe and when to retrun to the emergency department.