Thumb spica splinting can be done in any traumatic, primary care, or emergency setting by a physician, nurse, or technician. The process is performable by a single operator.

Thumb spica splints can extend from the thumb to mid-forearm or from thumb to above the elbow. In the setting of a scaphoid fracture, the use of a long-arm thumb spica splint may lead to shorter unions times in the first 4 to 6 weeks and diminish the shearing forces from the radius and ulna on the scaphoid.[10] However, by the end of splinting treatment, both long and short thumb spica splints will have equal efficacy in treating a scaphoid fracture.[10] A simple short-arm thumb spica splint is appropriate and effective for patients with De Quervain’s tenosynovitis and first metacarpal fractures (Bennet and Rolando fractures).[11]

It is vital that the splint allows for balanced function and maximal mobility of the unaffected areas such as the fingers, upper arm, and shoulder. The splint should also allow for maximal sensory perception, and the pressure of the splint should be distributed equally. The splint should not challenge the normal contours of the hand and forearm. If needed, the patient should have adequate analgesia before and alongside the splinting process.

1. Perform a comprehensive physical examination before splinting
2. Have the patient rest his or her elbow on a table, and the forearm should be in a neutral position
3. The thumb should be in the normal resting anatomic position
4. Measure a 4-inch wide, eight layers thick plaster measured from the tip of the thumb to the proximal forearm
5. Soak plaster in lukewarm water
6. Apply plaster to the radial side of forearm and thumb so that this area is protected from the thumb tip to the mid- to distal-third of the forearm (depending on the specific injury)[12]
7. Ensure no ridges or indentations are created
8. Cover the plaster with a one-layer soft wrap material to interpose between the plaster and the overlying most superficial wrap (e.g., ace wrap)
9. Recheck and document neurovascular exam

Compartment syndrome is the most consequential complication of splinting[13][14] Patients should receive education regarding the symptoms of compartment syndrome such as worsening pain, numbness, or tingling.[13] Joint stiffness, thermal injuries, pressure sores, bacterial or fungal infection, or dermatitis are other complications.[13] For these reasons, it is vital that splints only be worn for the duration that they are necessary and replaced if complications arise. Signs such as blanching of skin decreased capillary refill, or increased pain at the time of splinting may indicate that the splint is compromising the patient's normal anatomy.

Thumb spica splinting has proven to be effective in many different settings for the treatment of thumb, carpal and metacarpal injuries.  They are cost-effective, easily learned and taught, and accommodating. Further, splints are simple to manipulate for both the provider and the patient, and they are easy to remove for assessment of the extent and progression of injury throughout the healing process.

At the end of the procedure, the provider should educate the patient on basic splint maintenance, particularly keeping the area clean and dry. Instruct the patient to rest, ice and elevate the affected area in the immediate post-injury period to diminish expected swelling.[6] Generally, follow up is expected within one or two weeks from the time of splinting, but this length can vary on an individual basis.

Managing a wrist or hand injury may be as seemingly straightforward as splinting and necessary follow-up, but there are extrinsic factors involved in the healing process. For this reason, it is important to view the patient holistically. Many times these injuries will keep patients out of work or away from hobbies that bring them joy. There are reports that disability after an injury to the upper extremity highly correlates with depression [15]. For this reason, it's important to obtain a psychological evaluation at the time of the injury and closely monitor the patient throughout the healing process; this can be done through close follow-ups with the patient’s primary care provider or via therapy sessions to assess the patient’s coping strategies. Early enrollment into a program similar cognitive behavioral therapy programs may improve healing and disability in patients with orthopedic trauma.[16] Working with physical and occupational therapy has been shown to significantly increase strength in the wrist three to four months post-fracture.[17] Further, it is important to take into account cultural and socioeconomic aspects of each patient as close follow up is extremely important to recovery in patients with hand and wrist injuries.