Volar splinting can be performed by appropriately trained personnel including physicians, physician assistants, nurses, or technicians. The procedure can be performed by a single operator.

Volar splint length depends on the application. For a Colles or other wrist fracture, the splint extends from the second through fifth metacarpal heads (distal palmar crease) to 4 cm to 5 cm distal to the antecubital fossa. For a metacarpal fracture including a Boxer’s fracture, the splint should extend beyond the metacarpophalangeal joint and for a phalanx fracture to beyond the tip of the digits. Plaster takes longer to set and is more pliable than fiberglass.

The hardening of the splint material occurs through an exothermic reaction. The amount of heat released is proportional to the number of layers of cast material and the temperature of the water utilized. Limit the layers of plaster to no more than 12 (usually 8 to 10 layers suffice). Using cool, fresh water allows time to mold the splint and reduces the risk of burn. Apply adequate stockinette and cotton undercast padding to prevent heat penetration. Care is taken to avoid skin contact with plaster or fiberglass. Avoid resting the still wet cast on a pillow or mattress as this will interfere with the dissipation of heat. Extra padding over bony prominences, such as ulnar styloid, will help prevent pressure sores. The elastic wrap is used to hold the splint in place. It should be applied so that swelling is allowed, but the movement is limited. Neurovascular status should be assessed before and after application. A sling is then applied for elevation and protection.

1. Have all of the materials at hand.
2. Supinate the wrist and hold in 20 degrees of extension.
3. Apply the stockinette and smooth over the extremity with 2 cm extra proximally and distally.
4. Wrap the cast padding, starting at the metacarpal head circumferentially to the antecubital fossa. Avoid wrinkles and gaps in the padding.
5. Thoroughly wet the splint material with cool water and squeeze out the excess.
6. Lay the moist splint along the palmar aspect of the hand, wrist, and forearm to 4 cm proximal to the antecubital fossa.
7. Fold the excess stockinette over the ends of the plaster or fiberglass and wrap under the elastic wrap.
8. Beginning at the metacarpal heads, wrap the elastic bandage with 25% overlap circumferentially around the splint, working proximally, and secure with clips or tape.
9. Mold the splint to the palm and forearm maintaining the 20-degree extension and hold until firm. The elastic bandage should be tight enough to hold the splint in place but allow two fingers to be inserted underneath. 
10. Check the capillary refill. 
11. Elevate the arm with a sling.

Some complications of splints include joint stiffness, thermal burns, pressure ulcers, wound infections, and compartment syndrome. Splinting can be the definitive treatment or temporary treatment before casting.  

Volar splinting is a valuable technique for managing traumatic and non-traumatic conditions of the hand and wrist. The splint immobilizes and supports the metacarpals and carpals while allowing room for swelling. The splint can be removed to examine wounds that may accompany the injury.[1][9][1]

Instruct the patient to keep the splint clean and dry. The extremity should be elevated, and an ice pack applied to the splint for 20 minutes every few hours. If the fingers become cold, blue, numb, or painful, seek medical attention. The patient should have close follow up within a few days. The simple removal of the splint allows for wound care in some cases. Inform the patient of the potential complications of splinting and encourage the patient to return should a concern develop.

Volar splinting is often done by therapists, emergency department physicians, orthopedic nurses and surgeons. It is a invaluable technique to stablize injuries of the hand and the digits. At each visit, the splint can be removed and the hand visualized. The key to good outcomes is patient education on keeping the splint clean and knowing when to return to the hospital.