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Volar Splinting

Volar Splinting

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In general, splints are applied to decrease movement and provide support and comfort through stabilization of an injury. They are primarily used to stabilize nonemergency injuries to bones until the patient can be evaluated by a consultant such as an orthopedic surgeon. Splints are also used to assist in primary healing or to temporarily immobilize an extremity before surgery (eg, for open fracture). [1]

Unlike casts, splints are noncircumferential. They are often preferred in the emergency department (ED) setting, where injuries are frequently acute and continued swelling can occur. All patients with injuries that are splinted should be referred for evaluation by a consultant in a timely fashion (usually within 2-7 days, depending on the reason for splinting). [2, 3]

A volar splint can be used for various injuries, [4] including the following:

There are no absolute contraindications for volar splinting. Relative contraindications in injuries that require immediate evaluation or intervention by a consultant (eg, an orthopedic surgeon, hand surgeon, or plastic surgeon) include the following:

Howes DS, Kaufman JJ. Plaster splints: techniques and indications. Am Fam Physician. 1984 Sep. 30 (3):215-21. [Medline].

Pike J, Mulpuri K, Metzger M, Ng G, Wells N, Goetz T. Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger. J Hand Surg Am. 2010 Apr. 35 (4):580-8. [Medline].

Bloom JM, Khouri JS, Hammert WC. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013 Oct. 132 (4):560e-566e. [Medline].

Bethel CA, Meller MM. Volar, Splinting. Treasure Island, FL: StatPearls; 2017. [Full Text].

Kumnerddee W, Kaewtong A. Efficacy of acupuncture versus night splinting for carpal tunnel syndrome: a randomized clinical trial. J Med Assoc Thai. 2010 Dec. 93 (12):1463-9. [Medline].

Wang JC, Liao KK, Lin KP, Chou CL, Yang TF, Huang YF, et al. Efficacy of Combined Ultrasound-Guided Steroid Injection and Splinting in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2017 May. 98 (5):947-956. [Medline].

Golriz B, Ahmadi Bani M, Arazpour M, Bahramizadeh M, Curran S, Madani SP, et al. Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome. Prosthet Orthot Int. 2016 Oct. 40 (5):617-23. [Medline].

Meals C, Castro NJ, Moss D. Efficient Construction of Volar Wrist Splints: A Biomechanical Study Comparing Splints of Different Material, Thickness, and Design. Hand (N Y). 2016 Sep. 11 (3):310-313. [Medline]. [Full Text].

Sacchetti A, Senula G, Strickland J, Dubin R. Procedural sedation in the community emergency department: initial results of the ProSCED registry. Acad Emerg Med. 2007 Jan. 14 (1):41-6. [Medline].

Kaplan SS. Burns following application of plaster splint dressings. Report of two cases. J Bone Joint Surg Am. 1981 Apr. 63 (4):670-2. [Medline].

Hutchinson MJ, Hutchinson MR. Factors contributing to the temperature beneath plaster or fiberglass cast material. J Orthop Surg Res. 2008 Feb 25. 3:10. [Medline]. [Full Text].

Halanski MA, Halanski AD, Oza A, Vanderby R, Munoz A, Noonan KJ. Thermal injury with contemporary cast-application techniques and methods to circumvent morbidity. J Bone Joint Surg Am. 2007 Nov. 89 (11):2369-77. [Medline].

Nicolai B Baecher, MD Hand Surgery Fellow, Division of Hand, Microsurgery, and Reconstructive Orthopaedics, University of Pittsburgh Medical Center Hamot

Nicolai B Baecher, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, AO Foundation

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center

Andrew K Chang, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American Academy of Pain Medicine, American College of Emergency Physicians, American Geriatrics Society, American Pain Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Kenneth R Chuang, MD Attending Physician, Emergency Department, Long Beach Memorial Medical Center and Miller Children’s Hospital

Disclosure: Nothing to disclose.

Volar Splinting

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