Thumb Spica Splinting
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In general, splints are applied to decrease movement and provide support and comfort through stabilization of an injury. [1] They are primarily used to secure nonemergency injuries to bones until they can be evaluated by a consultant such as an orthopedic surgeon. They are also used to temporarily immobilize an extremity before surgery (eg, for an open fracture) or to assist in primary healing.
Unlike casts, splints are noncircumferential and are often preferred in the emergency department setting, where injuries are often 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 the splint).
A thumb spica splint (see the image below) can be used for various injuries, including the following:
In a clinical trial, Becker et al compared prefabricted neoprene hand-based thumb spica splints with custom-made thermoplast splints for treating trapeziometacarpal arthrosis. The trial concluded that the thumb spica splint was more comfortable, less expensive, and equally effective in treating the condition. [2]
Rocchi et al carried out a randomized prospective clinical trial that included 30 men who underwent surgical treatment of an acute complete UCL tear; after surgery, 15 of the patients received a standard spica splint, and the other 15 received a modified spica splint that allowed immediate postoperative motion. [3] The modified splint was associated with earlier functional recovery and better postoperative function.
There are no absolute contraindications for thumb spica splinting. Relative contraindications involve injuries that require immediate evaluation or intervention by a consultant (eg, an orthopedic surgeon, hand surgeon, or plastic surgeon), such as the following:
Howes DS, Kaufman JJ. Plaster splints: techniques and indications. Am Fam Physician. 1984 Sep. 30(3):215-21. [Medline].
Becker SJ, Bot AG, Curley SE, Jupiter JB, Ring D. A prospective randomized comparison of neoprene vs thermoplast hand-based thumb spica splinting for trapeziometacarpal arthrosis. Osteoarthritis Cartilage. 2013 May. 21(5):668-75. [Medline].
Rocchi L, Merolli A, Morini A, Monteleone G, Foti C. A modified spica-splint in postoperative early-motion management of skier’s thumb lesion: a randomized clinical trial. Eur J Phys Rehabil Med. 2014 Feb. 50(1):49-57. [Medline].
Hannibal M. Gamekeeper’s thumb. Medscape Drugs & Diseases. Available at http://emedicine.medscape.com/article/97679-overview. March 20, 2015; Accessed: March 31, 2017.
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].
Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons
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.
Special thanks to Dr Iris Gluzman and Mrs Leni L Chuang.
Thumb Spica Splinting
Research & References of Thumb Spica Splinting|A&C Accounting And Tax Services
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