Thumb spica splint

Background

• Notching the splinting material (shown) prevents buckling when wrapping around thumb.

Indications

• Scaphoid fracture - seen or suspected (i.e., snuffbox tenderness)
• De Quervain tenosynovitis / other ligamentous or soft tissue injuries to thumb (e.g., Gamekeeper's thumb, Skier's thumb)
• Nonangulated, nondisplaced, extra-articular fractures of the base of the first metacarpal

Procedure

Splint Application General Procedure

• Assess pre-procedure neurovascular status (i.e., distal pulse, motor, and sensation)
• Measure and prepare the splinting material
  • May use contralateral extremity if easier
  • Most splints use a width slightly greater than the diameter of the limb
• Apply stockinette (if applicable)
  • Extend 2" beyond estimated the splinting material length
• Apply padding (if applicable)
  • Use 2–3 layers over the area to be splinted / between digits (when applicable)
  • Add an extra 2–3 layers over bony prominences
• Apply splinting material
  • Lightly moisten the splinting material.
  • Place as appropriate to specific splint type
  • Once finished, if applicable fold the ends of stockinette back over the splinting material if there is excess
• Apply elastic bandaging (e.g., ace wrap)
• While still wet
  • May further mold the splint to the desired shape
  • Maintain position until splint material has hardened
• Re-check and document repeat neurovascular status

Splint-Specific Details

• Apply padding and splint material as shown in figure
• Splint course:
  • Radial aspect of mid-forearm to mid-distal phalanx of thumb
• Key anatomic positions
  • Forearm in neutral position
  • Wrist in slight extension (approximately 20°)
  • Thumb in functional "wineglass" position (ask patient to envision "holding a soda can")

See Also

• Splinting