Overview of Volar Splinting
Volar splinting is a way to keep an upper arm, hand or wrist still. This is often done to help heal injuries to bones and soft tissues, or to ease pain from conditions that don’t involve an injury. It’s useful for many types of fractures in the wrist and hand. However, it’s not typically used for fractures of the first finger bone or a small wrist bone known as the trapezium.
When we use a splint to help heal a fractured bone, we generally have to immobilize the joint above and below where the injury is. But, there are exceptions to this rule. For fractures near the end of bones like the Colles or Smith fractures, the injury is treated as if it’s actually in the joint. If the fracture is closer to the middle of the arm, splinting could involve wrapping around the whole arm, extending up above the elbow.
Volar splinting can also help with a painful type of arthritis called acute gouty arthritis, and conditions that affect the hand and wrist, like carpal tunnel syndrome and radial nerve palsy.
Splinting is usually used along with elevation and icing. This treatment helps improve comfort, speed up recovery and prevent further injury. Splints can offer temporary relief for dislocations or fractures in the wrist and hand while waiting for a more permanent treatment. The difference between a splint and a cast is that a splint isn’t as tight and can be easily removed, for example, to care for a wound.
Finally, even though splints made from plaster used to be the norm, it’s now common to see ones made from padded fiberglass or preformed plastic.
Anatomy and Physiology of Volar Splinting
When using a splint to stabilize a broken bone, it’s important that the splint stretches over the joint above and below the fracture. For example, if you’ve broken a bone in your hand (called a metacarpal), the splint should start halfway up your forearm and go past the joints connecting your fingers to your hand. Before the splint is put on, any wounds should be properly cleaned and dressed. It’s also very important that the doctor checks and records the condition of your nerves and blood vessels in the area where the splint will be placed, to make sure they are intact and functioning properly.
Why do People Need Volar Splinting
A volar splint is used when individuals experience certain injuries to the bones or soft tissues in their hands or wrists and it is necessary to keep those areas from moving. These injuries may include fractures in the lower radius or ulna bones in the arm, or in some bones in the hand, except for the first metacarpal or trapezium.
It can also be used for major cuts in the skin, or damage to tendons or ligaments. Tendons are the tissues in the body that connect muscles to bones, and ligaments link bones to other bones.
Aside from injuries, a volar splint can also help in reducing discomfort in joints that are swollen or painful but have not been injured. These conditions can occur in people with acute gout (a type of arthritis that mainly affects the joints), active rheumatoid arthritis (a chronic inflammatory disorder that can impact more than just your joints) or other conditions that cause inflammation and pain.
When a Person Should Avoid Volar Splinting
There aren’t any particular reasons why someone can’t have a volar splint. A volar splint is a type of support used to keep an injured body part like a wrist or a forearm secure and still. However, in some situations, extra thought is needed before deciding to use a volar splint. For example, if there are burns, open or dirty wounds, or the break in the bone isn’t stable, it’s necessary to think carefully about whether the benefits of using a volar splint are greater than any risks involved.
If the injured arm or hand is swollen and tight, it means the pressure inside the tissues is building, which can be a serious condition called compartment syndrome. If the area is also showing signs of rapidly increasing inflammation or infection, it will need constant monitoring, and this could mean that a splint may not be the best treatment choice.
Equipment used for Volar Splinting
When creating and applying a volar splint, which is a supportive cast for your arm and hand, the doctor needs the following items:
- Plaster or padded fiberglass: These materials are used to create the actual splint. They are strong and help keep the injured area from moving too much, aiding in healing.
- Stockinette: This is a type of soft, stretchy fabric that goes directly on your skin under the splint. It protects your skin and makes the splint more comfortable to wear.
- Undercast or cotton padding: This goes on top of the Stockinette, under the splint. It provides extra comfort and protects your skin from the hard plaster or fiberglass.
- Cool water: The cool water is used to wet the plaster or fiberglass before it’s applied. This helps mold the material to the perfect shape and can make it start to harden and form the splint.
- Elastic bandage: This is wrapped around the splint to hold it, and everything underneath it, in place.
- Sling: The sling is used to hold your arm and the splint in a convenient and comfortable position, usually elevated to help reduce swelling.
All of these components combined help position your arm in a way that promotes healing and provides support while you recover.
Who is needed to perform Volar Splinting?
Volar splinting is a procedure that can be done by different types of medical professionals who’ve had the right training. This could be doctors, specialized healthcare providers, nurses, sports health professionals, or medical technicians. Just one person can carry out this procedure.
Preparing for Volar Splinting
If you have injured your hand or wrist and need to wear a volar splint (a supportive device), the length of the splint may vary depending on your injury. For a Colles or wrist fracture, the splint needs to stretch from the crease of your palm to around 2 inches below your elbow. If you have a metacarpal fracture (broken bone in the hand) including a Boxer fracture (broken knuckle), the splint should go past the joint where the hand meets the fingers. For fractures in the fingers, the splint needs to go past the tips of your fingers.
If a healthcare professional is preparing a volar splint for you, there’s a couple things they need to remember. Plaster is more flexible than fiberglass, which is good for shaping around injuries, but it takes longer to harden and become supportive. The splint hardens because of a chemical process that releases heat. The more layers of plaster they use and the warmer the water they use, the hotter this reaction will be. When plaster is used, no more than 12 layers should be used, and usually 8 to 10 is enough. They’ll also use cool water, which not only gives them more time to shape the plaster but also reduces the chance of the heat from the hardening process burning your skin.
How is Volar Splinting performed
Managing Pain
Managing pain during the setting and healing of fractures is fundamental. To ensure comfort and ease during the process of setting a fracture and applying a cast, painkillers and anesthesia are used. For children, this procedure might require general anesthesia, unlike most adults who may just need regional anesthesia and additional pain relief measures. Another option in some cases is a hematoma block.
In a hematoma block, a needle is inserted into the site of the fracture to aspirate, or draw out, as much of the hematoma (or blood clot) as possible and inject a local anesthetic for pain relief. However, a hematoma block may not always be an option, particularly if a few hours have passed since the fracture occurred, or if the fracture is open. Pain medications are usually given before and after the fracture is set and the splint is applied, to keep the pain under control without causing significant sedation. Any persistent pain after these measures may be a sign of a condition called compartment syndrome, which can need a surgical consultation.
Setting a Fracture
Putting the broken bones back into position, a procedure called reduction, usually calls for applying gentle traction to align the ends of the broken bones. The amount of force used during traction should be enough to overcome muscle spasm. Different techniques may be required for certain types of fractures depending on the specific circumstances of the break. For instance, if the broken bone ends aren’t aligned or there are pieces of broken bone particle, these might need to be manipulated separately to achieve correct alignment.
Positioning the Injured Limb
The way the injured limb is positioned can greatly affect the healing process. Different fractures require different positioning; for example, fractures with a dorsally (towards the back) angulated (bent or curved) diaplacement are different from those with a volar (towards the front side of the body) angulation. Splinting is required to secure these bones in place appropriately so they can heal.
No matter the direction of the angulation, the purpose of splinting remains the same: to secure the bone and prevent further injury. For example, certain fractures require the wrist to be immobilized in a slightly turned (pronated or supinated) position. Others might require it to be neutrally positioned. The exact position for immobilization depends on where the fracture is located along the length of the bone, and any forces affecting the fracture.
For hand injuries involving the flexor and extensor tendons, a safe position for immobilization, called the posture of safe immobilization (POSI) is applied. This position ensures the wrist is flexed between 0 and 30 degrees, the metacarpophalangeal joints (the joints connecting fingers to the palm of the hand) are flexed between 70 to 90 degrees, and the interphalangeal joints (finger joints) are fully extended.
Applying a Splint
Before applying a splint, it’s important to check the blood supply and nerve function in the affected limb. The area must be wrapped with adequate padding to prevent injury from the heat produced by the setting of the splint material. The padding should be wrapped carefully, avoiding wrinkling, to prevent pressure sores. Sometimes, plaster or synthetic casting materials are used to create the splint. If necessary, the length of the material can be adjusted to properly fit the size and shape of the patient’s limb.
It’s important to take time and care when applying a splint. Proper preparation and technique help to ensure a successful and comfortable recovery.
Possible Complications of Volar Splinting
Problems that might arise from volar (palm side of the hand) splinting can range from joint stiffness to more serious issues. Joint stiffness refers to the difficulty or discomfort in moving the joints. Along with this, thermal burns, which are burns caused by heat, could also occur in rare cases.
Pressure ulcers, also known as bedsores, are injuries to the skin and underlying tissue which mainly result from prolonged pressure on the skin. Additionally, the splint might cause wound infections, where the wound under the splint gets infected by bacteria and other pathogens.
A particularly serious complication is compartment syndrome. This condition happens when excessive pressure builds up inside an enclosed muscle space in the body, such as the rigid space that exists under your splint. It can decrease blood flow, damaging nerves and muscles, and if left untreated, it may result in permanent damage to the muscles.
What Else Should I Know About Volar Splinting?
Volar splinting is a helpful method used to treat injuries and other conditions affecting the hand and wrist. This type of splint helps keep the bones in the hand and wrist stable and secure, while also leaving enough space to accommodate any swelling that might occur. The splint can be taken off to check on any wounds that might be present due to the injury.