Background

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 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 splinting).^{[2, 3]}

Indications

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

• Soft-tissue injuries of the wrist and hand
• Fractures of the second, third, and fourth metacarpals
• Fractures of the second, third, and fourth phalanges
• Positioning for rheumatoid arthritis
• Certain wrist fractures, including a pisiform fracture
• Positioning in the treatment of carpal tunnel syndrome (median nerve compressive neuropathy),^[4]  sometimes in conjunction with a metacarpophalangeal unit^[5]

Contraindications

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:

• Complicated fractures
• Open fractures
• Injuries with associated neurovascular compromise