What Is Volar Splinting?

Volar splints minimize movements and provide support and comfort by stabilizing an injury of the palm or foot, which also reduces pain and helps the injury heal faster.

Splints are usually applied to reduce movement and provide support and comfort by stabilizing an injury. They are primarily used during nonemergency injuries to the bones or ligaments until they can be evaluated by a consultant such as an orthopedic surgeon. They are also used to temporarily immobilize an extremity before surgery (e.g., for an open fracture) or enable healing.

Unlike casts, splints are preferred in an emergency setting, where injuries are often acute, and swelling may continuously increase. All patients with injuries that are splinted should be referred for evaluation by a consultant within two to seven days.

Volar relates to the palm or sole. Volar splints are applied to minimize movements and provide support and comfort by stabilizing an injury of the palm or foot. Immobilizing the joint reduces pain and helps the injury heal faster. Studies have reported that using a combination of corticosteroid injection with splinting may yield better results than using an injection alone in inflammatory conditions.

Volar splinting is used for the following:

• Soft-tissue injuries of the wrist and hand  
• Fractures of the palm and foot
• Positioning for rheumatoid arthritis 
• Certain wrist fractures 
• Treatment of carpal tunnel syndrome (medical condition due to compression of the nerve called the median nerve as it travels through the wrist)
• Ligament injuries and inflammation
• Inflammation of the tendon 

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

• Complicated fractures
• Open fractures
• Injuries with associated neurovascular compromise (damage to the nerves and blood vessels)

There are various types of splints made of various materials and have different techniques of application. Volar splints are generally applied by a healthcare professional.

Anesthesia

Volar splinting is usually tolerated without the use of anesthesia. In case of significant pain during joint manipulation or reduction of fracture, anesthesia and painkillers would be required.

Splinting of the volar

Volar splinting of the hand is also called a “cock up splint.” 

• The injured limb is completely exposed. 
• A stockinette is applied from the palm, covering the entire palm, to the forearm just beyond the mid-forearm. 
• A hole is made for the thumb to pass through. 
• Soft padding is applied over the stockinette. 
• The padding should extend 2-3 cm beyond the overlying plaster on both ends. 
• Plaster of Paris (POP) is applied over the padding. 
• A bandage wrap is applied over the wet plaster. 
• The hand remains immobile until the splint is dry. 
• The patient may feel some warmth released from the plaster as it dries.

In case of a simple sprain, the doctor may advise a simple brace with Velcro clips or a bandage wrap to be worn for two to six weeks to immobilize the joint.

Aftercare

The patient is advised to rest, elevate, and ice the injured limb. If the patient experiences weakness, numbness, color change (pale or bluish), increasing pressure or pain or spreading redness, they are advised to remove the splint and visit the emergency department right away. 

The splint must be kept clean and dry. The patient can be tempted to use sticks, pens, or hangers to scratch an itch inside the splint. Sticking objects into the splint to scratch yourself can wrinkle the padding and lead to pressure injuries or cause cuts in the skin, leading to infection. The splint is usually rechecked every 48 hours by the doctor. 

Complications of volar splinting include

• Thermal burns may occur due to the warmth as the plaster dries
• Pressure sores
• Contact dermatitis
• Neurovascular compromise (damage to the nerves and blood vessels)
• Decreased range of motion from immobilization. Hence, aftercare often requires physical therapy.