Volar Splint

Indications:
-Hand and Wrist injures (NOT distal radius or ulna fractures, can still supinate and pronate)
-Carpal fractures
-Lunate dislocation
-2nd-5th metacarpal head fracture
​
Application:
-Extends along volar forearm from metacarpal heads to just proximal to radial head
-Allow flexion of elbow
-Wrist at 20 degrees of extension
​-Can add dorsal "sandwich" for stability

​Ulnar Gutter Splint

Indications:
-4th and 5th phalanges and metacarpals

Application:
-Extends from 5th DIP to proximal forearm
-Wrist at 20 degrees of extension
-Flex MCPs at 50-70 degrees, PIP and DIPs in slight flexion

​Thumb Spica Splint

Indications:
-Scaphoid and lunate fractures
-1st metacarpal fracture
-Thumb fractures
-De Quervain tenosynovitis

Application:
-Extends from tip of thumb to proximal forearm
-Wrist at 20 degrees of extension
-Thumb slightly flexed

​Long Arm Splint

Indications:
-Proximal forearm and elbow fractures
-Intraarticular fractures of distal humerus and olecranon

Application:
-Elbow at 90 degrees of flexion
-Neutral forearm and wrist

Sugar Tong Splint

Indications:
-Wrist and distal forearm fractures

Application:
-Extends from MCPs on dorsum, around elbow, to volar midpalmar crease
-Elbow at 90 degrees of flexion
-Neutral forearm and wrist
​-Double sugar tong for complex or unstable forearm and elbow fractures

HPI:  23 yo male s/p MCC. Patient reports that he swerved to avoid hitting a vehicle in front of him that stopped abruptly and layed down his bike, landing on his right shoulder. He was helmeted and did not lose consciousness. Ambulatory after the event, hemodynamically stable, and complaining of right shoulder pain.
​
Exam:

Radiology:

Management:  Middle Third (80-85%)

Lateral Third (10-15%)

Medial Third (5-8%)

Treatment:

Nonop

• sling immobilization with gentle ROM exercises at 2-4 weeks and strengthening at 6-10 week

Operative

• ​ORIF

Resources:
​Orthobullets.com

HPI: 22 yo otherwise healthy male presents s/p head on MVC vs tree. Patient is awake and alert, hemodynamically stable, complaining of right hip pain.
​
Physical Exam: No external signs of trauma. Right lower extremity is shortened compared to the left and internal rotated. No numbness, 2+ DP pulse.

​Classification:
​- Simple: pure dislocation
​- Complex: with associated fracture of acetabulum or proximal femur

​Mechanism:
​- Axial load on femur while hip flexed and adducted or through flexed knee (dashboard injury such as this patient)​

​Requires emergent reduction (within 6 hours!) due to risk of vascular compromise to hip and osteonecrosis

​However...

​Examine femoral neck closely on XR to rule out fracture prior to attempting closed reduction.
​
With ipsilateral femoral neck fracture, closed reduction is contraindicated!

 
​Patient must be adequately sedated for procedure.  Propofol helps with tissue relaxation!

​Post reduction CT must be performed to evaluate for:
​- femoral head fractures
​- loose bodies 
​- acetabular fractures 

​Commonly associated with ipsilateral knee injuries (up to 25%) 

​Dispo: For simple dislocation, protected weight bearing for 4-6 weeks
​

Resources:
1. Serna, Fernando MD, Corczyca, John MD. Hip Dislocations and Femoral Head Fractures. University of Rochester Medical Center. March 2004.
2. Orthobullets.com