Flexion — A bending movement that decreases the angle between a segment and its proximal segment. For the purposes of making a splint for the hand, think about this as the movement applied to clenching a fist. Making a fist uses flexion of the muscles in your fingers. Extension — A straightening movement that increases the angle between body parts. You can think of this as the opposite of flexion, or making a fist with your hand. Extension will be moving your joints away from each other, or opening your from a closed fist.
Extensor tendon injuries — For this type of injury, the purpose of the splint will be to prevent any flexing of the hand and fingers. Place the split along the palm-side of the hand (volar side). The wrist should only have about 20 degrees of extension and the Metacarpophalangeal (MCP) about 10-15 degrees flexion (not straight). Thumb injuries — For injuries solely to the thumb, a thumb spica splint can be used and will allow the uninjured fingers to function normally. The interphalangeal joint of the thumb should be splinted in a straight position. The thumb spica splint will immobilize the wrist and thumb, adhering to the policy of splinting above and below the injured joint. Single finger injury — For injuries only to one finger, you can purchase aluminum splints with foam padding, which can be shaped to the right position. Alternatively, you can also use a tongue depressor cut to the appropriate size as a splint. Little finger (or “pinky”) injuries — When the only injury occurs to the smallest finger of your hand, an ulnar gutter splint can be used and will allow range of motion to the other uninjured fingers, possibly allowing for continued day-to-day use of the hand. The splint will be applied to the outer edge of the little finger running alongside the ulnar bone (the opposite side of the thumb). Often the little finger will be attached to the ring finger in the splint to provide greater support and the wrist is immobilized (since the splint extends down the wrist).
Many first-aid kits have splinting material that is firm enough to hold a fractured hand in place, but with a handle that the injured person can grasp with their fingers.
Pad the splint and your hand with cotton padding.
Take a rolled up crepe bandage segment, rolled gauze or a small cloth and set it between the resting fingers and the bottom of the splint to support the fingers in the resting position In general, the wrist is usually at a position of 20 degrees extension, and the metacarpophalangeal (MCP) joints are positioned in 70 degrees of flexion. The MCP joints are the joints at the base of your fingers that attach to your palm. The interphalangeal joints are the joints between your fingertips and the MCP joints and should be roughly straight. For finger injuries, be sure to allow the fingers to flex naturally. There should not be anything rigid that keeps the fingers from passively flexing or bending at rest.
Work from above the injury site to the injury site. If possible, wrap up to the injury, then put a different colored bandage over the injury. This allows the doctor to remove only the bandage over the injury to assess it, leaving the splint in place for support. A splint is not a cast, and should allow for more mobility. If the splint is wrapped too tightly, there will be no flexing (bending of your hand and fingers downward towards the natural resting position) and too much constant pressure may be applied to the injury. Ensure that the splint is only wrapped tightly enough to make the splint secure in its position. Check the fingertips for circulation by gently squeezing over the fingernail. If the color returns to the fingernail in good time, circulation is good. Otherwise, rewrap the bandage and retest the capillary refill in this manner.
Place cotton pieces or gauze between each finger.
As described in the previous section, do not wrap the splint to tightly against the injury. The splint should be held in place just enough to be secure and to provide adequate support. [8] X Research source Check the capillary refill of the fingers before you commit to the plaster of Paris.
Make sure the water is only lukewarm. Plaster of Paris will warm up as it sets, and you’ll risk burning the patient’s skin if the strips are dipped in hot water to start. You can also use fiberglass for the outer layer, which dries more quickly than plaster but is more expensive. Fiberglass is applied in the same way as the plaster of Paris strips. However, only a doctor should apply fiberglass to a cast, as a doctor should assess the injury and make sure it is set properly.
Plaster can take more than a half hour to set, whereas fiberglass dries in 15 to 30 minutes.
Apply an ice pack or cold compress for 10 to 20 minutes at a time. Just make sure the ice doesn’t get the splint or cast wet. Applying ice to the injury will help decrease swelling of the hand and can improve healing time.
If you develop numbness or pressure in the cast, go to the doctor and have it checked for compartment syndrome. When walking, it is important to keep the hand elevated and not naturally dangling along the side of the body, as is normally done. Arm slings may be prescribed by your doctor, but they usually keep your hand below the level of your heart, and they can increase the likelihood of shoulder stiffness. An arm sling can also cause additional problems and is not a necessity when caring for a fracture. Use an elevation sling for support rather than the traditional sling. This keeps the wrist and hand above the level of the heart and close to the body for protection
All of these are available over-the-counter. Be sure to follow the dosage recommendations on the bottle.
Increased pain Numbness, tingling, burning or stinging in the injured area Pressure against the inside of the cast that turns to throbbing, tingling or pain Circulation problems (look for discolored, pale, blue, gray or cold fingers and nails) Bleeding, pus, or bad odors coming from the splint or cast
