Middle phalangeal volar plate avulsions and stable reduced PIP joint dislocations Refer for angulated, displaced, rotated, oblique, or significant intra-articular fracture or failure to regain full range of motionĮncourage active range of motion at PIP and MCP joints Nondisplaced proximal/middle phalangeal shaft fracture and sprainsĮncourage active range of motion in all joints Refer for angulated, displaced, intra-articular, incompletely reduced, or unstable fracture Stable thumb fractures with or without closed reductionįracture of the middle/proximal one third of the scaphoid treated with casting Nondisplaced, nonangulated, extra-articular first metacarpal fractures Thumb, first metacarpal, and carpal bones Second and third proximal/middle phalangeal shaft fractures and select metacarpal fractures Refer for angulated, displaced, rotated, oblique, or intra-articular fracture or failed closed reduction Proper positioning of MCP joints at 70 to 90 degrees of flexion, PIP and DIP joints at 5 to 10 degrees of flexion This article highlights the different types of splints and casts that are used in various circumstances and how each is applied.įourth and fifth proximal/middle phalangeal shaft fractures and select metacarpal fractures Indications and accurate application techniques vary for each type of splint and cast commonly encountered in a primary care setting. Selection of a specific cast or splint varies based on the area of the body being treated, and on the acuity and stability of the injury. All patients who are placed in a splint or cast require careful monitoring to ensure proper recovery. Excessive immobilization from continuous use of a cast or splint can lead to chronic pain, joint stiffness, muscle atrophy, or more severe complications (e.g., complex regional pain syndrome). To maximize benefits while minimizing complications, the use of casts and splints is generally limited to the short term. Because of this, casts provide superior immobilization but are less forgiving, have higher complication rates, and are generally reserved for complex and/or definitive fracture management. This quality makes splints ideal for the management of a variety of acute musculoskeletal conditions in which swelling is anticipated, such as acute fractures or sprains, or for initial stabilization of reduced, displaced, or unstable fractures before orthopedic intervention. Splints are noncircumferential immobilizers that accommodate swelling. Management of a wide variety of musculoskeletal conditions requires the use of a cast or splint.
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