How do I create a volar wrist splint with stockinette, padding, fiberglass, and ace (elastic compression) wrap?

How to Apply a Volar Wrist Splint

Apply a volar wrist splint using 8-ply plaster with a longitudinal ridge for optimal strength and cost-effectiveness, positioning the wrist in neutral (0 degrees) rather than extension, as this provides equivalent immobilization to casting while using less material. 1

Materials Preparation

• Use 8-ply plaster with longitudinal ridging rather than 10 or 12-ply non-ridged splints, as ridged 8-ply plaster exceeds the strength of non-ridged 10-ply material and matches fiberglass strength while being lighter and cheaper 1
• Plaster splints limit wrist motion more effectively than fiberglass splints in all planes of movement (flexion, extension, radial deviation, ulnar deviation) 2
• Gather stockinette, padding (cast padding/webril), plaster or fiberglass material, elastic (ace) wrap, and water basin 1

Step-by-Step Application Technique

1. Stockinette Application

• Apply tubular stockinette from mid-forearm to beyond the fingertips, extending 2-3 inches proximal and distal to where the splint will end 3
• Cut a thumb hole in the stockinette to allow the thumb to protrude 3

2. Padding Layer

• Wrap cast padding circumferentially around the forearm, wrist, and hand, starting proximally and working distally 3
• Apply 2-3 layers of padding, ensuring extra padding over bony prominences 3
• The padding should be comfortably snug but not constrictive 3

3. Splint Construction and Molding

• Measure plaster from the metacarpal heads (just proximal to the MCP joints) to approximately 2-3 inches distal to the elbow on the volar forearm 1
• Create 8 layers of plaster and fold to create a longitudinal ridge down the center of the splint for added strength 1
• Immerse the plaster in water, squeeze out excess, and smooth the layers together 1
• Position the wrist in neutral (0 degrees), NOT in extension, as neutral positioning is equally effective and prevents complications 4, 5
• Apply the splint to the volar (palm) side of the forearm, wrist, and hand 2
• Mold the splint carefully to the contours of the volar hand, wrist, and forearm while maintaining neutral wrist position 1
• Ensure the splint does not restrict metacarpophalangeal (MCP) joint motion—the splint should end proximal to the MCP joints to allow full finger flexion 3

4. Securing with Elastic Wrap

• Once the splint is positioned and molded, fold the proximal and distal ends of the stockinette back over the splint edges 3
• Wrap the elastic (ace) bandage circumferentially from distal to proximal, securing the splint in place 3
• The wrap should be snug but not tight enough to cause constriction or compromise circulation 3

Critical Post-Application Instructions

Immediate Mobilization Protocol

• Instruct patients to begin active finger motion exercises immediately for all digits to prevent stiffness, as finger motion does not adversely affect adequately stabilized fractures 3, 6
• Active motion of unaffected joints is extremely cost-effective and has significant impact on patient outcome 3
• Failure to encourage immediate finger mobilization leads to severe hand stiffness requiring multiple therapy visits and possibly surgical intervention 3, 6

Follow-Up Timing

• Schedule radiographic follow-up at approximately 3 weeks to assess healing 7, 3
• Plan for splint removal and transition to aggressive wrist motion exercises when immobilization is discontinued 7, 3

Common Pitfalls to Avoid

• Do NOT position the wrist in extension (30 degrees), as neutral positioning provides equivalent immobilization with better functional outcomes 4, 5
• Do NOT use fiberglass instead of plaster for initial splinting, as plaster limits motion more effectively in all planes 2
• Do NOT over-immobilize by restricting MCP joint motion—the splint must end proximal to the MCP joints 3
• Do NOT fail to instruct immediate finger exercises—delayed motion is the most common preventable cause of hand stiffness 3, 6
• Do NOT use more than 8-ply plaster with ridging, as this wastes material without improving strength 1