What types of injuries are volar short arm splints used for?

Volar Short Arm Splints: Clinical Indications

Volar short arm splints are primarily used for minimally displaced or stable distal radius fractures, stable metacarpal and phalangeal fractures, and soft tissue injuries of the hand and wrist requiring temporary immobilization.

Primary Indications

Distal Radius Fractures

• Minimally displaced distal radius fractures are appropriate for volar splint treatment 1
• Displaced distal radius fractures can be initially managed with volar splints after adequate closed reduction, though these require rigid immobilization rather than removable splints for definitive treatment 1
• Volar plaster wrist splints perform similarly to short arm casts in limiting flexion, extension, and radial deviation, making them effective for initial fracture stabilization 2

Metacarpal and Phalangeal Fractures

• Stable volar fractures of the PIP joint (including the fifth digit) can be treated with buddy taping and dorsal night splinting in 10° flexion 3
• Most metacarpal and phalangeal fractures visible on standard radiographs can be initially managed with volar splinting 1
• Volar splints are particularly useful when early active finger motion is desired, as they allow for controlled mobilization 1

Post-Operative Immobilization

• After volar plate fixation of distal radius fractures, short-term splinting (up to 2 weeks) may be used, though immediate mobilization without splinting shows superior early outcomes 4, 5
• When splinting is used post-operatively, limiting duration to 2 weeks or less prevents complications like adhesive capsulitis and CRPS 4

Important Clinical Considerations

When NOT to Use Volar Splints

• Unstable distal radius fractures require rigid immobilization (casting) rather than removable splints 1
• Volar Barton fractures with any intra-articular displacement are inherently unstable and require surgical fixation, not splinting 6
• Post-reduction parameters indicating instability (radial shortening >3mm, dorsal tilt >10°, or intra-articular displacement) mandate rigid immobilization or surgery 6

Splint Material Selection

• Volar plaster wrist splints outperform fiberglass splints in limiting wrist motion in all planes (flexion, extension, radial and ulnar deviation) 2
• Plaster splints should be preferentially selected when maximum immobilization is required 2

Critical Management Principles

Active Finger Motion

• Patients must perform active finger motion exercises immediately following splint application to prevent finger stiffness, which is the most functionally disabling complication 1
• Finger motion does not adversely affect adequately stabilized fractures and is cost-effective prevention of long-term disability 1

Follow-Up Protocol

• Patients treated nonsurgically with splints require radiographic evaluation for 3 weeks and at cessation of immobilization to detect loss of reduction 1, 3
• If initial radiographs are negative but clinical suspicion remains high, repeat radiographs at 10-14 days after splint placement is an acceptable option 1

Common Pitfalls to Avoid

• Do not use removable splints for displaced or unstable fractures—these require rigid cast immobilization 1
• Avoid prolonged immobilization without finger motion exercises, as this leads to difficult-to-treat finger stiffness requiring extensive therapy 1
• Do not assume all distal radius fractures are appropriate for splinting—carefully assess stability criteria and consider CT for complex fractures 1
• When using volar splints post-operatively after plate fixation, limit duration to prevent complications while recognizing that immediate mobilization may be superior 4, 5