Place the arm in a neutral position. Position the 4th and 5th fingers flexed downward as much as possible, or as close to 90 degrees as possible, depending on the patient. Make a slit in the stockinette for the thumb on one side of the stockinette. On the opposite side of the stockinette, cut a slit and then up the side of the stockinette for the other fingers to pass through. Place the stockinette over the fingers and down the forearm. We're going to take our 1-inch stockinette and cut about 3 quarters of the way up. Place either 1 or 2-inch stockinette over the 4th and 5th fingers with a 1 to 2-inch overlap. Begin wrapping with cotton padding at the wrist and work distally. Come up high on the back of the hand and through the web space of the index finger and thumb. Continue working more distally. Incorporate the 4th and 5th fingers with cotton padding. Be sure not to pull the fingers too tight together. Keeping the fourth and fifth fingers to 90 degrees and the wrist back at 30 degrees, continue to wrap down the hand and forearm. Make three turns at the proximal end for a bumper. Continue to wrap back up the arm proximally to the ulnar styloid. Apply extra padding to the ulnar styloid for patient comfort. Then fold the fiberglass splint in half lengthwise and cut one end of the fold so that it is shaped like the top of a heart. Trim the length of the fiberglass splint so it leaves half an inch of padding at both ends of the splint padding. Wet the fiberglass and wring out as much water as possible. Keeping the fourth and fifth fingers at 90 degrees, apply the splint to the ulnar side of the patient's forearm. Use gauze to wrap the fiberglass splint from the fingers down to the proximal end of the cotton padding, keeping the fourth and fifth fingers at 90 degrees and the wrist back at 30 degrees. Mold the splint, continuing to keep 4th and 5th fingers at 90 degrees and wrist back at 30 degrees. Cut the padding at each end and fold the stockinette over at the ends to help hold the fiberglass splint against the patient. Ensure that you can see the tip of both the fourth and fifth fingers and that they are not overlapping. When you break your fifth metacarpal, those fingers tend to try to cross, so you really want to pay attention that you're not casting on them that way. Cut your padding here and there, and then that folds back there. You can fold your stockinette back. Cut your slits at the top so you can fold your padding back there. Using the elastic bandage, start at the fourth and fifth fingers and wrap the elastic bandage or adhesive self-adhering wrap proximally. If needed, apply second elastic bandage or adhesive self-adhering wrap to give more conforming tension.

splint application

hand injury

neutral position

cotton padding

fiberglass splint