Sugar-Tong Forearm Splinting Technique: Application of Sugar-Tong Splint, Postprocedural Care, Complications

Sugar-tong splints may be made from a variety of materials and in several different ways. A useful and common method is described below.

Find a flat work surface on which to prepare the splint; a table or countertop is ideal. Remove all circumferential materials from the patient’s injured limb, including clothing, bracelets, and watches. Rings, in particular, may cut off circulation to swollen fingers and should be removed. Lubrication with soapy water and gentle manipulation usually suffice. A ring cutter may be used if necessary.

Wrap one or two layers of splint padding material around the wrist and elbow. Extra protection is necessary at these sensitive areas. (For clarity, this step is omitted in the images below.)

Roll out a length of splint padding material sufficient to extend from the patient’s palm, around his or her flexed elbow, and onto the back of the hand to the base of the fingers. (See the image below.) Approximately 5 cm of extra length should be added.

Roll out three more sheets of splint padding material, all equal in length to the first. Arrange two sheets side to side on the work surface. Lay a third sheet on the seam between the first two sheets. Lay the fourth and final sheet directly on top of the third (see the image below).

Roll out 10 layers of 10-cm plaster roll to a length approximately 2 cm shorter than the splint padding material (see the image below). Once wet, the plaster will shrink about 3 cm further.

Holding the plaster layers by both ends, submerge the plaster in room-temperature water (see the image below).

Squeeze any excess water from the plaster before drawing it back out to length. Hold the wet plaster splint high with one hand, and use the other hand to strip excess water from the splint between the index and middle fingers. This laminates the layers of plaster (see the image below).

Lay the wet plaster strip onto the stacked splint padding material. Fold the exposed portions of the splint padding material around the plaster strip (see the image below). A stack of split padding material and plaster is thus created, composed of three layers of splint padding material, covered by 10 layers of wet plaster, covered by a single layer of splint padding material folded over from the bottom. (The final, folded-over layer of splint padding material prevents the elastic roller bandage from sticking once it is applied).

Bring the prepared splint material to the patient’s forearm. Position one end of the splint in the patient's palm at the midpalmar crease (see A in the image below), with the triple layer of splint padding material against the patient’s skin. Bring the splint material down around the elbow and then back up onto the back of the hand. The plaster should reach to the base of the fingers on the back of the hand but not beyond (A in the image below). A corner of the splint should be folded away from the base of the thumb in the palm to prevent the thumb from being immobilized (B in the image below). To ensure proper length, the splint may be folded back on itself slightly on the back of the hand.

Make a perpendicular cut through three quarters of the width of the elastic roller bandage, and place the apex of this cut in the web space between the patient’s thumb and index finger (C in the image above). Wrap the elastic roller bandage around the palm and then toward the elbow, completely covering the underlying splint material with a single layer of elastic roller bandage (D in the image above). The elastic roller bandage should be stretched lightly—enough to engage the elastic in the material but not more. Secure the end of the elastic roller bandage with short strips of tape if necessary (not shown).

Gently mold the splint to the contour of the elbow, forearm, and wrist. Hold the splint in place with the elbow in 90°, the forearm in neutral rotation, and the wrist in neutral flexion/extension (D and E in the image above) until the plaster is hard.

The patient should now be able to make a full fist in the splint without difficulty (E in the image above). If the patient is unable to do so, it is likely that the splint extends beyond the midpalmar crease in the palm or has not been sufficiently folded away from the base of the thumb.

Pearls

Sugar-tong splints may be difficult for one person to apply. Seek out an assistant. If no assistant is available, it may be advantageous to position the patient prone with his or her shoulder abducted and the injured forearm hanging from the bed/stretcher with the elbow at 90° of flexion. This allows gravity to aid in positioning of the splint.

To avoid excessive manipulation of the patients injured forearm or wrist, measure the splint length on the patient’s uninjured limb. The splint applier’s own limb may be used as a guide.

Instead of sandwiching splint padding material and plaster before application of the splint, splint padding material may be wrapped directly around the patient’s limb. Three layers should be created, with an additional layer or two at the ulnar styloid, the olecranon, and the ulnar nerve on the medial side of the elbow. Extra care is required to do this without tensioning the splint padding material. Tight splint padding material may constrict the limb as the forearm and wrist swell.

Instead of a perpendicular cut made in the elastic roller bandage, a hole may be cut in one end of the bandage to accommodate the thumb. (See the video below.)

Sugar-tong splints may be made with prefabricated splinting material (eg, Orthoplast), which eliminates the need to layer plaster and splint padding material. Prefabricated splinting material is easy to use but does not mold to the limb as well as plaster does. Plaster is generally better at holding broken bones in place.

If the patient can comfortably make a fist, consider asking the patient to hold the palm end of the prepared splint material against his or her midpalmar crease with the tips of the fingers. The splint material may be then wrapped around the elbow and onto the back of the hand. This ensures proper splint length at the patient’s palm and aids in securing the splint.