be flexed to 90 degrees at the elbow with no rotation of the forearm The hand is dorsiflexed minimally (have the patient hold a small roll of tape or Webril) With the arm positioned as described, measure from the midpalm around the elbow to the knuckles dorsally (add to in to allow for shrinkage) The splinting material should be wide enough to support the arm along the volar and dorsal surfaces but not so wide as to overlap Prepare and apply the materials as described in the “General Splinting” section Ensure sufficient padding is placed over the elbow to prevent pressure ulcers A properly measured splint allows 90 degrees of flexion of the fingers and approaches, but does not cover, the knuckles dorsally An assistant is helpful when applying this splint Ensure the thumb is free to move in all directions Discharge the patient with a sling with the hand slightly above the level of the elbow Thumb Spica Splint Indications Nonrotated, nonangulated, nonarticular fractures of the thumb metacarpal or phalanx Ulnar collateral ligament injuries (gamekeeper’s thumb) Suspected or documented scaphoid fracture Procedure The splint extends in a U-shaped manner along the radial side of the thumb and forearm from the thumbnail to the midforearm ( Fig 130.49H ) The proper splinting position maintains the wrist in slight dorsiflexion, the thumb in some flexion and abduction, and the interphalangeal joint in slight flexion The final position is as though the patient were holding a glass or catching a ball, and will allow apposition of the index finger and thumb Determine the appropriate length of splint material by measuring from the patient’s thumbnail to the midforearm The splint should be wide enough to completely encircle the thumb Prepare and apply the splint materials as described in the “General Splinting” section The Webril should cover the thumb, hand, and forearm Mold the splint so the thumb is maintained in the position previously described A sling is usually unnecessary but may assist in reminding the patient to keep the site elevated Dorsal Extension Finger Splint