Casting and Splinting Management for Hand Injuries in the In-Season Contact Sport Athlete

Abstract

Context: Upper extremity injuries are extremely common in contact sports such as football, soccer, and lacrosse. The culture of competitive athletics provides an environment where hand injuries are frequently downplayed in an effort to prevent loss of game time. However, studies have shown that many sport-induced hand injuries do not actually require immediate surgical attention and can be safely treated through immobilization so that the athlete may complete the athletic season. In these cases, appropriate casting and splinting measures should be taken to ensure protection of the injured player and the other competitors without causing loss of game time.

Evidence acquisition: Articles published between 1976 and 2015 were reviewed to capture historical and current views on the treatment of hand injuries in the in-season athlete.

Study design: Clinical review.

Level of evidence: Level 5.

Results: Although traditionally many sports-induced traumatic injuries to the hand held the potential to be season-ending injuries, experience has shown that in-season athletes do not necessarily need to lose game time to receive appropriate treatment. A thorough knowledge of converting everyday splints and casts into game day, sport-approved protective immobilization devices is key to safely allowing athletes with select injuries to play while injured.

Conclusion: Protective techniques allow for maximum functionality during gameplay while safely and effectively protecting the injury from further trauma while bony healing takes place.

Keywords: athletics; casting; hand injury; in-season injury; splinting.

Figure 1.

Bennett fracture anatomy. The base of the thumb metacarpal bone fractures, allowing the attachment of the abductor pollicis longus (APL) to displace the metacarpal fragment. The avulsion fragment dislocates at the carpometacarpal joint in a dorsal and radial manner due to the APL and proximally due to the medial thenar muscles. The oblique posteromedial ligament retains the smaller fragment’s attachment to the trapezium.

Figure 2.

Thumb spica cast molding positions. Note: Size of arrows indicates relative force applied. (a) Bennett fracture: Thumb is in abduction with ulnar pressure applied at the lateral base of the thumb carpometacarpal joint. (b) Thumb metacarpal shaft fracture: 3-point pressure is applied dorsally over the midshaft and volarly over the metacarpal head to resist the apex dorsal deformity.

Figure 3.

Short thumb spica cast. (a) The stockinette is pulled back to allow free wrist and metacarpophalangeal motion of the fingers. (b) The casting material is checked for potential pressure points. (c) A mold is applied to hold the thumb in abduction. (d) The final cast can carefully be cut and reapplied as needed.

Figure 4.

Ulnar gutter cast. See Figure 5 for step-by-step application instructions. (a) The cast is applied, extending distally to encompass the entire tip of the included digits. (b) The hand and wrist are held in the intrinsic plus position. Cast is shown with a dorsal mold at the base of the small finger metacarpal for stabilization of a carpometacarpal fracture-dislocation.

Figure 5.

Short ulnar gutter cast for gameplay. (a) With the hand held in the intrinsic plus position, cast padding is applied over the ring and small fingers until the wrist crease is reached. (b) Casting material is then placed lengthwise on the fingers and wrapped proximally. (c and d) An assistant ensures that the strips remain in place. (e) The proximal portion of the stockinette is retracted to allow for full motion at the wrist. (f) Molding may be done depending on the injury. (g) The final cast leaves the thumb free with full motion at the first metacarpophalangeal (MCP) joint and at the MCP joints of the nonencapsulated digits.

Figure 6.

Fractures of the middle phalanx. Note: Size of arrows indicates relative force applied. (a) Proximal fractures present with an apex dorsal fracture pattern and should be splinted with the proximal interphalangeal (PIP) joint flexed and the distal interphalangeal (DIP) joint in extension, with a mold in the volar direction. (b) Midshaft and distal fractures present with an apex volar fracture pattern and should be splinted with the PIP joint in extension and the DIP joint in flexion, with a mold applied in the dorsal and distal aspect of the splint. FDS, flexor digitorum superficialis; P1, proximal phalanx; P2, middle phalanx; P3, distal phalanx.

Figure 7.

Prefabricated plastic splint for the treatment of bony injury to the distal aspect of the digit. (a) The splint is fixed with athletic tape and (b) used to hold the distal interphalangeal joint in full extension.

Figure 8.

Small finger carpometacarpal (CMC) fracture dislocation anatomy. There are 2 main types of dislocations that occur at the CMC joint, which can be classified as dorsal or volar based on the direction of displacement. Dorsal is most common in both athletic and nonathletic injuries. CMC fracture dislocations occur with the highest frequency at the small finger CMC joint due to the relative ligamentous laxity of the fifth metacarpal compared with that of other CMC joints.