Region	Type of splint/cast	Indications	Pearls/pitfalls	Follow-up/referral
Ulnar side of hand	Ulnar gutter splint/cast	Fourth and fifth proximal/middle phalangeal shaft fractures and select metacarpal fractures	Proper positioning of MCP joints at 70 to 90 degrees of flexion, PIP and DIP joints at 5 to 10 degrees of flexion	One to two weeks Refer for angulated, displaced, rotated, oblique, or intra-articular fracture or failed closed reduction
Radial side of hand	Radial gutter splint/cast	Second and third proximal/middle phalangeal shaft fractures and select metacarpal fractures	Proper positioning of MCP joints at 70 to 90 degrees of flexion, PIP and DIP joints at 5 to 10 degrees of flexion	One to two weeks Refer for angulated, displaced, rotated, oblique, or intra-articular fracture or failed closed reduction
Thumb, first metacarpal, and carpal bones	Thumb spica splint/cast	Injuries to scaphoid/trapezium Nondisplaced, nonangulated, extra-articular first metacarpal fractures Stable thumb fractures with or without closed reduction	Fracture of the middle/proximal one third of the scaphoid treated with casting	One to two weeks Refer for angulated, displaced, intra-articular, incompletely reduced, or unstable fracture Refer displaced fracture of the scaphoid
Finger injuries	Buddy taping	Nondisplaced proximal/middle phalangeal shaft fracture and sprains	Encourage active range of motion in all joints	Two weeks Refer for angulated, displaced, rotated, oblique, or significant intra-articular fracture or failure to regain full range of motion
	Aluminum U-shaped splint	Distal phalangeal fracture	Encourage active range of motion at PIP and MCP joints
	Dorsal extension-block splint	Middle phalangeal volar plate avulsions and stable reduced PIP joint dislocations	Increase flexion by 15 degrees weekly, from 45 degrees to full extension
			Buddy taping permitted with splint use
	Mallet finger splint	Extensor tendon avulsion from the base of the distal phalanx	Continuous extension in the splint for six to eight weeks is essential
Wrist/hand	Volar/dorsal forearm splint	Soft tissue injuries to hand and wrist Acute carpal bone fractures (excluding scaphoid/trapezium) Childhood buckle fractures of the distal radius	Consider splinting as definitive treatment for buckle fractures	One week Refer for displaced or unstable fractures Refer lunate fractures
	Short arm cast	Nondisplaced, minimally displaced, or buckle fractures of the distal radius Carpal bone fractures other than scaphoid/trapezium
Forearm	Single sugar-tong splint	Acute distal radial and ulnar fractures	Used for increased immobilization of forearm and greater stability	Less than one week Refer for displaced or unstable fractures
Elbow, proximal forearm, and skeletally immature wrist injuries	Long arm posterior splint, long arm cast	Distal humeral and proximal/midshaft forearm fractures Nonbuckle wrist fractures	Ensure adequate padding at bony prominences	Within one week Refer for displaced or unstable fractures
	Double sugar-tong splint	Acute elbow and forearm fractures, and nondisplaced, extra-articular Colles fractures	Offers greater immobilization against pronation/supination	Less than one week Refer childhood distal humeral fractures