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Braces, Splints and Supports

When braces, splints and supports help upper-limb conditions, the main types, how to use them, and what the evidence shows for sprains, tendon problems, arthritis and after surgery.

Overview

Removable splints and orthoses provide effective conservative management for several common orthopaedic conditions, offering advantages in convenience and cost over traditional immobilization. For minimally displaced distal radial fractures, removable splints reduce hospital visits and healthcare costs [1]. In elderly patients with distal radial fractures, four weeks of cast immobilization is generally sufficient [4], though orthoses serve as a viable alternative to plaster casts for stable fracture types [6]. Similarly, in primary reverse total shoulder arthroplasty, pain and functional outcomes with no immobilization are comparable to those achieved with a three-week immobilization period [7].

In the hand, splinting is an effective short-term conservative treatment for adult trigger finger, offering symptom relief and functional improvement comparable to corticosteroid injections [5]. A proximal interphalangeal joint orthosis combined with therapeutic exercise demonstrates feasibility and short-term clinical improvement, although it cannot be established as superior to other conservative treatments due to the absence of a control group [3]. For pediatric low-risk ankle fractures, supportive bandages, removable splints, and walking casts are well tolerated with similar complication rates, though equipoise remains regarding the optimal choice [9].

For ligamentous and carpal injuries, non-operative options include the Cross Brace Protocol for ACL injuries, which may provide satisfactory anatomical and functional healing for certain patient groups [2]. Adult patients with scaphoid waist fractures displaced by ≤ 2 mm should initially be treated with cast immobilization, with early fixation recommended for subsequent nonunion [12]. Notably, between one and five years after randomization, union consolidated in scaphoid waist fracture patients with > 20% bridging without intervention [8]. Regarding waterproof casts for upper limb fractures in children, pooling of studies is limited by heterogeneity and small sample sizes, necessitating definitive RCTs to confirm efficacy and cost-effectiveness [10].

How It Works

Distal Radius Fractures: Removable splints for minimally displaced fractures reduce additional hospital visits [1] and save the healthcare system money [1]. Orthoses offer a good alternative to plaster casts for stable distal radius fracture types [6].

Anterior Cruciate Ligament (ACL) Injuries: The Cross Brace Protocol provides a non-operative option for ACL injuries [2]. This protocol may be associated with satisfactory anatomical and functional healing for certain patient groups with ACL injuries [2].

Trigger Finger Management: Splinting is an effective short-term conservative treatment for adult trigger finger [5]. It offers symptom relief and functional improvement comparable to corticosteroid injections [5]. Proximal interphalangeal joint orthosis combined with therapeutic exercise demonstrates feasibility and short-term clinical improvement [3]. However, this combination cannot establish superiority over other conservative treatments due to the absence of a control group [3]. Relative motion and metacarpophalangeal joint blocking orthoses support interchangeable use for managing trigger finger based on symptom severity, pain, hand function, and orthosis wearability outcomes [13].

Scaphoid Fractures: Adult patients with a displaced scaphoid waist fracture of ≤ 2 mm should be treated initially with immobilization in a cast, followed by early fixation of a nonunion [12]. Scaphoid waist fractures with > 20% bridging consolidate between one and five years after randomization without intervention [8].

Shoulder Arthroplasty and Repair: Pain and functional outcomes after primary reverse total shoulder arthroplasty are comparable between three-week immobilization and no immobilization [7]. Mid-frequency electrical muscle stimulation during immobilization after arthroscopic rotator cuff repair effectively prevents early post-operative deltoid muscle atrophy [15] and accelerates early recovery of shoulder muscle strength [15].

Paediatric Fractures: There is equipoise regarding the best treatment for low-risk ankle fractures in children, with supportive bandages, removable splints, and walking casts appearing well tolerated with similar complication rates [9]. Pooling of studies on waterproof casts for upper limb fractures in children was limited by heterogeneity and small study sizes [10]. Definitive RCTs are required to confirm the efficacy and investigate the cost-effectiveness of waterproof casts for upper limb fractures in children [10].

Hand Rehabilitation: Maintaining an appropriate balance between mobilization and immobilization has a decisive impact on tissue healing, functional recovery, and patient outcomes in hand rehabilitation [11].

What the Evidence Shows

Distal Radius Fractures

Removable splints: For minimally displaced distal radial fractures, removable splints save patients time and inconvenience regarding hospital visits and save the healthcare system money [1]. Cast immobilization: Four weeks of cast immobilization is sufficient for most distal radial fractures in elderly patients [4]. Orthoses: Orthoses offer a good alternative to plaster casts, especially for stable distal radius fracture types [6].

Scaphoid Fractures

Conservative management: Between one and five years after randomization, union consolidated in scaphoid waist fracture patients with > 20% bridging without intervention [8]. Initial treatment: Adult patients with a scaphoid waist fracture displaced by ≤ 2 mm should be treated initially with immobilization in a cast, followed by early fixation of a nonunion [12].

Ankle Fractures

Pediatric low-risk fractures: There remains equipoise regarding the best treatment for low-risk ankle fractures in children, with supportive bandages, removable splints, and walking casts appearing well tolerated with similar complication rates [9].

Shoulder Injuries and Arthroplasty

Post-arthroplasty immobilization: Three-week immobilization after primary reverse total shoulder arthroplasty yields pain and functional outcomes comparable to those obtained with no immobilization [7]. Subacromial pain syndrome: Adding thoracic extension exercises or thoracic kinesio taping to shoulder exercises results in significant improvements in activity-related pain and self-reported disability exceeding previously reported MCID values for adults with subacromial pain syndrome [20]. Recurrent dislocation: Kinesio taping combined with conventional rehabilitation leads to more significant improvements in shoulder range of motion and functional scores compared to conventional rehabilitation alone for military personnel with recurrent shoulder dislocation caused by training injury [21]. Waterproof casts: Waterproof casts for upper limb fractures in children require definitive RCTs to confirm efficacy and investigate cost-effectiveness due to limited pooling of studies from heterogeneity and small study sizes [10].

Hand and Finger Conditions

General principles: Maintaining an appropriate balance between mobilization and immobilization has a decisive impact on tissue healing, functional recovery, and patient outcomes in hand rehabilitation [11]. Trigger finger conservative care: Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement comparable to corticosteroid injections [5]. Orthosis selection: Relative motion orthoses and metacarpophalangeal joint blocking orthoses support interchangeable use for managing trigger finger based on symptom severity, pain, hand function, and wearability outcomes [13]. PJO orthosis: Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement for trigger finger but cannot establish superiority over other conservative treatments due to the absence of a control group [3].

Knee and Ligament Injuries

ACL injuries: The Cross Brace Protocol provides an additional non-operative option for ACL injuries and may be associated with satisfactory anatomical and functional healing for certain patient groups [2]. UCL repair: Athletes who underwent UCL repair with internal brace reported excellent midterm PROs statistically similar to those after UCL reconstruction, including proportion successfully returning to preinjury sport [18]. Syndesmotic injuries: The embrace technique yielded equivalent outcomes compared with suture button fixation for managing syndesmotic injuries [19].

Practical Considerations

Fracture Management: Removable splints for minimally displaced distal radial fractures save patients time and inconvenience regarding additional hospital visits [1] and save the healthcare system money [1]. Orthoses offer a good alternative to plaster casts, especially for stable fracture types [6]. For elderly patients with distal radial fractures, four weeks of cast immobilization is sufficient [4]. In pediatric upper limb fractures, pooling of studies on waterproof casts was limited by heterogeneity and small study sizes [10], and definitive RCTs are required to confirm efficacy and investigate cost-effectiveness [10].

Ligamentous and Joint Injuries: The Cross Brace Protocol provides a non-operative option for ACL injuries [2] and may be associated with satisfactory anatomical and functional healing for certain patient groups [2]. For low-risk ankle fractures in children, there remains equipoise regarding the best treatment among Supportive bandage, Removable splint, or Walking casts [9]. These modalities appear well tolerated with similar complication rates [9]. In scaphoid waist fractures, union consolidated in patients with > 20% bridging without intervention between one and five years after randomization [8]. Initial cast immobilization with fixation is the optimal form of treatment for adults with a scaphoid waist fracture nonunion [16]. Small quality-adjusted life year gains for initial surgery were not sufficient to justify the higher costs compared to initial cast immobilization [16].

Hand and Shoulder Rehabilitation: Splinting is an effective short-term conservative treatment for adult trigger finger [5] and offers symptom relief and functional improvement comparable to corticosteroid injections [5]. Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement in trigger finger management [3], but cannot establish superiority over other conservative treatments due to the absence of a control group [3]. Maintaining an appropriate balance between mobilization and immobilization has a decisive impact on tissue healing, functional recovery, and patient outcomes in hand rehabilitation [11]. Pain and functional outcomes after primary reverse total shoulder arthroplasty are comparable between three-week immobilization and no immobilization [7].

Emerging Technologies and Decision Aids: Limitations of 3D-printed orthoses include small sample sizes, lack of standardized assessment methods, and durability concerns [14]. Use of a codesigned patient decision aid for total knee arthroplasty decisions was feasible in practice [17].

Key Evidence

  • [L2] If patients can be treated safely using a removable splint, this will save them time and inconvenience in terms of additional visits to the hospital, and save the healthcare system money. (10.1302/0301-620x.107b1.bjj-2024-0634.r1)
  • [L2] The Cross Brace Protocol provides an additional non-operative option for ACL injuries and may be associated with satisfactory anatomical and functional healing for certain patient groups. (10.1177/2325967126s00013)
  • [L4] Because of the absence of a control group, these findings demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments. (10.1016/j.jhsg.2026.101038)
  • [L5] The authors should be commended for a well-designed, well-executed randomized controlled trial that makes a compelling case that 4 weeks of cast immobilization is sufficient for most distal radial fractures in elderly patients. (10.2106/jbjs.25.00333)
  • [L2] Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement comparable to corticosteroid injections. (10.1016/j.jhsg.2025.100881)
  • [L1] Hence, orthoses offer a good alternative to plaster casts, especially for stable fracture types. (10.1186/s12891-026-09585-4)
  • [L1] The pain and functional outcomes are comparable to those obtained with a 3-week immobilization period. (10.1016/j.jse.2025.02.015)
  • [L1] Between one and five years after randomization, union consolidated in those with > 20% bridging without intervention. (10.1302/0301-620x.108b1.bjj-2025-0125.r1)
  • [L2] There remains equipoise regarding the best treatment of these injuries, with all three treatments appearing well tolerated with similar complication rates. (10.1302/0301-620x.107b1.bjj-2024-0354.r1)
  • [L1] However, pooling of studies was limited by heterogeneity and small study sizes, and definitive RCTs are required to confirm efficacy and investigate cost-effectiveness. (10.1302/0301-620x.107b6.bjj-2025-0011)
  • [L5] The review highlights that maintaining an appropriate balance between mobilization and immobilization is a central challenge in hand rehabilitation and has a decisive impact on tissue healing, functional recovery and patient outcomes. (10.1177/17531934251413908)
  • [L1] The recommendation that adult patients with a fracture of the waist of the scaphoid which is displaced by ≤ 2 mm should be treated initially with immobilization in a cast, followed by early fixation of a nonunion, is further corroborated by these findings. (10.1302/0301-620x.108b1.bjj-2025-0122.r1)
  • [L1] Symptom severity, pain, hand function, and orthosis wearability outcomes support interchangeable use of relative motion and metacarpophalangeal joint blocking orthoses for managing trigger finger. (10.1016/j.jht.2025.05.018)
  • [L1] However, limitations such as small sample sizes, lack of standardized assessment methods, and durability concerns must be addressed through further research. (10.1186/s12891-025-09070-4)
  • [L3] The application of the MFEMS during immobilization period after ARCR effectively prevented early post-operative deltoid muscle atrophy and accelerated early recovery of shoulder muscle strength. (10.1002/ksa.70303)
  • [L1] Initial cast immobilization with fixation for nonunion is the optimal form of treatment for adults with a scaphoid waist fracture, as the small quality-adjusted life year gains for those who underwent surgery initially were not sufficient to justify the higher costs. (10.1302/0301-620x.108b1.bjj-2025-0116.r1)
  • [L1] Use of the aid in practice was feasible. (10.1016/j.arth.2025.05.104)
  • [L3] Athletes who underwent UCL repair with internal brace reported excellent midterm PROs statistically similar to those after UCL reconstruction, including proportion successfully returning to preinjury sport. (10.1177/03635465251314054)
  • [L3] The embrace technique yielded equivalent outcomes compared with suture button fixation for managing syndesmotic injuries. (10.1186/s13018-025-06620-3)
  • [L1] All interventions resulted in significant improvements across several outcomes, with improvements in activity-related pain and self-reported disability exceeding previously reported MCID values. (10.1016/j.jse.2026.02.001)
  • [L4] The combined intervention of kinesio taping and conventional rehabilitation led to more significant improvements in shoulder range of motion and functional scores compared to conventional rehabilitation alone. (10.1186/s12891-026-09753-6)

References

[1] Do patients with minimally displaced distal radial fractures need a plaster cast?. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b1.bjj-2024-0634.r1

[2] Short-term Outcomes of the Cross Brace Protocol for ACL Rupture Management: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967126s00013

[3] Effectiveness of Proximal Interphalangeal Joint Orthosis and Therapeutic Exercise in the Management of Trigger Finger: A Prospective Case Series. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101038

[4] Adequately Reduced Distal Radial Fractures in Elderly Patients: How Long Should We Immobilize?. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.25.00333

[5] Efficacy of Splinting in Managing Adult Trigger Finger: A Systematic Review of Short-Term Outcomes. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100881

[6] Outcome analysis of conservative treatment of a distal radius fracture with OPTIVOhand orthosis versus plaster cast: a randomized controlled trial. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09585-4

[7] Three-week immobilization vs. no immobilization in primary reverse total shoulder arthroplasty: a randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.015

[8] Radiological outcome of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture: five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0125.r1

[9] Supportive bandage, removable splint, or walking casts for low-risk ankle fractures in children: a feasibility randomized controlled trial. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b1.bjj-2024-0354.r1

[10] Waterproof casts for the management of upper limb fractures in children. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b6.bjj-2025-0011

[11] Achieving a balance between mobilization and immobilization after surgical or conservative treatment of the hand. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934251413908

[12] Clinical effectiveness of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture: five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0122.r1

[13] A randomized comparative trial: Relative motion vs metacarpophalangeal joint blocking orthoses for trigger finger management. Journal of Hand Therapy. 2026. DOI: 10.1016/j.jht.2025.05.018

[14] The current state of 3D-printed orthoses clinical outcomes: a systematic review. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09070-4

[15] Mid‐frequency electrical muscle stimulation during immobilization may prevent early deltoid muscle atrophy and promote early strength recovery after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70303

[16] Cost-effectiveness of early surgical fixation versus cast immobilization for adults with a scaphoid waist fracture: five-year follow-up of the Scaphoid Waist Internal Fixation for Fractures Trial. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0116.r1

[17] A Codesigned Patient Decision Aid Supports the Decision Quality of Patients Considering Total Knee Arthroplasty: A Randomized Controlled Trial. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.104

[18] Clinical Outcomes of Ulnar Collateral Ligament Repair With Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251314054

[19] Outcomes of suture button fixation versus embrace fixation for syndesmotic injury. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-025-06620-3

[20] Effects of adding thoracic extension exercises or thoracic kinesio taping to shoulder exercises on pain and function in adults with subacromial pain syndrome: a randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.001

[21] A retrospective analysis of the promoting effect of kinesio taping on the rehabilitation of military personnel with recurrent shoulder dislocation caused by training injury. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09753-6

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