Splinting

Background

Splint Materials

• Stockinette
  • Cloth sleeve
  • Base layer for splint/cast
  • Protects skin
• Cast padding (eg Webril)
  • Used with plaster of Paris
  • 2-3 layers with padding of bony points as needed
  • Wrapping circumferentially with 50% overlap will automatically create 2 layers
• Plaster of Paris
  • 6-10 layers for upper extremity splints, 12-15 for lower extremity splints
  • Takes 20 minutes to cure, sooner if warmer water is used
  • Watch for exothermic reaction
• Elastic bandage
  • Outer layer to hold splint in place
  • Excessive tightness can lead to pain, less room for swelling
• Fiberglass
  • Pre-wrapped material
  • Use cool or room temperature water
  • Not as pliable as plaster of Paris
  • Trim or cover cut edges to prevent injury

Pearls

• Try to avoid large crinkles/folds with padding, can cause skin damage and breakdown
• Apply splint firmly but not too tight
  • Allow room for anticipated swelling
  • Tight splint can lead to compartment syndrome
• Mold splint material with palms rather than fingers to prevent ridges, may be uncomfortable for patient

Splint Types

• Hand
  • Buddy tape splint
  • Finger splint
• Arm
  • Coaptation splint
  • Forearm volar splint‎
  • Long arm posterior splint
  • Radial gutter splint
  • Sling and swathe splint
  • Sugar tong splint
  • Double sugar tong splint
  • Thumb spica splint
  • Ulnar gutter splint
• Leg
  • Long leg posterior splint
  • Stirrup splint
  • Posterior ankle splint

Splint Types Gallery

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  Buddy tape splint

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  Finger splint

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  Coaptation splint

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  Forearm volar splint

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  Long arm posterior splint

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  Radial gutter splint

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  Sling and swathe splint

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  Sugar tong splint

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  Double sugar tong splint

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  Thumb spica splint

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  Ulnar gutter splint

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  Long leg posterior splint

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  Ankle stirrup splint

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  Posterior ankle splint

Splinting Overview by Area

Adult Humerus Fracture Management Table

Fracture	Splint	Disposition
Proximal	Sling and swathe splint, or coaptation splint	Non-emergent, but many need surgery, refer to ortho vs ED consult
Shaft	U-shaped coaptation splint (upper arm sugar-tong splint) + sling and swathe	R/o neurovasc injury and compartment syndrome, but many need surgery, refer to ortho vs ED consult
Elbow Fracture (Adult)	Long arm posterior splint	R/o neurovasc injury and compartment syndrome, but many need surgery, refer to ortho vs ED consult
Olecranon	Nondisplaced: Sling and Swathe Splint Displaced: Long Arm Posterior Splint or emerg. ORIF	R/o neurovasc injury and compartment syndrome, refer to ortho within 24 hrs

Pediatric Humerus Fracture Management Table

Fracture	Splint	Disposition
Proximal	Sling and swathe splint, or coaptation splint	Non-emergent Ortho follow up
Shaft	Long arm posterior splint, sling and swathe splint, or coaptation splint	Non-emergent Ortho f/u
Supracondylar	Long Arm Posterior Splint	Ortho consult for Type 2 or 3

Upper extremity

• • Forearm
  • Carpals
  • Hand

Torso

• • Chest
  • Spine
  • Pelvis

Lower extremity

• • Femur
  • Distal leg
  • Foot

See Also

• Vacuum splint
• Fractures (main)