Splinting
(Redirected from Splint)
Background
- 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
Procedure
Splint Materials
- Stockinette [1]
- Cloth sleeve
- Base layer for splint/cast
- Protects skin
- Cast padding (e.g., 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
Splint Application General Procedure
- Assess pre-procedure neurovascular status (i.e., distal pulse, motor, and sensation) [2]
- Measure and prepare the splinting material
- May use contralateral extremity if easier
- Most splints use a width slightly greater than the diameter of the limb
- Apply stockinette (if applicable)
- Extend 2" beyond estimated the splinting material length
- Apply padding (if applicable)
- Use 2–3 layers over the area to be splinted / between digits (when applicable)
- Add an extra 2–3 layers over bony prominences
- Apply splinting material
- Lightly moisten the splinting material.
- Place as appropriate to specific splint type
- Once finished, if applicable fold the ends of stockinette back over the splinting material if there is excess
- Apply elastic bandaging (e.g., ace wrap)
- While still wet
- May further mold the splint to the desired shape
- Maintain position until splint material has hardened
- Re-check and document repeat neurovascular status
Splint Types
- Hand
- Arm
- Leg
Splint Types Gallery
Splinting Overview by Area
Adult Humerus Fracture Management Table
| Fracture | Splint | Disposition |
| Proximal | Non-emergent, but many need surgery, refer to ortho vs ED consult | |
| Shaft |
|
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 |
|
R/o neurovasc injury and compartment syndrome, refer to ortho within 24 hrs |
Pediatric Humerus Fracture Management Table
| Fracture | Splint | Disposition |
| Proximal | Non-emergent Ortho follow up | |
| Shaft | Non-emergent Ortho f/u | |
| Supracondylar | Long Arm Posterior Splint | Ortho consult for Type 2 or 3 |
Forearm Fracture Management Table
| Fracture | Splint | Disposition |
| Radial head fracture |
Nondisplaced Displaced
|
|
| Monteggia fracture-dislocation (ulnar shaft w/prox radioulnar disloc) | Emergent ortho for ORIF | |
| Galeazzi fracture (distal radius w/distal ulnar disloc) | Emerg. ortho for ORIF | |
| Elbow dislocation | Long arm posterior splint after reduction | If associated fracture emergent ortho consult |
| Forearm fracture | Sugar Tong Splint | |
| Colle's fracture (distal radius with dist dorsal angulation) | Sugar Tong Splint | |
| Smith fracture (reverse colles with volar angulation) | Sugar Tong Splint |
Hand Fracture Management Chart
| Fracture | Splint | Disposition |
| Flexor tendon injury | Finger Splint | hand specialist referral |
| Extensor tendon injury | Poss ED repair + Finger Splint | hand specialist referral |
| Mallet finger | Finger Splint to DIP (DIP in slight hyperextension) | |
| Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb) | Thumb Spica Splint | |
| Scaphoid fracture | Thumb Spica Splint | |
| Carpal fracture | Volar Splint | |
| Bennet's fracture (intrarticular fracture at base of 1st MCP) | Thumb Spica Splint | |
| Rolando's fracture (comminuted base of 1st MCP) | Thumb Spica Splint | |
| Boxer's fracture | Ulnar Gutter Splint | |
| 4th and 5th MCP fracture | Ulnar Gutter Splint | |
| 2nd and 3rd MCP fracture | Radial Gutter Splint | |
| Finger (Phalanx) Fracture | Finger Splint or Buddy Tape |
Foot and Toe Fractures Management Chart
| Fracture | Splint | Disposition |
| Talus fracture | Posterior ankle splint | |
| Calcaneus fracture | Posterior ankle splint | |
| Lisfranc injury | Posterior ankle splint | |
| Navicular fracture | Posterior ankle splint | |
| Cuboid fracture | Posterior ankle splint | |
| Cuneiform fracture | Posterior ankle splint | |
| Fifth metatarsal fracture Jones | Posterior ankle splint | Ortho follow up 3-5D |
| Non-fifth metatarsal fracture | Posterior ankle splint | Ortho follow up 2-3 days |
| Toe Fracture | Posterior Ankle Splint |
Distal Leg Fractures Management Chart
| Fracture | Splint | Disposition |
| Tibial plateau fracture | Knee immobilizer | Ortho referral in 2-7d |
| Tibial shaft fracture | Long leg posterior splint | |
| Pilon Fracture | Long leg posterior splint | |
| Maisonneuve Fracture | Long leg posterior splint | |
| Ankle fracture | Posterior ankle splint |
Complications
- Burn
- Compartment syndrome
- Compressive ischemia
- Dermatitis
- Deep venous thrombosis
- Joint stiffness (e.g., frozen shoulder)
- Peripheral nerve injury
- Pressure ulcer, skin breakdown
See Also
References
- ↑ Principles of Casting and Splinting http://www.aafp.org/afp/2009/0101/p16.html Accessed April 4, 2017
- ↑ Splints and Casts: Indications and Methods. http://www.aafp.org/afp/2009/0901/p491.html Accessed April 5, 2017