Splinting: Difference between revisions
 
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==Types==
==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 <ref name="Principles of Casting and Splinting">Principles of Casting and Splinting
http://www.aafp.org/afp/2009/0101/p16.html
Accessed April 4, 2017</ref>
**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}}
 
==Splint Types==
*Hand
*Hand
**[[Buddy tape splint]]
**[[Buddy tape splint]]
**[[Finger splint]]
**[[Finger splint]]
*Arm
*Arm
**[[Coaptation splint]]
**[[Double sugar tong splint]]
**[[Double sugar tong splint]]
**[[Forearm volar splint‎]]
**[[Forearm volar splint‎]]
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**[[Ulnar gutter splint]]
**[[Ulnar gutter splint]]
*Leg
*Leg
**[[Long leg posterior splint]]
**[[Posterior ankle splint]]
**[[Stirrup splint]]
**[[Stirrup splint]]
**[[Posterior ankle splint]]
**[Long leg posterior splint]]
==Upper Extremity==
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Fracture'''
| align="center" style="background:#f0f0f0;"|'''Splint'''
| align="center" style="background:#f0f0f0;"|'''Disposition'''
|-
|[[Humeral shaft fracture]]
|{{Humerus shaft fracture splint}}
|
|}
===Humerus===


*[[Supracondylar Humeral Fracture]]
===Splint Types Gallery===
**[[Long Arm Posterior Splint]] (ortho consult for Type 2 or 3)
<gallery mode="packed">
*Humeral condyle fracture
File:Buddy-taping-finger.png|[[Buddy tape splint]]
**[[Long Arm Posterior Splint]] and ortho for ORIF if displaced
File:Finger splint.jpg|[[Finger splint]]
*Olecranon Fracture
File:Coaptation splint.jpg|[[Coaptation splint]]
**Nondisplaced
File:Forearm Volar Splint.gif|[[Forearm volar splint]]
***[[Sling and Swathe Splint]]
File:Long Arm Posterior Splint.gif|[[Long arm posterior splint]]
**Displaced
File:Radial Gutter3.gif|[[Radial gutter splint]]
***[[Long Arm Posterior Splint]] or emerg. ORIF
File:Sling and Swathe.jpg|[[Sling and swathe splint]]
File:Sugar Tong.gif|[[Sugar tong splint]]
File:Double Sugar Tong.gif|[[Double sugar tong splint]]
File:Thumb Spica.gif|[[Thumb spica splint]]
File:Ulna Gutter 2.gif|[[Ulnar gutter splint]]
File:long leg posterior splint.jpg|[[Long leg posterior splint]]
File:Stirrup Splint.gif|[[Ankle stirrup splint]]
File:Posterior Ankle Splint.gif|[[Posterior ankle splint]]
</gallery>


===Forearm===
==Splinting Overview by Area==
*Radial Head Fracture
{{Adult Humerus Fracture Management Table}}
**Nondisplaced
{{Pediatric Humerus Fracture Management Table}}
***[[Sling and Swathe Splint]]
{{Forearm Fracture Management Table}}
**Displaced
{{Hand Fracture Management Chart}}
***[[Long Arm Posterior Splint]] or emerg. ORIF
{{Foot and toe fractures}}
*Monteggia (ulnar shaft w/prox radioulnar disloc)
{{Distal Leg Fracture Management Chart}}
**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 assoc. Fx-emerg. ortho)
*[[Forearm Fracture]]
**[[Sugar Tong Splint]]
*[[Colle's Fracture]] (distal radius with dist dorsal angulation)
**[[Sugar Tong Splint]]
*Smith Fracture (reverse colles w/ volar angulation)
**[[Sugar Tong Splint]]


===Hand===
==Complications==
*Flexor tendon injury
*[[Burn]]
**[[Finger Splint]] + hand specialist ref.
*[[Compartment syndrome]]
*Extensor tendon injury
*[[Acute arterial ischemia|Compressive ischemia]]
**Poss ED repair + [[Finger Splint]] to hand specialist
*[[Dermatitis]]
*[[Mallet Finger]]
*[[Deep venous thrombosis]]
**[[Finger Splint]] to DIP (DIP in slight hyperextension)
*Joint stiffness (e.g., frozen shoulder)
*[[Gamekeeper's Thumb]]
*[[Peripheral nerve syndromes|Peripheral nerve injury]]
**[[Thumb Spica Splint]]
*[[Pressure ulcer]], skin breakdown
*[[Scaphoid Fracture]]
**[[Thumb Spica Splint]]
*Carpal Fracture
**[[Forearm Volar Splint|Volar Splint]]
*[[Bennet's Fracture]] (intrarticular Fx at base of 1st MCP)
**[[Thumb Spica Splint]]
*Rolando Fracture (comminuted base of 1st MCP)
**[[Thumb Spica Splint]]
*[[Boxer's Fracture]]
**[[Ulnar Gutter Splint]]
*MCP Fracture
**4th and 5th
***[[Ulnar Gutter Splint]]
**2nd and 3rd
***[[Radial Gutter Splint]]
*[[Finger (Phalanx) Fracture]]
**[[Finger Splint]] or [[Buddy Tape]]


==Lower Extremity==
==See Also==
*[[Vacuum splint]]
*[[Fractures (main)]]


==References==
==References==
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]
[[Category:Procedures]]
[[Category:Procedures]]
[[Category:Sports Medicine]]

Latest revision as of 21:37, 13 September 2023

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

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

See Also

References

  1. ↑ Principles of Casting and Splinting http://www.aafp.org/afp/2009/0101/p16.html Accessed April 4, 2017
  2. ↑ Splints and Casts: Indications and Methods. http://www.aafp.org/afp/2009/0901/p491.html Accessed April 5, 2017
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