General Splinting Techniques (Emergency Medicine)

• Splints can be used for temporary immobilization for several orthopedic problems, including fractures; dislocations; injury of muscles, tendons, and ligaments; protection of vascular/nerve repairs; and postsurgical wound protection.
• For the appropriate splints for various fractures, see Table 1 below.

Table 1

• Infection
• Impending compartment syndrome
• Diabetic or other neuropathy

Plaster splints

• Slightly warm (not over 24°C) water and bucket
• Stockinette (optional)
• Soft cotton bandage/undersplint material (e.g., Webril® padding), available in 2-, 3-, 4-, and 6-inch width sizes
• Plaster bandages, available in 2-, 3-, 4-, and 6-inch width sizes
• Elastic bandages (Ace)
• Adhesive tape

Fiberglass splints

• Water
• Prefabricated fiberglass splint (e.g., Ortho-Glass) available in 3-, 4-, and 5-inch width sizes
• Elastic bandages (Ace)
• Adhesive tape

• Postsplinting radiography
  • If a reduction maneuver was performed, obtain a second set of radiographs to confirm that anatomic reduction was not lost during splinting.
  • Re-reduce the fracture before reapplying splint if indicated.
• Neurovascular examination
  • Repeat a thorough neurovascular examination of the splinted limb.
  • If there are signs of neurovascular compromise, re-apply the elastic bandage with less compression. If the deficit persists, remove the splint, examine the extremity and place a new splint. Persistent neurovascular deficits require immediate orthopedic consultation.
• Postsplinting instructions
  • Instruct the patient to keep the splint clean and dry.
  • Keep the extremity elevated for the first 2-3 days to decrease swelling.
  • Tell the patient to loosen the elastic bandage if neurovascular symptoms arise.
  • Patients should return for evaluation for pressure ulcer or infection if increased pain or a burning sensation develops.

• Plaster burn
• Pressure sores
• Nerve palsy
• Vascular compromise
• Splint dermatitis
• Permanent joint stiffness