General Splinting Techniques (Internal Medicine)

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • 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

Appropriate Splints for Upper and Lower Extremity Fractures
Upper extremity fractures
Appropriate splints
  Proximal humerus   See Coaptation Splint Techniques for further details
  Midshaft humerus   See Sugar Tong Splint for further details.   
  See Coaptation Splint Techniques for further details
  Distal humerus   See Long Arm Splint for further details
  Olecranon/radial head   See Long Arm Splint for further details
  Forearm   See Long Arm Splint for further details
  Distal radius   See Sugar Tong Splint for further details
  Scaphoid   See Thumb Spica Splint for further details
  Other carpus   See Short Arm Splint for further details
  Thumb, metacarpal, phalanges   See Thumb Spica Splint for further details
Lower extremity fractures
Appropriate splints
  Midshaft femur fracture   See Long Leg Splint for further details
  Distal femur/ proximal tibia   See Long Leg Splint for further details
  Patella fracture/ligament injury of knee   See Long Leg Splint for further details
  Midshaft tibia fracture   See Long Leg Splint for further details
  Distal tibia/ankle fracture   See Short Leg Splint for further details

CONTRAINDICATIONS
  • Infection
  • Impending compartment syndrome
  • Diabetic or other neuropathy
EQUIPMENT
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

PROCEDURE
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The full content of this section includes:
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  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • 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.
COMPLICATIONS
  • Plaster burn
  • Pressure sores
  • Nerve palsy
  • Vascular compromise
  • Splint dermatitis
  • Permanent joint stiffness
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