General Splinting Techniques (Training Physician)

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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   
  Midshaft humerus   
  Distal humerus   
  Olecranon/radial head   
  Forearm   
  Distal radius   
  Scaphoid   
  Other carpus   
  Thumb, metacarpal, phalanges   
Lower extremity fractures
Appropriate splints
  Midshaft femur fracture   
  Distal femur/ proximal tibia   
  Patella fracture/ligament injury of knee   
  Midshaft tibia fracture   
  Distal tibia/ankle fracture   
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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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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