Long Arm Splint (Internal Medicine)

• Temporary immobilization for:
  • Elbow joint dislocation
  • Olecranon fracture
  • Distal humerus fracture
  • The elbow following operative reduction and internal fixation
  • The distal humerus following operative reduction and internal fixation

• Infection
• Impending compartment syndrome
• Diabetic or other neuropathy

• 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  sizes
• Plaster bandages, available in 2-, 3-, 4-, and 6-inch sizes
• Elastic bandages (Ace)
• Adhesive tape

• Axillary artery and the brachial plexus are located in the axilla.
• Anterior circumflex humeral artery lies just distal to the surgical neck of the humerus.
• At the elbow, the ulnar nerve is posterior to the lateral epicondyle, the median nerve is anterior to the joint along with the brachial artery, and the radial nerve lies anterior to the medial epicondyle.
• The radial nerve supplies sensation to the dorsolateral hand (dorsal and thenar areas) and proximal thumb, the median nerve supplies sensation to the lateral palm and the palmar/distal first and second digits, and the ulnar nerve supplies sensation to the medial hand (dorsal and palmar) and the fifth digit.

Figure 1 :  Posterior elbow dislocation

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Figure 2 :  Equipment

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Figure 3 :  Anatomy

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The full content of this section includes:

• Step-by-step text instructions for performing the procedure
  
• 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

Figure 5 :  Measure the splint

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Figure 7 :  Apply splint and elastic bandage

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• Confirm radiographically that reduction was achieved and maintained.
• Conduct a neurovascular examination.
• Instruct the patient to keep the splint clean and dry.
• The extremity should be kept elevated for the first 2-3 days.
• Loosen the elastic bandage if neurovascular symptoms arise.
• Reevaluate if increased pain or burning develops.

• Plaster burn
• Pressure sores
  • The epicondyles and olecranon process are particularly vulnerable.
• Nerve palsy
  • Use extra padding to protect the subaxillary area.
  • The ulnar nerve is particularly vulnerable to compression at the posterior lateral epicondyle, and the radial is particularly vulnerable at the anterior medial epicondyle.
• Vascular compromise
  • The axillary/brachial artery is vulnerable to compression from bone fragments, swelling, and splinting.
• Splint dermatitis
• Permanent joint stiffness