Splinting

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Splinting
Hughes Spalding Childrens Hospital

• Dan Hirsh, MD
• Emory PECC Orientation
• June 19, 2008

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A splint is a non-circumferential immobilization
device to treat fractures, lacerations of skin or
tendon, and sprains.
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Complications Prevention
Risk of ischemia Compartment Syndrome Possible neurovascular compromise Keep splint snug Check distal neurovascular status after placement
Skin breakdown Keep splint dry Use minimal water necessary and dry thoroughly before placement Use padding Avoid kinks
Pain or Ineffective Immobilization Check splint after placement If either of these too, replace the splint
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Tell patients and family that

• Splint material will get warm when it
  hardensFiberglass cures in 15 minutes with
  ambient humidity5 minutes with cold water1
  minute with warm water
• Should be snug, not tight (fingers shouldnt
  tingle)

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Stockinette
Ace wrap
Webril / wadding
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Optional Apply stockinet to extremity Extend it
past the proximal and distal ends of where the
splint will end Cut out any areas that bunch up
that could damage the skin Create thumb hole
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Use cold water May use NO water, just ambient
humidity (this will take much longer to harden)
Hot water will cause the fiberglass to harden
very quickly
If you use water, keep padding as dry as possible
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Protect the skin. If cotton padding is wet, dry
it.
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Some fiberglass material comes with a thick
padded side and a thin side. Protect the skin.
Always place the thick-side to the skin-side.
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Wrap the splint in placenot too loose or too
tight. Protect the skin. Do not apply pressure
with finger tips, use a curved palm.
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Keep joint in a protective position. Keep hand
slightly extended at the wrist, thumb-up,
fingers curved around an object
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Discharge Instructions

• Make sure neurovascular intact in not pain from
  splint
• Elevate, ice rest injured extremity
• Keep splint dry
• Splints are non/partial weight bearing, use
  crutches
• If fingers become tingly or blue, re-wrap the
  bandage
• If splint hurts, or there is increasing pain,
  TAKE THE SPLINT OFF! Seek medical attention

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• Posterior Arm
• Used for stable elbow injuries
• Width ½ arm circumference
• Length dorsal aspect of mid-upper arm down ulnar
  side to distal palmer flexion crease

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• Sugar Tong
• Can be applied both proximally or distally or
  both at the same time
• When in doubt, use the sugar tong
• Width slightly overlap radial and ulnar edges of
  arm
• Length dorsal aspect of knuckles around elbow to
  volar palmer flexion crease
• Can place patient prone for easy installation
• Must keep arm in 90 flexion
• Dont let the splint slide up or down

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• Gutter
• Metacarpal and/or proximal phalnageal fractures
• Ulnar immobilizes 5th 4th digits, radial 2nd
  3rd
• Width wrap to midline of hand on dorsal and
  volar surfaces
• Length nail base to proximal forearm

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• Volar
• Distal forearm or wrist fractures
• Dont use in small children
• Width fully cover volar aspect of forearm
• Length from proximal fingers to proximal forearm

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• Thumb Spica
• Non-displaced fractures of 1st metacarpal bone,
  proximal phalanx of thumb, scaphoid fracture
• Length nail base to proximal forearm

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• Posterior Leg
• Distal Tibia and/or fibula injuries, ankle, foot
• Width at least ½ leg circumference, but
  NON-circumferential
• Length level of fibular neck to base of digits
• Shape splint into neutral position, 90 flexion
• These are partial/non weight bearing splints

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• Buddy Tape
• Padded metal strip may go dorsal or volar

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• Stirrup
• Provides lateral support, may use with Posterior
  Leg splint for added stability (aka Cadillac
  Splint)
• Width at least ½ leg circumference, but
  NON-circumferential
• Length level of fibular head around heel and
  back up the leg
• Shape splint into neutral position, 90 flexion
• These are partial/non weight bearing splints

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Sugar Tong Stirrup
Long Arm Short Posterior leg
Thumb Spica
Volar