splinting dan hirsh, md emory pecc orientation june 19, 2008 hughes spalding children’s hospital

Splinting

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

Hughes Spalding

Children’s Hospital

A splint is a non-circumferential immobilization device to treat fractures, lacerations of skin or

tendon, and sprains.

Complications Prevention

Risk of ischemiaCompartment Syndrome

Possible neurovascular compromise

Keep splint snugCheck distal neurovascular status

after placement

Skin breakdown

Keep splint dryUse minimal water necessary and dry

thoroughly before placement

Use paddingAvoid ‘kinks’

Pain or Ineffective Immobilization

Check splint after placement

If either of these too, replace the splint

Tell patients and family that•Splint material will get warm when it hardens

Fiberglass cures in :

~15 minutes with ambient humidity

~5 minutes with cold water

~1 minute with warm water•Should be snug, not tight (fingers shouldn’t tingle)

Ace wrapAce wrap

Webril / Webril / waddingwadding

Stockinette

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

Hot water will cause the fiberglass to harden very

quickly

Use cold water

May use NO water, just ambient

humidity (this will take much longer to

harden)

If you use water, keep padding as dry as possible

Protect the skin. If cotton padding is

wet, dry it.

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.

Wrap the splint in place—not too

loose or too tight. Protect the skin. Do not apply pressure

with finger tips, use a curved palm.

Keep joint in a protective position.

Keep hand slightly extended at the wrist,

‘thumb-up’, fingers curved around an

object

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

• “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

• “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• Don’t let the splint slide up or down

• “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

• “Volar”• Distal forearm or wrist

fractures• Don’t use in small children• Width: fully cover volar

aspect of forearm• Length: from proximal

fingers to proximal forearm

• “Thumb Spica”• Non-displaced fractures of

1st metacarpal bone, proximal phalanx of thumb, scaphoid fracture

• Length: nail base to proximal forearm

• “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

• “Buddy Tape”• Padded metal strip

may go dorsal or volar

• “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

Thumb Spica

Volar

Long Arm & Short

Posterior leg

Sugar Tong & Stirrup