orthopedic splinting
TRANSCRIPT
ORTHOPEDIC SPLINTING
Overview Purpose of splinting Pre-splinting Requirements Selecting the appropriate splint
Type of splinting material Where the splint is to be placed Type of injury
Hands-on splinting Short arm sugar tong splint L and U splint
Instructor demos
Learning Objectives To develop a basic understanding as to
what orthopedic injury gets what type of splint
To garner a basic understanding of the hazards of improper splinting technique(s) and how to avoid them
To demonstrate learned objectives with a hands-on (beginners level) application of an upper extremity splint and a lower extremity splint
What is a Splint? A splint should be defined as an
object or body part that is utilized to support or immobilize an injured limb or other body part.
A splint can be premanufactured or custom fabricated with material that is rigid or semi-rigid in design and have in it’s construction some sort of softer padding that will be a barrier between the skin and splint to prevent further injury or discomfort.
Some examples of immediate action splints utilizing available materials:
Purpose of Splinting To provide immobilization to the injured
area To protect the injured area To prevent further injury To help reduce pain To provide a means for the injury to have
room for swelling To offer a sense of security
Pre-splinting Requirements
Introduce yourself to your patient Inspect circulation
Check for neurovascular continuity Use the 5 P’s (pain, pallor, pulse, paresthesia, paralysis)
Treat wounds and slow/stop any bleeding Remove jewelry!
If the injury is an acute fracture, immobilize the joint proximal to the injury and the joint distal the injury (if possible)
Before application of splint, gather ALL materials first! Don’t leave your patient alone to go get more stuff!
Give the patient a brief description of the process and what to expect. If you leave them anxious, you may be picking them up off the floor.
Selecting The Appropriate Splint
Upper Extremity Splints Volar splint Thumb Spica splint Radial Gutter splint Ulnar Gutter splint Short Arm Sugar Tong splint Long Arm Double Sugar Tong splint Long Arm Posterior splint Coaptation splint
Lower Extremity Splints Short Leg Posterior splint Short Leg L and U splint Long Leg Posterior splint Long Leg Posterior w/ Medial and Lateral Slabs
Orthopedic Splinting MaterialsThe Rigid Dressing Materials: Plaster of Paris
Casting tape roll Pre-cut splinting slabs
Fiberglass Casting tape roll Pre-cut splinting slabs
Soft Underpadding: Synthetic cast padding Cotton Webril StockinetteOverwrap: Bias-cut stockinette ACE bandage CoBan
UPPER EXTREMITYSPLINTING
The Volar Splinta.k.a. Carpal Tunnel Splint, Cock-up Splint (non- DME) and Wrist Splint
Application/Location: Applied on volar aspect of the arm and circumvents the thumb proximally to the Thenar eminence, proximally approaches both the proximal and distal palmer creases and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees.
Utilization: Used for wrist sprains/strains and fractures, post-surgical fracture repairs as well as carpal tunnel releases. With appropriate splint modification, this splint can be used to treat metacarpal and phalangeal issues as well.
Thoughts before application: Is this a removable or non-removable splint?Will this splint need a modification? If so, what?Is this for treating a patient for an initial injury or is this for post-operative treatment?
The Thumb Spica SplintAlso known as Radial Gutter Spica Splint
Application/Location: Applied on radial aspect of the arm and includes the thumb from its most distal tip and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees and thumb in direct opposition of the index finger (as if holding a soda can).
Utilization: Used for thumb sprains/strains and fractures, post-surgical fracture repairs as well as DeQuervains Tendonitis/Tenosynovitis and Scaphoid injuries/fractures. Thoughts before application: Is this a removable or non-removable splint?Will this splint need a modification? If so, is it IP free or IP frozen?Is this for treating a patient for an initial injury or is this for post-operative treatment?
The Radial Gutter Splint
Application/Location: Applied on radial aspect of the arm circumventing the base of thumb and includes the 1st and 2nd digits from their most distal tip and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees and fingers flexed from 70 – 90 degrees of intrinsic position (position of function) at the MPJs.
Utilization: Used for 1st and 2nd metacarpal fractures and/or finger fractures, post-surgical fracture repairs as well as tendon repair. Thoughts before application: Is this a removable or non-removable splint?Will this splint need a modification? If so, what?What digits will be necessary to include in splint?Is this for treating a patient for an initial injury or is this for post-operative treatment?
70◦ - 90◦ Flexion at
MPJ’s
0◦ - 30◦ Extension of Wrist
The Ulnar Gutter SplintAlso known as Boxer’s Fracture Splint
Application/Location: Applied on ulnar aspect of the arm and includes the 5th and 4th digits from their most distal tip and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees and fingers flexed from 70 – 90 degrees of intrinsic position (position of function) at the MPJs.
Utilization: Used for 4th and 5th metacarpal fractures, post-surgical fracture repairs as well as tendon repair. (Initial Boxer’s fracture treatment of choice).
Thoughts before application: Is this a removable or non-removable splint?Will this splint need a modification? If so, what?What digits will be necessary to include in splint?Is this for treating a patient for an initial injury or is this for post-operative treatment?
70◦ - 90◦ Flexion of
MP’s
0◦ - 30◦ Extension of
Wrist
The Short Arm Sugar Tong Splint
Application/Location: Applied on the dorsum and volar aspects of the arm from proximal the palmer creases volarly, around the elbow posteriorly and completes proximal the metacarpal heads dorsally. Usually applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow. The finish product resembles a “sugar tong” which is used to pick up sugar cubes from a dish.
Utilization: Used for various radial and ulnar fractures, post-surgical fracture repairs as well as tendon repair and quite often the treatment of choice before casting arm due to swelling from fracture(s). This splint usually requires an arm sling.
Thoughts before application: Will this splint need a modification? Will the wrist need supination or pronation?Is this for treating a patient for an initial injury or is this for post-operative treatment?
The Long Arm Double Sugar Tong Splint
Application/Location: A Short Arm Sugar Tong is applied first, then a second “sugar tong” will start approx. 2” distal from Axilla, continue around the elbow and finish laterally on the head of the biceps. Usually applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow. The finish product resembles two intersecting “sugar tongs”.
Utilization: Used for various radial and ulnar fractures, post-surgical fracture repairs as well as tendon repair and quite often the treatment of choice before casting arm due to swelling from fracture(s). The bicipital Sugar Tong may even go above the biceps and become a Coaptive-type splint. This splint usually requires an arm sling.
Thoughts before application: Will this splint need a modification? Will the wrist need supination or pronation?Is this for treating a patient for an initial injury or is this for post-operative treatment?
The Long Arm Posterior Splint
Application/Location: Applied on posterior aspect of the arm from proximal the distal palmer crease ulnarly and completes approximately two inches distal the Axilla posteriorly. Usually applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow.
Utilization: Used for various radial and ulnar fractures, elbow fractures, post-surgical fracture repairs as well as tendon repair. This splint usually requires an arm sling.
Thoughts before application:Is this a removable or non-removable splint?Will this splint need a modification? Will the wrist need supination or pronation?Ask what digits to be included in splint.Is this for treating a patient for an initial injury or is this for post-operative treatment?
The Coaptation SplintAlso referred to as a “Sarmiento” splint
Application/Location: Usually applied by starting about 2-3 inches distal the Axilla medially upon the humeral aspect of the upper arm, continue around the elbow and finish anteriorly over the humeral head to include as much of the shoulder as possible without encroaching upon the neck. Applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow. This splint can also become a “long arm sugar tong coaptive splint by simply adding the short arm sugar tong splint.
Utilization: Used primarily for various proximal humerus fractures, post-surgical fracture repairs as well as tendon repair. This splint usually requires an arm sling, a cuff-n-collar sling or shoulder immobilizer.
Thoughts before application: Will this splint need a modification? What type of fracture is being treated?Sling, shoulder immobilizer or Cuff-n-Collar?
LOWER EXTREMITY SPLINTING
The Short Leg Posterior Splinta.k.a “L” splint or Short Leg Splint
Application/Location: Usually applied slightly distal the most prominent of the digits on the plantar aspect bending posteriorly around the heel and terminating distally 2 - 3 inches of the Popliteal Fosse. Usually applied with foot in neutral position of the ankle and the ankle is at 90 degrees. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance!
Utilization: Used for foot and/or ankle sprains/strains and fractures, post-surgical fracture repairs as well as tendon repair. With appropriate splint modification, can be used to treat acute Achilles tendon injuries with slight plantar modification.
Thoughts before application:Is this a removable or non-removable splint?Will this splint need a modification? If so, what?Is this for treating a patient for an initial injury or is this for post-operative treatment?
The Short Leg Posterior w/Sugar Tong Splinta.k.a “L & U” splint, an AO (German) Splint, Short Leg Posterior with Stirrup and a “Jones” or “Bulky Jones” Splint
Application/Location: Usually a Short Leg Posterior Splint is applied first. At this time a “sugar tong” is applied by centering casting material under the midfoot and occupying both the medial and lateral aspects of the ankle to the most proximal end of the previous splint bilaterally or slightly less than and without closing the anterior aspects of the extremity. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance!
Utilization: Used for foot and/or ankle sprains/strains and fractures, post-surgical fracture repairs as well as tendon repair. Usually applied with bulky cotton to treat severely swollen acute foot and/or ankle fractures.
Thoughts before application:Is this a removable or non-removable splint?Will this splint need a modification? If so, what?Is this for treating a patient for an initial injury or is this for post-operative treatment?
The Long Leg Posterior SplintAlso known as Long Leg Extension Splint Application/Location: Usually applied slightly distal the most prominent of the digits on the plantar aspect bending posteriorly around the heel and terminating distally 2 - 3 inches of the Gluteal Sulcus (Fold of the Buttock). Usually applied with foot in neutral position of the ankle and the ankle is at 90 degrees and the knee at 0 – 10 degrees of flexion. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance!
Utilization: Used for midshaft and/or high tib/fib fractures, tibial plateau fractures, acute femur fractures and knee injuries/fractures. Thoughts before application:Is this a removable or non-removable splint?Is there a preference on the type of casting material?Will this splint need a modification? If so, what?Is this for treating a patient for an initial injury?
The Long Leg Posterior Splint With Medial/Lateral Slabs
Application/Location: Usually a Long Leg Posterior Splint will be applied first. The “slabs” are then applied by centering casting material under the midfoot and occupying both the medial and lateral aspects of the ankle to the most proximal end of the previous splint bilaterally or at least above the knee without closing the anterior aspects of the extremity unless required. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance!
Utilization: Used for midshaft and/or high tib/fib fractures, tibial plateau fractures, acute femur fractures and knee injuries/fractures.
Thoughts before application:Is there a preference on the type of casting material?Will this splint need a modification? If so, what?Is this for treating a patient for an initial injury?
What To Watch Out For When Applying A Splint
Before and after every splint: check for distal circulation! All rings and bracelets should be removed from the affected limb. All wounds, rashes and other skin compromises should be treated
prior to splinting Splint should go from joint to joint from the epicenter of the injury Affix an appropriate amount of padding (whether to the splint or to
the skin) to prevent splint rub and pad extra over boney prominences as well as obvious irritations
Pay special attention to the ends of the splint to ensure that all rough and sharp edges are well padded
Avoid all wrinkles in padding as well as in the splinting material as these can cause skin irritations
Avoid using fingers to form any molding into the splint as your fingers will leave “a lasting impression” that may not be well tolerated
Ensure if fingers or toes are secured together, a padding is placed between them before securing them
What To Watch Out For When Applying A Plaster Splint
Don’t just dunk your plaster and then quickly laminate with the “two finger slide” technique that many do This removes most of the plaster from the splint Splint hasn’t been properly moistened for needed lamination strength
Don’t use too many layers As a general rule:
Upper Extremity splints 10 – 15 layers (xtra-fast setting) Lower Extremity splint 15 – 25 layers (fast setting)
Don’t over work the lamination! Over worked plaster is weak You lose working time for the needed mold
Don’t use hot water! Exothermic reaction is exponentially increased with hotter temp water – this can cause the
splint to be too hot to apply to the patient Set time is increased; the plaster may not be usable if set time is compromised
Change water between splint applications Exothermic reaction is exponentially increased due to the salts from the previous plaster in the
water – this can also cause the splint to be too hot to apply to the patient Set time is increased; the plaster may not be usable if set time is compromised (you can use
this to your advantage) Saline water will speed up set time and LR water will slow set time While allowing the splint to dry, ensure that adequate ventilation around the splint has been made
Plastic, naugahyde, and like materials will reflect heat back to the patient and can cause severe burns
Terry cloth towels, linens and like materials work best for letting the splint cool down from its reactive process
What To Watch Out For When Applying A Fiberglass Splint
Use cool water (not too cool) to allow for longer molding time Do not let fiberglass spend longer than a few seconds in the water, then squeeze
and ready yourself to apply it If the fiberglass is cut, ensure that all fiberglass frays are concealed in some sort of
padding or edging material The cut edges of fiberglass splints can cut into a patient’s skin The small frays can break off into the splint and cause a great deal of itching
and other discomfort Take care to not laminate with too many layers
Upper Extremity: 5 – 10 layers Lower Extremity: 8 – 12 layers
Do not allow splint to become stuck to itself in a manner that encircles or encloses the extremity (this goes for any splint) This makes taking the splint off extremely difficult Could cause vascular compromise or even muscular compartment issues
Ensure to place a protective barrier between patient and the area being splinted Fiberglass resin does not come out of clothes Fiberglass resin on skin requires immediate action to remove which can
compromise splinting process Always wear gloves as a protective measure to not get fiberglass resin on your skin
NOW TIME FOR HANDS-ON SPLINTING
The Short Arm Sugar Tong SplintAnd
The L and U Splint
WHAT WE’VE LEARNED• What a splint is• What purpose a splint serves in treating injuries• What materials can be considered for splinting• How to conduct pre-splinting procedures • How to select the appropriate splint for the injury• What precautions and hazards are associated with
improper splinting• Through hands-on application, the objectives for
training are clearly illustrated by individual experience
Orthopedic Splinting Quiz
A.
B.
C.
D.
E.
Benny just fell off his bicycle and sustained a nasty forearm injury. He is 24 years old and in good shape and healthy. Which splint would be most appropriate if you suspect a forearm fracture?
Short arm thumb spica splint
Coaptation splint
Long arm posterior splint
Short arm volar splint
Short arm sugar tong splint
A.
B.
C.
D.
E.
Which splint would you fabricate on an octogenarian with a radiologically confirmed distal humerus fracture?
Short arm thumb spica splint w/ cuff-n-collar
Short arm sugar tong splint
Long arm posterior splint
Short arm volar splint w/ sling
Coaptation Splint w/ cuff-n-collar
A.
B.
C.
D.
E.
Which splint would be most appropriate for an unknown status of a status post MVA Left ankle injury with deformity?
DME Ankle lace-up
DME Air splint
Long leg posterior splint
Short leg posterior splint
Short leg L and U splint
TRUE or FALSE?TRUE or FALSE?A plaster splint sets slower with sugar in the water and faster with salt in the water.
TRUE or FALSE?TRUE or FALSE?
If a person has a 20 layer plaster short leg posterior splint that has been allowed to set upon a naugahyde covered exam table, a 3rd degree burn is possible.
Which splint is most appropriate for most all ankle and foot injuries?
The Short Leg L and U Splint
Which splint is most appropriate for most wrist, forearm and elbow injuries?
The Short Arm Sugar Tong Splint
What is the very first and last assessment that should be made prior to and after applying a splint?
Check for distal circulation
Match the splint to its most appropriate injury treatment:
Short Leg Posterior Splint
Volar Splint
Ulnar Gutter Splint
Short Leg L and U Splint
Thumb Spica Splint
DeQuervain’s Tenosynovitis
Boxer’s Fracture
Ankle Sprain
Carpal Tunnel Symptoms
Bi-malleolar Fracture
