Splinting Page 1 of 9

Paul Kolecki, M.D. Paul.Kolecki@jefferson.edu

Splinting
READINGS
Davis DP. Splinting. In: Rosen P, Chan TC, Vilke GM, Sternbach G. Eds. Atlas of Emergency
Procedures. St. Louis: Mosby, 2001:272-284.

EDUCATIONAL GOALS
 Discuss the indications and contraindications for splinting an injured extremity.
 Name the equipment needed for splinting.
 Discuss the procedure for splinting an extremity.
 Name the indications for specific splints.
 Discuss the complications of a splint.
KEY WORDS AND DRUGS
 Ace bandages  Sugar tong splint
 Compartment syndrome  Thumb spica
 Finger splint  Ulnar gutter
 Posterior splint  Volar splint
 Splinting  Webril

INDICATIONS FOR SPLINTING

1. Temporary immobilization of any orthopedic injury, including fractures and soft tissue injuries, until a
definitive procedure is performed or immobilization device applied.
2. Protection of an injured extremity when occult injury is suspected although radiographs did not reveal
a fracture.
3. Immobilization for control of pain from severe arthritis, contusions, or soft tissue injuries.
Contraindications for splinting
1. Necessity for open reduction of an unstable or open fracture.
2. Concern for compartment syndrome in the affected extremity.
3. Skin at high risk for infection (i.e., with abrasions or ulcerations).
Equipment
1. Orthopedic or trauma scissors
2. Standard gloves
3. Splinting slabs or rolls in a quantity that will create 5 to 10 layers for an upper extremity splint and 10
to 15 layers for a lower extremity splint.
4. Webril rolls in 1 inch wider that splinting material in a quantity that will create three to five layers on
the “skin side” of the splint and one layer on the outside of the splint, as well as extra to pad pressure
points.
5. Bucket or basin of cool water.
6. Elastic bandages (Ace wrap).
Procedure
1. Measure the opposite extremity using Webril roll to determine the length of plaster necessary to create
the splint. Plaster should be ½ to 1 inch longer than measured because some degree of contraction
will occur. Layer out 3 – 5 layers of Webril
2. Roll out 5 – 10 layers of plaster for the upper extremity (10 – 15 layers for the lower extremity) on top
of the Webril.
3. Arrange the patient in a comfortable position. Place extra Webril over bony prominences.
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Paul Kolecki, M.D. Paul.Kolecki@jefferson.edu

4. Submerge plaster (but not Webril) into cool water. Squeeze the plaster and resaturate it several times.
Lift the plaster out of the water and squeeze to remove as much excess water as possible. For
fiberglass or other resins do not squeeze the material after removing it from the water the last time.
5. Lay the plaster back onto the Webril and run the heels of both hands along the plaster to remove
bubbles and seal the plaster layers to each other. Flip the plaster over and repeat on the other side.
6. Place the splint over the extremity in desired position. Have an assistant hold the splint in place while
the Ace wrap is applied. To avoid causing compartment syndrome, do not use excessive tension.
7. Once the Ace wrap covers the splint entirely, place the extremity into proper position and maintain for
at least 5 – 10 minutes. Do not allow the extremity to move during this critical period, or the splint
will crack and become useless. Determine which splint surfaces are most crucial for holding the
extremity in proper position and hold pressure on these areas for the entire setting period using the
heel of your hand to ensure a flat surface.
8. Instruct the patient not to move or “test” the splint, especially during the hour after the application.
The affected extremity should be elevated when possible to minimize edema formation, and the splint
should be kept dry at all times, regardless of the material used.
9. In the presence of paresthesias or numbness, the Ace wrap may be carefully loosened, but if the
paresthesias or numbness does not subside, the patient should return immediately for reevaluation.
10. Patients can remove their splint to apply ice to reduce pain and swelling.
11. If there are wounds under the splint, the patient should be instructed to remove the splint 2 –3 times a
day to check for signs of infection.
Specific splints

Volar splint
1. Useful for protecting wrist “sprains, ” carpal tunnel syndrome, dorsal tendon injuries, dorsal surface
lacerations, and carpal injuries (except scaphoid).
2. The splint should extend from the distal palmar crease to the midforearm.
3. A hole should be cut in the plaster before wetting to allow space for the thumb. The splint should not
immobilize the thumb.
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Paul Kolecki, M.D. Paul.Kolecki@jefferson.edu

Ulnar gutter splint

1. Useful for 4th and 5th metacarpal injuries, carpal injuries on the ulnar side, isolated ulnar styloid
fractures, and unstable phalangeal fractures of the ring and little fingers.
2. The splint should extend from the PIP joint to midforearm. The wrist should be held in 15 – 30
degrees of extension, and the MCP joints should be held in 90 degrees of flexion.
3. The plaster should be wide enough to encompass the 4th and 5th metacarpals.

Thumb spica splint

1. Useful for gamekeeper’s thumb, de Quervain’s tenosynovitis, 1st metacarpal fractures, and scaphoid
fractures.
2. The splint should extend from the thumb tip to midforearm, with the wrist in neutral position. The
thumb should be in neutral position to allow opposition of the thumb and middle finger for scaphoid
and metacarpal fractures and de Quervain’s tenosynovitis. Slight adduction is used for gamekeeper’ s
thumb.
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Paul Kolecki, M.D. Paul.Kolecki@jefferson.edu

Sugar tong splint

1. Useful for any radius or ulna fractures (except isolated ulnar styloid fractures or radial head fractures).
2. Splint should extend from the palmar crease around the elbow to the dorsal MCP joint. The wrist
should be in neutral position with regard to both flexion-extension and supination-pronation in most
cases.
3. Arm sling helps to prevent shoulder strain. Shoulder range of motion maneuvers should be taught to
prevent adhesive capsulitis.
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Paul Kolecki, M.D. Paul.Kolecki@jefferson.edu

Finger splint
1. Useful for stable phalangeal fractures, mallet finger injuries, and boutonniere deformities.
2. A commercially available metal splint may be placed over the affected joint.
3. For mallet finger injuries, the splint should be placed on the dorsal surface of the DIP joint in
extension.
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Paul Kolecki, M.D. Paul.Kolecki@jefferson.edu

4. For boutonniere deformities the splint should be placed on the volar surfaces of the PIP joint in
extension.
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Paul Kolecki, M.D. Paul.Kolecki@jefferson.edu

5. For stable fractures, “buddy tape” or a splint may be use

Posterior splint of lower extremity
1. Useful as an adjunct to the sugar tong splint for lower extremity fractures and for Achilles’ tendon
injuries, calcaneus fractures, or metatarsal fractures.
2. Splint should extend from the toes to the upper calf.
3. For Achilles’ tendon injuries the ankle should be placed in plantar flexion; otherwise the ankle should
be placed at 90 – 110 degrees.
4. The patient should be placed prone with the knee bent to allow the practitioner access to the foot and
ankle.
5. The patient should be given crutches and crutches instructions.
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Complications
1. Compartment syndrome resulting from edema or excessive pressure from the splint and Ace wrap.
2. Skin breakdown from pressure over the bony prominences.
3. Skin breakdown and maceration in areas of excessive pressure.
4. Inadequate immobilization of unstable fractures.
5. Joint stiffness or adhesions caused by prolonged immobilization.
6. Patients need to be instructed to loosen the splint if there is any signs or symptoms of compartment
syndrome (severe and constant pain, muscle weakness, hypoesthesia, absent pulses and coolness of
the extremity) or return to the Emergency Department.