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Splinting

Hughes Spalding
Childrens Hospital

Dan Hirsh, MD
Emory PECC Orientation
June 19, 2008

A splint is a noncircumferential
immobilization device to
treat fractures, lacerations
of skin or tendon, and
sprains.

Complications
Risk of ischemia
Compartment Syndrome
Possible neurovascular compromise

Prevention
Keep splint snug
Check distal neurovascular status
after placement

Keep splint dry


Skin breakdown

Pain or Ineffective
Immobilization

Use minimal water necessary and dry


thoroughly before placement

Use padding
Avoid kinks
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 shouldnt tingle)

Stockinette

Ace wrap

Webril /
wadding

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

Use cold water


Hot water will cause the
fiberglass to harden very
quickly

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 skinside.

Wrap the splint in


placenot 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: 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
Dont 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
Dont 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 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 leg
circumference, but NONcircumferential
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

Long Arm &


Short
Posterior leg

Sugar Tong &


Stirrup

Thumb
Spica
Volar