ALL YOU NEED TO KNOW ABOUT SPLINTING

Konstantinos Gus Agoritsas, MD

Initial Approach

• ABC’s• Evaluate involved limb for:

– Neurovascular compromise– Open fractures/compartment syndrome– Fractures with increased risk for significant bleeding-

Pelvic/Femur Fxs– Consider associated injury– Pain Management– Radiographic evaluation– Splinting

GOAL OF A SPLINT

• IMMOBILIZATION and COMFORT– Decreases pain– Prevents further injury– Controls bleeding– Decreases risk of converting a minor injury to a

major injury

Indications for Splinting

• Not just for Fractures

• Sprains

• Joint Infections

• Tenosynovitis

• Lacerations over joints

• Puncture wounds and animal bites of the hands and feet

Complications

• Neurovascular compromise

• Pressure sores

• Contact dermatitis

Preparation

• Define injury and what splint is required

• Splint in position of function

• Clean and repair skin lesions prior to splint application

• Document neurovascular examination before splint application

• Anticipate ability for child to remove clothes after splint is applied

Splinting Equipment

• Plaster of paris

• Orthoglass

• Stockinette

• Padding- Webril

• Ace wraps

Splinting Materials

Splinting Equipment• Plaster of Paris

– Gypsum- calcium sulfate dihydrate– exothermic reaction when wet– warm water faster set but increases risk of

burns– Fast drying- 5-8 min to set– Extra fast drying 2-4 min to set thus less time to

mold– Can take up to one day to reach maxinum

strength

Splinting Equipment

• Ready Made Splinting Material– Othoglass (fiberglass)

• Cures rapidly (20 min)

• Less messy

• Stronger, lighter

• Less moldable

• Stockinette– protects skin, looks nifty– cut longer than splint– several size widths

• Padding- Webril– 2-3 layers, more if anticipate lots of swelling– Extra over elbows, heels, and other joints– Be generous over bony prominences– Always pad between digits when splinting

hands/feet or when buddy taping– Avoid wrinkles– Do not tighten

• Ace wraps

General Principles• Stockinette applied to extend about 2-3 inches

beyond plaster

• Use opposite arm to measure length.

• 2-3 layers of webril are applied and smoothed

• Plaster or orthoglass applied

• 8-10 layers for UE

• 12-14 layers for LE

• Ace wrap applied over plaster

• Mold the plaster/orthoglass as it dries

RULES OF SPLINTING

• Check distal circulation before you splint.

• Pad, pad and pad.

• Your splint must be long enough, strong and wide ENOUGH.

• Immobilize the joints above and below the injury.

• Check splint for tightness

• Check and document distal pulse, sensation and motor function after splint is applied

Upper Extremity Splints

• Sugar tong splint

• Ulna gutter splint

• Volar splint

• Long arm posterior splint

• Digit splint

• Thumb spica splint

Lower Extremity Splints

• Posterior short leg splint

• Stirrup splint (Sugar tong)

• Knee immobilizer

• Long leg splint

LONG ARM POSTERIOR SPLINT

• Fractures of elbow

• Fractures of forearm

• Flex elbow at 90’

• Forearm in neutral position

• Slight dorsiflexion at wrist

• Distal palmar flexion crease

• Up ulnar forearm

• Across olecranon

• Dorsal mid upper arm

• Collar and cuff initially

SUGAR TONG

• Fractures of Forearm • Distal palmar flexion crease to the elbow

• Elbow to dorsum hand proximal to MCP

• Must use sling• Elbow flexed at 90’

and wrist in neutral position

ULNAR GUTTER

• Fractures of 4th and 5th digits (metacarapal and/or proximal phalangeal )

• Flex MCP 35-40’(70’)• Flex IP 20-30’• Extend wrist 20-30’

VOLAR SPLINT

• Fractures of the hand• Fractures of fingers

• Extend wrist 30’

THUMB SPICA

• Fractures of scaphoid• Fractures of thumb

• Holding a BEER/SODA can

• Radial forearm• 1st tail across thenar

eminence to distal palmar crease

• 2nd tail around thumb

FINGER SPLINTS

• Fractures of fingers • Flex MCP 90’• Flex PIP 45’• Foam padded

aluminum splints• Tape to “buddy” and

dorsum of hand

Posterior Splint Short Leg

• Fractures of the foot• Fractures of the ankle

• Flex ankle to 90’• From level of fibular

neck, over the heel of the foot, to the base of the digits

• May use with a sugar tong splint for more support

LONG LEG SPLINT

• Distal femur• Proximal tibia/fibula• Soft tissue and/or

ligament injuries of the knee

• Below the buttock to the heel of the foot

• Knee in slight flexion and ankle in neutral position

• Knee in full extension if knee injury

Discharge Instructions

• Keep injured limb elevated

• Apply ice often for the next 36 hrs

• Keep splint dry

• Pain management

• Instructions to return immediately for pain or sensory changes distal to the splint or pain under the splint

• Provide orthopedic follow up

Common Splints in Ped’s Fractures

• Pad bony prominences• Use appropriate:

– Material

– Shape

– Size

• Not too tight and not too loose

• Adequate instructions

Webril roll over stockinette

Splint applied

Ace wrap

Now its time to play!!!!!!