1.SPLINTS Guided by : Dr. Nitin Sir Done By : Dr. Rupeshkumar Hatwar

2. What is a splint? A splint is a rigid support with padding made from metal, plaster or plastic. It is used to support, protect, or immobilize an injured or inflamed part of the body. The splint is secured in place with an elastic bandage or an ACE wrap .The purpose of the splint is to preve nt movement of the injured extremity which helps pre vent further injury, and to minimize pain 3. Indications for Splinting Fractures Sprains Joint infections Tenosynovitis Acute arthritis / gout Lacerations over joints Puncture wounds and animal bites of the hands or feet 4. To reduce/prevent contracture To increase grip strength To stabilize and rest joint in ligamentous injury To correct deformity To support and immobilize joints and limbs postoperatively until healing has occured 5. Contraindications of Splinting syndrome Compartment Need for open reduction Skin at high risk for infection 6. Splinting Material Plaster of Paris Made from gypsum - calcium sulfate dehydrate Exothermic reaction when wet - recrystallizes (can burn patient) Average setting time 3-9 min Average drying time 24-72 hours 7. Factors decreasing setting time :Hot water, Salt, Borax, Resins Factors increasing setting time :Cold water, sugar Upper extremities : use 8-10 layers Lower extremities :-12-15 layers up to 20 if big person (increased risk of burn!) 8. Advantage Disadvantage Easier to mold Less expensive More difficult to apply Gets soggy when getting wet 9. Splinting Material Ready Made Splinting Material (1) Plaster (OCL) 10 -20 sheets of plaster with padding and cloth cover(2) Fiberglass (Orthoglass) Cure rapidly (20 minutes) Less messy Stronger, lighter, wicks moisture better Less moldable Disadvantage More expensive More difficult to mold 10. (3) Prefabricated splints Plastic shells lined with air cells, foam or gel components Same advantages and disadvantages as fiberg lass splints 11. (4)Air splints Provide less support than plaster and fibergla ss Splints Used for ankle sprains rather than fractures o r Dislocations Used to prevent eversion/inversion while perm itting free flexion and extension of ankle Provides clear vie w of injury during x-ray 12. (4) Vacuum splints - Styrofoam chips contained inside an airtight cloth, pliable sleeve - Molds to shape of injury using a handheld pump to draw out the air from within the sleeve 13. Pre / Post - Splint Checks F Function A Arterial Pulse C Capillary Refill T Temperature (Skin) S - Sensation 14. Choose your splints Upper Extremity Shoulder And Arm - Figure of eight - Sling and Swathe - Aeroplane splint Elbow/Forearm Long Arm Posterior Double Sugar - Tong Forearm/Wrist Volar Forearm / Cockup Sugar - Tong Hand/Fingers Ulnar Gutter Radial Gutter Thumb Spica Finger Splints Knuckle-bender splint 15. Lower Extremity Hip and Thigh - Von Rosens Splint - Thomas Splint - Bohler-Braun SplintSpine -Cervical Collar Four-post Collar SOMI (Sternal Occipital Mandibular Immobilizer) Knee - Knee Immobilizer / Bledsoe - Bulky Jones - Posterior Knee Splint Ankle - Posterior Ankle - Stirrup Foot - Denis-Brown splint - Buddy taping- Scoliosis - Milwaukee Brace - Boston Brace - Taylors Brace 16. Traction 1. Manual Traction 2. Skin Traction 3. Skeletal Traction 17. Upper Extremity 18. Shoulder and Arm (1) Figure of eight Indications: Clavicle fractures Most figure of eight splints are prefabricated and Application is simple. Read the product information insert before applying the splint about the correct application process. Apply with patient standing and hands on iliac crest. Shoulders should be abducted 19. Figure of eight 20. (2) Sling and Swathe Indication: Shoulder and humeral injuries Slings supports weight of shoulder Swathe holds arm against chest to prevent shoulder rotation Apply the sling and swath with the patient standing. Place the injured arm in the sling with the elbow at 90 degrees of flexion. Next place the strap that is attached to the sling over the patient head so that the weight of the arm is supported 21. Sling and Swathe Apply the swath. This can be anything from an ACE wrap to a prefabricated swath. This is designed to hold the patients affected arm that is in the sling against the body. The swath should wrap around the front and back of the sling keeping the affected extremity against the mid-abdomen 22. (3) Aeroplane SplintIndication- Brachial plexus injury 23. Elbow/Forearm (1) Long Arm Posterior Indications: - Forearm and elbow injuries - Olecranon and radial head fractures - Distal humeral fracture Not recommended for unstable fractures Applied from palmer crease, wrapping around lateral metacarpals, extending up to posterior arm with elbow flexed at 90 degreesNOTE - Doesnt completely eliminate supination / pronation either add an anterior splint or use a double sugar-tong if complex o r unstable distal forearm fx. 24. Long Arm Posterior 25. (2) Double Sugar - Tong Indications :- Elbow and forearm fx - prox/mid/distal radius and ulnar fx. Better for most distal forear m and elbow fx because li mits flex/extension and pro nation / supination. 26. (2) Double Sugar - Tong 27. Forearm/Wrist (1) Volar Forearm / Cockup Indications: - Distal forearm and wrist fractures -Soft tissue hand / wrist injuries - sprain , carpal tunnel night splints, etc - 2nd -5th metacarpal fx. - Radial Nerve palsy Applied from volar palmer crease to 2/3 forearm Allows elbow and finger ROM NOTE - Not used for distal radius or ulnar fx - can still supinate and pronate. 28. Volar Forearm / Cockup 29. (2) Forearm Sugar - Tong Indications Wrist and distal forearm fractures Extends from MCP joints on dorsum of hand, tracks along the forearm, wraps around back of elbow to volar surface of the arm and exte nds down to mid-palmer creaseImmobilises wrist, forearm, and elbow 30. Forearm Sugar - Tong 31. Hand/Fingers (1) Ulnar Gutter Splint(2) Radial Gutter Splint Indications: Indications Phalangeal and metacarpal - Fractures, phalangeal and fractures metacarpal and soft tissue Most common use-Boxer injuries of the index and fractures middle fingers. 5th MCP fracture Soft tissue injury to little and ring finger. 32. Ulnar Gutter Splint Extends from DIP joint to the proximal 2/3 of the forearm Should immobilize the ring and little finger MCP should be in 70 degrees of flexion, PIP should be in 30 degrees of flexion and DIP in no more than 10 degrees of flexion 33. Ulnar Gutter Splint 34. Ulnar Gutter Splint 35. Radial Gutter Splint 36. (3) Thumb Spica Indications: Scaphoid fractures , thumb phalanx fractures or dislocations Most Common use: 1) Gamekeepers thumb or skiers thumb 2) Dequiervans tenosynovitis Extends from DIP joint of thumb, incorporates the thumb and extends up 2/3 of the proximal lateral forearm 37. Thumb Spica 38. (4) Finger Splints Sprains - dynamic splinting (buddy strapping). Dorsal/Volar finger splints - phalangeal fx, though gutter splints probably better for proximal fxs. 39. Finger Splints(a) Stack Splint Use management of mallet finger 40. (b) Aluminium Splint Uses - phalangeal fx, -mallet finger 41. (c) Oval-8 Finger splint 42. Oval-8 Finger splint 43. Finger splints 44. (d) Tripoint Splint Uses Boutonniere deformity , Swan neck deform ity 45. Tripoint Splint 46. (5) Knuckle-bender Splint Indication- Ulnar Nerve Palsy 47. Lower Extremity 48. (1) Von Rosens Splint Indication Congenital dislocation of the Hip H shaped malleable splint Hip should be properly reduced before it is splinted Object is to held hip somewhat flexed an d abducted Extreme positions are avoided and Joint should allowed some movement in the splint 49. (2) Hip Spica Cas Uses- Fracture shaft of femur in children and in tyoung adults once the fracture becomes sticky encircles one or both arms or legs and the chest o r trunk. It generally is strengthened with a reinforcement ba r. 50. Hip Spica Cast When applied to a lower extremity , the c ast is trimmed in the anal and genital ar eas to allow elimination of urine and sto ol. 51. Hip Spica Cast 52. (3) Thomas Splint Devised by H.O. Thomas initially for T B of the knee. Indication - Now commonly used for immo bilisation of hip and thigh injuries It has a ring and two bars joined distally. The ring is at an angle of 120 degree to the i nside bar The ring size is found by addition of 2 inche s to the thigh circumference at the highest p oint of the groin The length is the measurement from the hig hest point on the medial side of the groin u p to the heel plus 6 inches. 53. Thomas Splint - used as traction splint 54. (4) Bohler-Braun Splint Indication ;- Fracture femur anywhere More convenient than Thomas splint since it has n o ring. As the ring of Thomas splints is a common ca use of discomfort, especially in old people. No in-built system of counter-traction , hence it Is n ot suitable for transportation. 55. Knee (1) Knee Splint Indications: - knee injuries - proximal Tib/fib fractures Place knee in full extension The plaster is placed from the posterior buttocks to 3 inches above level of bilateral malleoli 56. Knee Splint 57. Ankle (1) Posterior Ankle Splint Indications - Distal tibia/fibula fx. - Reduced dislocations - Severe sprains - Tarsal / metatarsal fx Use at least 12-15 layers of plaster. Placed from metatarsal heads on plantar surface foot, extends up back of leg to level of fibular neck NOTE - Adding a coaptation splint (stirrup) to the posterior splint eliminates inversion / eversion - especially useful for unstable fx and sprains. 58. (2) Stirrup Splint Indications - Similar to posterior splint. - Unstable ankle fx Less inversion /eversion and actually less plantar flexion compared to posterior splint. Great for ankle sprains. 12-15 layers of 4-6 inch plaster. 59. Stirrup Splint The splint should be long enough to involve the leg from below the medial side of knee, wrap around the under surface of the heel, and back up to the lateral side of the same knee. 60. Stirrup Splint 61. Foot (1) Denis-Brown splint Indication Congenital Talipes Equino Varus (C.T.E.V.) Used after successful correction of deformity ,to prevent relapse. used throughout the day before child starts walking. Once child starts walking ,a DB s plints is used at night and CTEV shoes during the day. 62. Denis-Brown splint 63. (2) Buddy strapping Indications: Phalangeal fractures of the toes Small piece of wadding placed between toes to prevent maceration Fractured toe secured to adjacent toe with tape 64. Buddy strapping Use a small piece of wadding and place between the injured toe and an adjacent toe to prevent maceration The fractured toe is secured to the adjacent toe with a piece of tape 65. Spine 66. (1) Cervical Collar Flexible foam/Rigid/Adjustable collar Encircles the neck to support the skull against the thorax inferiorly Motion control and keeping warm at cervical level Soft tissue injury, minor sprains for first few days after injury Post operative immobilisationNote :- They are not useful for very unstable injury pattern 67. Cervical Collar Soft Cervical Collar Commonly used for mild soft tissue strain s and sprains 68. Cervical Collar Semi-Rigid Cervical Colla r Can provide access to t he trachea Moderate Control of RO M Adjustable 69. (2) Four-post Collar Indication Neck immobilisation in cervical spine injury More stable than cervical collar Applying pressure to mandible , occiput , sternum and up per thoracic spine They can be uncomfortable 70. (3) SOMI (Sternal Occipital Mandibular Immobilizer) Uses cervical spine injur Rigidy Frame Design Commonly used in stable fractures and Moderate to Severe soft tissue damage Limits Flexion and Extension Extends Inferior into the Thoracic Region for greater control of all cervical levels 71. (4) Milwaukee Brace Indication- Scoliosis Named after the city of Milwaukee where it was designed. It fits snugly over the pelvis below; chin and head pads prom ote active postural correction and thoracic pad presses on t he ribs at the apex of the curves 72. (4) Boston Brace Indication-Scoliosis Used for low curves Worn 23 Hours / Day Made of semi-rigid plastic and foam 73. (5) Lyon Brace Indication-Scoliosis 74. (6) SpineCore Brace Indication-Scoliosis 75. Scoliosis Braces 76. (7)Taylors Brace Indication Dorso-lumbar Immobilisation Anterior Compression Fractures of the vertebral body Semi rigid design Commonly used for osteoporosis, trauma, Degenerative spine disease 77. Traction 78. Traction Traction is a pulling effect exerted on a part of the skeletal system. It is a treatment measure for musculoskeletal trauma and disorders. Traction is used to acco mplish the following: Reduce muscle spasms Realign bones Relieve pain Prevent deformities 79. Types of Traction 80. 1. Manual TractionManual traction means pulling on the body using a person's hands and muscular strengt h. It most often is used briefly to realign a broken bone . It also is used to replace a dislocated bone int o its original position within a joint. 81. Manual Traction 82. 2. Skin Traction Skin traction means a pulling effect o n the skeletal system by applying devi ces, such as a pelvic belt and a cervical halter, to the skin. Commonly applied forms of skin tractio n are Buck's traction Russell's traction Bryants (gallows) traction Dunlop traction 83. Skin Traction Limited force can be applied - generally not to exceed 5 lbs More commonly used in pediatric patients Can cause soft tissue problems especially in elderly or rheumatoid patients Not as powerful when used during operative procedure for both length or rotational control 84. Skin TractionA)Pelvic Traction(B) Cervical halter 85. (1) Pelvic Traction Uses Relief of pain of Sciatica and other backaches Traction is applied to a pelvic harness with weights over the e nd of bed An alternative in Sciatica is the 90-90 traction 86. (2) Cervical halter Uses - short term cervical traction -minor neck injuries with out obvious trauma e.g. Whiplash injury, neck muscle spasm , conservative treatment of cervical disk lesion Note Contraindicated in mandibular fracture 87. (3) Buck's traction Uses femoral fractures, lower backache Acetabular and hi p fracturesConventional skin traction 88. Buck's traction Provide temporary comfort in hip fracture s Maximal weight - 10 pounds Watch closely for skin problems, especially in elderly or rheumatoid patients 89. (4) Russell's traction Uses - Trochanteric fractures 90. (5) Gallows traction Uses- fracture shaft of femur in children below 2 year s Imp check the state of the circulation in the limb frequently , because of danger of vascular compli cations 91. Bryants Traction Useful for treatment femora l shaft fx in infant or smal l child Combines gallows traction and Bucks traction Raise mattress for counte r traction Rarely, if ever used currentl y 92. (6) Dunlop traction Use- mainly used in the maintenance of reductio n in supracondylar fractures of humerus in child ren. Forearm skin traction with weight on upper arm Elbow flexed 45 degrees Allows swollen elbow to settl e Contraindicated in open fra ctures and skin defects 93. Dunlop traction 94. (7) Femoral Traction Older Child in Balkan Frame Indications Child> 12 kg Femoral fractures Skin must be intact 95. Balkan Frame 96. 3. Skeletal Traction Skeletal traction means pull exerted directly on the skeletal system by attaching wires, pins, or tongs into or through a bone. Skeletal traction is applied c ontinuously for an extended period. 97. Skeletal Traction More powerful than skin traction May pull up to 20% of body weight for the lower extremity Requires local anesthesia for pin insertion if patient is awake Preferred method of temporizing long bone, pelvic, and acetabular fractures until operative treatment can be performed 98. (1) HALO TRACTION Rigid Frame Design Commonly used in unstable fractures Limits All motion Extends Inferior into the Thoracic Region for greater control of all cervical levels Screws Directly into the skullDisadvantages - Pin problems - Respiratory compromise 99. HALO TRACTION BRACE 100. (2) Gardner Wells Tongs Used for C-spine reduction / traction Pins are placed one finger breadth above pinna, slightly posterior to external auditory meatus Apply traction beginning at 5 lbs. and increasing in 5 lb. increments with serial radiographs and clinical exam 101. (3) Olecranon Traction Uses - supracondylar and comminuted fractures of lower end of the humerus and unstable fracture of shaft of humer us Rarely used today Small to medium sized pin placed from medial to lateral in proximal olecranon - enter bone 1.5 cm from tip of olecranon and walk pin up and down to confirm midsubstance location. Support forearm and wrist with skin traction - elbow at 90 degrees 102. (4)Distal Femoral Traction Uses- Method of choice for acetabular and proximal femur fractures If there is a knee ligament injury usually use distal femur instead of proximal tibial traction Place pin from medial to lateral at the adductor tubercle - slightly proximal to epicondyle 103. (5) 90-90 Traction Useful for subtrochanteric and proximal 3rd femur fx Especially in young children Matches flexion of proximal fragment Can cause flexion contracture in adult 104. (6) Acetabular Tractio n Uses- to maintain reduction in central fractur e dislocation of acetabulum 105. How do I take care of the splint? Do not get the splint wet. Use plastic bags to cover the splint while bathing. Do not walk on the splint. Do not stick anything down the splint Such as a coat hanger to scratch or itch. This may lead to injury and infection. 106. What danger signs should to look for? Numbness, tingling, increased pain, change in coloration of fingers or toes, or swelling in fingers or toes. If these symptoms occur, you should call your doctor immediately 107. Complications Burns - Thermal injury as plaster dries - Hot water, Increased number of layers, extra fast-drying , poor padding all increase risk - If significant pain - remove splint to cool Ischemia - Reduced risk compared to casting but still a possibility - Do not apply Webril and ace wra ps tightly - Instruct to ice and elevate extremi ty - Close follow up if high risk for swelling, ischemia. - When in doubt, cut it off and look Remember - pulses lost late. Pressure sores Smooth Webril and plaster well Infection - Clean, debride and dress all wounds before splint application - Recheck if significant wound or increasing pain