Splinting Dan Hirsh, MD Emory PECC Orientation June 19, 2008 Hughes Spalding Children’s Hospital

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

ComplicationsPrevention Risk of ischemia Compartment Syndrome Possible neurovascular compromise Keep splint snug Check distal neurovascular status after placement Skin breakdown Keep splint dry Use minimal water necessary and dry thoroughly before placement Use padding Avoid ‘kinks’ Pain or Ineffective Immobilization 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 shouldn’t tingle)

Ace wrap Webril / wadding Stockinette

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

Hot water will cause the fiberglass to harden very quickly Use cold water 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 skin-side.

Wrap the splint in place—not 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: ½ 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 Don’t let the splint slide up or down

“Gutter” Metacarpal and/or proximal phalnageal fractures Ulnar immobilizes 5 th & 4 th digits, radial 2 nd & 3 rd Width: wrap to midline of hand on dorsal and volar surfaces Length: nail base to proximal forearm

“Volar” Distal forearm or wrist fractures Don’t use in small children Width: fully cover volar aspect of forearm Length: from proximal fingers to proximal forearm

“Thumb Spica” Non-displaced fractures of 1 st 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 ½ 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 ½ leg circumference, but NON- circumferential 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

Thumb Spica Volar Long Arm & Short Posterior leg Sugar Tong & Stirrup