Splinting basics 4/15/2017

Introduction Selected extremity splinting techniques Misty Wright, PA-C 4/15/2017

Topics of Discussion Upper extremity Lower extremity Finger splinting 4/15/2017

Upper extremity splinting Volar splints used mostly for sprains of the wrist, tendonitis, or any inflammatory process at the the wrist level. A Volar splint is placed volarly on the forearm from the palmar crease to the proximal 1/3 forearm, allowing movement of the thumb, and the metacarpal phalangeal joints. 4/15/2017

Volar splint 4/15/2017

Velcro splint 4/15/2017

More UE Splints A thumb spica splint is a volar splint with the thumb immobilized in neutral, and used for thumb injuries, and suspected scaphoid fractures. 4/15/2017

Thumb Spica 4/15/2017

One More UE Splint The Coaptation splint extends from the axilla medially, and runs laterally around the elbow to the acromioclavicular joint. It is used to immobilize mid to distal humerus fractures. Sarmiento Fracture cuff- midshaft humerus fractures, circumferential support 4/15/2017

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Coaptation splint 4/15/2017

Sarmiento fracture brace 4/15/2017

The Best Upper Extremity Splint The Sugar tong or stirrup splint for the forearm and wrist goes from the palmer crease, around elbow, and ends at the dorsal MP joints. It prevents pronation/supination of the forearm, and is used for distal radius and forearm fractures. 4/15/2017

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Another Upper Extremity Splint The posterior splint is used for elbow injuries and fractures, and goes from the proximal 1/3 of the humerus, posteriorly, and can stop at the wrist, or extend to the MP joints, as needed. 4/15/2017

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Posterior Splint 4/15/2017

Lower Extremity Splints Short leg splints are used for foot and ankle injuries. The posterior splint is used for foot and soft tissue injuries, or to prevent equinous contracture. The three way, trauma, stirrup, or lower extremity sugar tong splint is for ankle joint injuries. 4/15/2017

Air Splint 4/15/2017

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Components of 3-way 4/15/2017

Cam Walker Boot 4/15/2017

Lower Extremity Splints Any Bony injury above the ankle level should be immobilized with a long leg splint, or knee immobilizer. Hip Reductions can go in knee immobilizers, or an abduction brace, to prevent re-dislocation. 4/15/2017

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Long leg cast 4/15/2017

Abduction Pillow 4/15/2017

Knee Immobilizer 4/15/2017

Finger Splints Use stack splints, or malleable metal splints to splint digits in position of comfort or reduction. Splint Mallet, or avulsion fractures in extension, and do not allow the patient to remove. 4/15/2017

Mallet finger 4/15/2017

Mallet splint 4/15/2017

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Splinting pitfalls Do not apply splints too tight. Use Bias wrap for upper extremity splints, and do not stretch elastic when applying ace wrap. 4/15/2017

Too Much splinting Is not good Over splinting can lead to stiff joints, and should be avoided. Adults older than 40 at risk for frozen shoulder/elbow syndromes. Geriatric patients must be closely monitored for skin breakdown. 4/15/2017

Questions Check your splints Bill for any special applications, molding, and splint checks. - AHCCCS no longer pays for any prefab splints, just FYI. 4/15/2017

Common fracture patterns Is it broken or fractured? 4/15/2017

A word about peds fracture patterns 4/15/2017

Salter harris fracture- Type 2 Thurston Holland fragment Salter harris fracture- Type 2 4/15/2017

Supracondylar fracture- Type 1 4/15/2017

Supracondylar fracture- Type 2 4/15/2017

Supracondylar fracture- Type 3 4/15/2017

Common Upper Extremity Fractures 4/15/2017

Monteggia fracture 4/15/2017

Galeazzi fracture 4/15/2017

Scaphoid fracture 4/15/2017

Scapholunate widening Terry thomas sign Scapholunate widening 4/15/2017

Perlinuate dislocation 4/15/2017

Perilunate dislocation 4/15/2017

Flexor Tenosynovitis 4/15/2017

Kanavel Signs of Flexor Tenosynovitis - Pain passive extension - fusiform swelling (sausage like) - flexed posture - flexor sheath tenderness 4/15/2017

Lower Extremity Fracture Patterns 4/15/2017

Lizfranc Fracture 4/15/2017

4/15/2017 “just” an ankle sprain?

Maisonneuve Fracture 4/15/2017

Pilon Fracture 4/15/2017

Tibial Plateau Fracture Very commonly causes lateral lower extremity Compartment Syndrome 4/15/2017

Commonly present with Tibia Plateau Fractures 4/15/2017

Proximal Femur Fractures 4/15/2017

The End 4/15/2017