1. Splinting “Basic Splinting Techniques” M.T. Fitch, B.A. Nicks, M. Pariyadath, H.D. McGinnis, D.E. Manthey New Engl J Med 359: e32, 2008 Video If link above doesn’t work, go to …\teaching videos\basicsplinting_nejm2008.wmv W. Rose

2. Indications & Benefits Splinting useful in initial management of musculoskeletal injuries to distal extremities. Splinting immobilizes injured extremities, prevents further injury, decreases pain and bleeding, allows healing to begin. Fractures: stabilization of an extremity fracture with a splint will preserve proper bone alignment and alleviate discomfort. Dislocations: After reduction of a dislocated joint, anatomical positioning is maintained by application of a splint. Sprains: Splinting may be used to maintain joint position and to alleviate pain for patients with ligamentous sprains. Fitch et al. (2008) NEJM 359: e32.

3. Upper Extremity Splints Volar splint: triquetral fracture, lunate dislocation, metacarpal head fracture Ulnar gutter splint: fractures of phalanges 4 & 5, metacarpals; flex MCP, PIP, DIP joints Thumb spica splint: fractures of scaphoid, lunate, first metacarpal, thumb Long-arm splint: fractures of proximal forearm, elbow; stabilize intraarticular fractures of distal humerus, olecranon; prevents elbow flex/ext & forearm pronation/supination Sugar tong splint: wrist & distal forearm fractures; prevents wrist flex/ext & forearm pronation/supination

4. Fitch et al. (2008) NEJM 359: e32. Lower Extremity Splints Posterior leg splint: severe sprains, reduced ankle dislocations, fractures of distal leg, ankle, & foot Posterior leg splint with stirrup: as above; also prevents ankle inversion/eversion

5. Fitch et al. (2008) NEJM 359: e32. Other terms; Questions Compartment syndrome Advantage of splinting over casting in the acute setting (soon after injury)?