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ED 103: splinting basics
Thao M Nguyen, MDDaniel A Hirsh, MD
Pediatric Emergency MedicineEmory University
Children’s Healthcare of Atlanta
2
Objectives
Indications & Contraindications Basic Principles Common Mistakes Prepare patient/parent Step-by-step instructions Complications Discharge Instructions
3
Indications
Temporary immobilization Protection Pain control
4
Contraindications
Compartment syndrome Need for open reduction Skin at high risk for infection
5
Basic Principles
Temporary Non-circumferential Non-weight bearing Protect the skin
• Pad bony prominences• Place a dry splint
6
Common Mistakes
Placement of a Circumferential splint Placement a Wet splint Placement of a Tight Splint Not allowing time for the fiberglass to adequately
harden
7
Patient/Parent Expectations
Placement should not hurt Most injuries feel significantly better with splinting
alone Splint material will get warm when it hardens Should be snug, not tight
• Fingers & toes shouldn’t tingle or turn deep purple
8
Step 1: Choose your splints
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Choosing the splint types:upper extremities
Volar• Distal radius/
ulna & wrist fx Sugar Tong
• Distal radius/ ulna & wrist fx
Long Arm• Elbow &
forearm injuries
- Fleisher, 2006 -
10
Choosing the splint types:upper extremities
Ulnar Gutter• Boxer’s fx and
uncomplicated 4th & 5th phalangeal fx
Radial Gutter• 2nd & 3rd MCP or
phalangeal fx
- Fleisher, 2006 -
11
Choosing the splint types:upper extremities
Thumb Spica• Nonrotated,
nonangulated, nonarticular fx of the thumb MCP or phalanx; gamekeeper’s thumb; scaphoid (navicular fx)
Buddy Tape
- Fleisher, 2006 -
12
Choosing the splint type:lower extremities
Posterior leg• Foot, ankle & distal fibula fx• Ankle sprains
Stirrup• Foot, ankle & distal
tibia/fibula fx Cadillac Splint
- Fleisher, 2006 -
13
Step 2: Gather all of your supplies
14
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Splinting Splinting MaterialMaterial
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StockinetteStockinette
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““Cotton Wadding” Cotton Wadding” “Cast Padding”“Cast Padding”
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Ace wrapAce wrap
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ShearsShears
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Step 3: Protect the skin
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Apply stockinette to extremity
Extend it past the proximal and distal ends of where
the splint will end
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Cut out any areas that bunch up that could
damage the skin
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Create thumb hole
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Protect bony prominences
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Cut splint material to proper
size
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Protect the skin by creating ~1.5 cm border of cotton by cutting the
fiberglass
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Step 4: Activate the Fiberglass
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Approximate initial hardening times• Ambient Humidity: 15 min• Cold Water: 5 min• Hot Water: 2 min
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Hot water will cause the fiberglass to harden very
quickly
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Cold water
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Keep padding as dry as possible
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Protect the skin. If cotton padding is wet, dry it.
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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.
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Step 5: Apply the Splint
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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.
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Allow time for the fiberglass to cure
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Step 6: Check splint placement
Make sure patient has normal sensation distal to splint
Make sure there is normal capillary refill after splint placement
Make sure the splint does not cause any pain
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Splint Complications
PreventionComplications
Check splint after placementIf either of these, replace the splint
Pain or Ineffective Immobilization
Keep splint dryUse minimal water necessary and dry thoroughly before placement
Use paddingAvoid ‘kinks’
Skin breakdown
Keep splint snugCheck distal neurovascular status after placement
Risk of ischemiaCompartment SyndromePossible neurovascular compromise
PreventionComplications
Check splint after placementIf either of these, replace the splint
Pain or Ineffective Immobilization
Keep splint dryUse minimal water necessary and dry thoroughly before placement
Use paddingAvoid ‘kinks’
Skin breakdown
Keep splint snugCheck distal neurovascular status after placement
Risk of ischemiaCompartment SyndromePossible neurovascular compromise
40
Discharge Instructions
Protect the skin. Keep splint dry If extremities become tingly or blue, re-wrap the
bandage Don’t allow weight bearing on the splint If splint hurts, or there is increasing pain, TAKE
THE SPLINT OFF! Seek medical attention
41
Case 1
12 yo female s/p bike accident, fell and landed on wrists
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Case 2
3 yo male fell while running and landed on leg
43
Case 2
44
Case 3
16 yo female with left wrist injury ~ 6 wks ago. Extremity was splinted w/o reduction; unable to F/U with orthopedics
45
Suggested Reading
Fleisher, GR. Textbook of Pediatric Emergency Medicine, 5th ed, 2006