Splinting

(Redirected from Splinting: Humerus)

Background

  • Try to avoid large crinkles/folds with padding, can cause skin damage and breakdown
  • Apply splint firmly but not too tight
    • Allow room for anticipated swelling
    • Tight splint can lead to compartment syndrome
  • Mold splint material with palms rather than fingers to prevent ridges, may be uncomfortable for patient

Procedure

Splint Materials

  • Stockinette [1]
    • Cloth sleeve
    • Base layer for splint/cast
    • Protects skin
  • Cast padding (e.g., Webril)
    • Used with plaster of Paris
    • 2-3 layers with padding of bony points as needed
    • Wrapping circumferentially with 50% overlap will automatically create 2 layers
  • Plaster of Paris
    • 6-10 layers for upper extremity splints, 12-15 for lower extremity splints
    • Takes 20 minutes to cure, sooner if warmer water is used
    • Watch for exothermic reaction
  • Elastic bandage
    • Outer layer to hold splint in place
    • Excessive tightness can lead to pain, less room for swelling
  • Fiberglass
    • Pre-wrapped material
    • Use cool or room temperature water
    • Not as pliable as plaster of Paris
    • Trim or cover cut edges to prevent injury

Splint Application General Procedure

  • Assess pre-procedure neurovascular status (i.e., distal pulse, motor, and sensation) [2]
  • Measure and prepare the splinting material
    • May use contralateral extremity if easier
    • Most splints use a width slightly greater than the diameter of the limb
  • Apply stockinette (if applicable)
    • Extend 2" beyond estimated the splinting material length
  • Apply padding (if applicable)
    • Use 2–3 layers over the area to be splinted / between digits (when applicable)
    • Add an extra 2–3 layers over bony prominences
  • Apply splinting material
    • Lightly moisten the splinting material.
    • Place as appropriate to specific splint type
    • Once finished, if applicable fold the ends of stockinette back over the splinting material if there is excess
  • Apply elastic bandaging (e.g., ace wrap)
  • While still wet
    • May further mold the splint to the desired shape
    • Maintain position until splint material has hardened
  • Re-check and document repeat neurovascular status

Splint Types

Splint Types Gallery

Splinting Overview by Area

Adult Humerus Fracture Management Table

Fracture Splint Disposition
Proximal Non-emergent, but many need surgery, refer to ortho vs ED consult
Shaft R/o neurovasc injury and compartment syndrome, but many need surgery, refer to ortho vs ED consult
Elbow Fracture (Adult) Long arm posterior splint R/o neurovasc injury and compartment syndrome, but many need surgery, refer to ortho vs ED consult
Olecranon R/o neurovasc injury and compartment syndrome, refer to ortho within 24 hrs

Pediatric Humerus Fracture Management Table

Fracture Splint Disposition
Proximal Non-emergent Ortho follow up
Shaft Non-emergent Ortho f/u
Supracondylar Long Arm Posterior Splint Ortho consult for Type 2 or 3

Forearm Fracture Management Table

Fracture Splint Disposition
Radial head fracture

Nondisplaced

Displaced

Monteggia fracture-dislocation (ulnar shaft w/prox radioulnar disloc) Emergent ortho for ORIF
Galeazzi fracture (distal radius w/distal ulnar disloc) Emerg. ortho for ORIF
Elbow dislocation Long arm posterior splint after reduction If associated fracture emergent ortho consult
Forearm fracture Sugar Tong Splint
Colle's fracture (distal radius with dist dorsal angulation) Sugar Tong Splint
Smith fracture (reverse colles with volar angulation) Sugar Tong Splint

Hand Fracture Management Chart

Fracture Splint Disposition
Flexor tendon injury Finger Splint hand specialist referral
Extensor tendon injury Poss ED repair + Finger Splint hand specialist referral
Mallet finger Finger Splint to DIP (DIP in slight hyperextension)
Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb) Thumb Spica Splint
Scaphoid fracture Thumb Spica Splint
Carpal fracture Volar Splint
Bennet's fracture (intrarticular fracture at base of 1st MCP) Thumb Spica Splint
Rolando's fracture (comminuted base of 1st MCP) Thumb Spica Splint
Boxer's fracture Ulnar Gutter Splint
4th and 5th MCP fracture Ulnar Gutter Splint
2nd and 3rd MCP fracture Radial Gutter Splint
Finger (Phalanx) Fracture Finger Splint or Buddy Tape

Foot and Toe Fractures Management Chart

Fracture Splint Disposition
Talus fracture Posterior ankle splint
Calcaneus fracture Posterior ankle splint
Lisfranc injury Posterior ankle splint
Navicular fracture Posterior ankle splint
Cuboid fracture Posterior ankle splint
Cuneiform fracture Posterior ankle splint
Fifth metatarsal fracture Jones Posterior ankle splint Ortho follow up 3-5D
Non-fifth metatarsal fracture Posterior ankle splint Ortho follow up 2-3 days
Toe Fracture Posterior Ankle Splint

Distal Leg Fractures Management Chart

Fracture Splint Disposition
Tibial plateau fracture Knee immobilizer Ortho referral in 2-7d
Tibial shaft fracture Long leg posterior splint
Pilon Fracture Long leg posterior splint
Maisonneuve Fracture Long leg posterior splint
Ankle fracture Posterior ankle splint

Complications

See Also

References

  1. Principles of Casting and Splinting http://www.aafp.org/afp/2009/0101/p16.html Accessed April 4, 2017
  2. Splints and Casts: Indications and Methods. http://www.aafp.org/afp/2009/0901/p491.html Accessed April 5, 2017