ED%20103:%20splinting%20basics

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ED 103 splinting basics

• Thao M Nguyen, MD
• Daniel A Hirsh, MD
• Pediatric Emergency Medicine
• Emory University
• Childrens Healthcare of Atlanta

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Objectives

• Indications Contraindications
• Basic Principles
• Common Mistakes
• Prepare patient/parent
• Step-by-step instructions
• Complications
• Discharge Instructions

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Indications

• Temporary immobilization
• Protection
• Pain control

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Contraindications

• Compartment syndrome
• Need for open reduction
• Skin at high risk for infection

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Basic Principles

• Temporary
• Non-circumferential
• Non-weight bearing
• Protect the skin
• Pad bony prominences
• Place a dry splint

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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

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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 shouldnt tingle or turn deep
  purple

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Step 1 Choose your splints
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Choosing the splint typesupper extremities

• Volar
• Distal radius/ ulna wrist fx
• Sugar Tong
• Distal radius/ ulna wrist fx
• Long Arm
• Elbow forearm injuries

- Fleisher, 2006 -
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Choosing the splint typesupper extremities

• Ulnar Gutter
• Boxers fx and uncomplicated 4th 5th phalangeal
  fx
• Radial Gutter
• 2nd 3rd MCP or phalangeal fx

- Fleisher, 2006 -
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Choosing the splint typesupper extremities

• Thumb Spica
• Nonrotated, nonangulated, nonarticular fx of the
  thumb MCP or phalanx gamekeepers thumb
  scaphoid (navicular fx)
• Buddy Tape

- Fleisher, 2006 -
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Choosing the splint typelower extremities

• Posterior leg
• Foot, ankle distal fibula fx
• Ankle sprains
• Stirrup
• Foot, ankle distal tibia/fibula fx
• Cadillac Splint

- Fleisher, 2006 -
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Step 2 Gather all of your supplies
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Splinting Material
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Stockinette
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Cotton Wadding Cast Padding
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Ace wrap
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Shears
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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 placenot 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
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Discharge Instructions

• Protect the skin. Keep splint dry
• If extremities become tingly or blue, re-wrap the
  bandage
• Dont allow weight bearing on the splint
• If splint hurts, or there is increasing pain,
  TAKE THE SPLINT OFF! Seek medical attention

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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
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Case 2

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Case 3
16 yo female with left wrist injury 6 wks ago.
Extremity was splinted w/o reduction unable to
F/U with orthopedics
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Suggested Reading

• Fleisher, GR. Textbook of Pediatric Emergency
  Medicine, 5th ed, 2006