SPLINTING TECHNIQUES

BASELINE MATERIALS

l Stockinette l Padding l Splinting material l Elastic bandaging l Plaster l Bucket/receptacle of water (the warmer — Upper extremity: 8–10 layers the water, the faster the splint sets) — Lower extremity: 10–12 layers l Trauma shears l Fiberglass BASELINE PROCEDURE Measure and prepare the splinting material. l Length: Measure out the dry splint on the contralateral extremity l Width: Slightly greater than the diameter of the limb 1 2 3 4 5

1 2 3 4 5 6 Apply the Apply 2–3 layers Lightly moisten Apply the elastic While still wet, Once hardened, stockinette to of padding over the splinting bandaging. use palms to mold check extend 2" beyond the area to be material. Place it the splint to the neruovascular the splinting splinted and and fold the ends desired shape. status and motor material. between digits of stockinette function. being splinted. over the splinting Add an extra 2–3 material. layers over bony prominences.

EMRA.ORG | 972.550.0920 POSTERIOR LONG ARM VOLAR SPLINT SPLINT

INDICATIONS INDICATIONS l Olecranon fractures l Soft tissue injuries of the hand and wrist l Humerus fractures l Carpal bone fractures l Radial head and neck fractures l 2nd–5th metacarpal head fractures CONSTRUCTION CONSTRUCTION l Start at posterior proximal arm l Start at palm at the metacarpal heads l Down the ulnar forearm l Down the volar forearm l End at the metacarpophalangeal joints l End at distal forearm APPLICATION APPLICATION l Cut hole in stockinette for thumb l Cut hole in stockinette for thumb l Elbow at 90º l Forearm in neutral position with thumb up l Forearm neutral position with thumb up l Wrist slightly extended (10–20º) l Neutral or slightly extended wrist (10–20º) l Like holding a can

SUGAR DOUBLE TONG SUGAR TONG SPLINT SPLINT

INDICATIONS INDICATIONS l Distal radius and ulna fractures l Complex and unstable forearm and elbow fractures CONSTRUCTION CONSTRUCTION l Metacarpal heads on the dorsal hand l Forearm splint: as above l Around elbow l Arm splint l End at volar metacarpal phalangeal joints — Start at anterior proximal humerus — Around elbow APPLICATION l End at posterior proximal humerus l Cut hole in stockinette for thumb l Elbow at 90º APPLICATION l Forearm neutral with thumb up l Cut hole in stockinette for thumb l Slightly extended wrist (10–20º) l Elbow at 90º l Forearm neutral with thumb up l Slightly extended wrist (10–20º)

EMRA.ORG | 972.550.0920 RADIAL GUTTER THUMB SPICA SPLINT SPLINT

INDICATIONS INDICATIONS l Fractures and soft tissue injuries of index and 3rd digits l Injuries to scaphoid, lunate, thumb and 1st metacarpal l Fractures of the neck, shaft and base of the 2nd and l Gamekeeper’s/Skier’s thumb 3rd metacarpals l De Quervain tenosynovitis CONSTRUCTION CONSTRUCTION l Starts at mid-forearm l Start at mid-distal phalanx of thumb l Down the radial forearm l End at mid-forearm l End mid-distal phalanx of 2nd and 3rd digits APPLICATION APPLICATION l Cut hole in stockinette for thumb l Cut hole in stockinette and splinting material for the l Cut wedges on both sides of splinting thumb material at MCP joint l Hand in position of function l Forearm in neutral position with thumb l Forearm in neutral position in wineglass position l Wrist slightly extended l MCP 50º of flexion l Proximal interphalangeal and distal interphalangeal joints 5º–10º flexion

ULNAR GUTTER SPLINT

INDICATIONS MALLET FINGER l Fractures and soft tissue injuries of 5th digit l Fractures of the neck, shaft, and base of 4th FINGER SPLINTS and 5th metacarpals CONSTRUCTION INDICATION INDICATION l Mallet Finger l Phalanx fractures l Start at mid-forearm l Tendon repairs l Extend down ulnar forearm CONSTRUCTION l End at mid-distal phalanx l Splint only the distal CONSTRUCTION l Include the 4th and 5th digits interphalangeal joint l Splint across fractured APPLICATION phalanx or repaired APPLICATION tendon l Hand in position of function l Splint distal l Forearm in neutral position interphalangeal joint APPLICATION l Wrist slightly extended in hyperextension l If tendon repair: splint l MCP 50º of flexion l DIP must remain in in flexion or extension, l Proximal interphalangeal and distal interphalangeal continuous extension depending on tendon joints 5–10º flexion for 6–8 weeks repaired l If boxer’s fracture: flex the metacarpal phalangeal joints to 90º

EMRA.ORG | 972.550.0920 POSTERIOR POSTERIOR KNEE SPLINT ANKLE & STIRRUP SPLINTS

INDICATIONS INDICATIONS l Patients with legs too large for knee immobilizer l Grade 2–Grade 3 ankle sprains l Angulated fractures l Fractures of distal fibula and tibia l Injuries that require urgent operative fixation l Reduced ankle dislocations l Can add stirrup splint for unstable ankle fractures CONSTRUCTION l Start just inferior to buttocks crease CONSTRUCTION—POSTERIOR ANKLE l Down the posterior leg l Start at plantar surface of the metatarsal heads l End approximately 6cm above the malleoli l Extend up posterior leg l End at the level of the fibular head APPLICATION l Slightly flexed knee CONSTRUCTION—STIRRUP l Laterally, start 3–4cm below the level of fibular head l Extend under the plantar surface of foot l End at medial and lateral side of leg to just below fibular head APPLICATION l Place with the patient in the prone position l Ankle at 90º l Place posterior ankle splint first

SPLINTING COMPLICATIONS

l Compartment syndrome l Pressure sores, skin breakdown l Ischemia l Infection l Neurologic injury l Dermatitis l Thermal injury l Joint stiffness RESOURCES Boyd A, Benjamin H, Asplund C. Principles of Casting and Splinting. Am Fam Eiff MP, Hatch RL. Fracture Management for Primary Care. Philadelphia, PA: Physician. 2009 Jan 1;79(1):16–22. Elsiver/Saunders, 2012. AUTHOR REVIEWER R. Ian Ross, MD Anna L. Waterbrook, MD, FACEP, CAQ-SM Stanford/O’Connor Hospital, Primary Care Sports Medicine Fellow, 2017 University of Arizona 2016–17 Chair, EMRA Sports Medicine Division Associate Professor, Dept. of Emergency Medicine Member, U.S. Figure Skating Sports Science & Medicine Associate Program Director, South Campus Residency Program Associate Program Director, Sports Medicine Fellowship ILLUSTRATOR Assistant Team Physician, Intercollegiate Athletics Matthew Holt 2016–18 Chair, ACEP Sports Medicine Section Bodyrender

EMRA.ORG | 972.550.0920