Splinting Dan Hirsh, MD Emory PECC Orientation June 19, 2008 Hughes Spalding Children’s Hospital.
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Transcript of Splinting Dan Hirsh, MD Emory PECC Orientation June 19, 2008 Hughes Spalding Children’s Hospital.
Splinting
• Dan Hirsh, MD• Emory PECC Orientation• June 19, 2008
Hughes Spalding
Children’s Hospital
A splint is a non-circumferential immobilization device to treat fractures, lacerations of skin or
tendon, and sprains.
Complications Prevention
Risk of ischemiaCompartment Syndrome
Possible neurovascular compromise
Keep splint snugCheck distal neurovascular status
after placement
Skin breakdown
Keep splint dryUse minimal water necessary and dry
thoroughly before placement
Use paddingAvoid ‘kinks’
Pain or Ineffective Immobilization
Check splint after placement
If either of these too, replace the splint
Tell patients and family that•Splint material will get warm when it hardens
Fiberglass cures in :
~15 minutes with ambient humidity
~5 minutes with cold water
~1 minute with warm water•Should be snug, not tight (fingers shouldn’t tingle)
Ace wrapAce wrap
Webril / Webril / waddingwadding
Stockinette
Optional: Apply stockinet to extremity
Extend it past the proximal and distal ends of where the splint will
end
Cut out any areas that bunch up that could damage the skin
Create thumb hole
Hot water will cause the fiberglass to harden very
quickly
Use cold water
May use NO water, just ambient
humidity (this will take much longer to
harden)
If you use water, keep padding as dry as possible
Protect the skin. If cotton padding is
wet, dry it.
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.
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.
Keep joint in a protective position.
Keep hand slightly extended at the wrist,
‘thumb-up’, fingers curved around an
object
Discharge Instructions• Make sure neurovascular intact & in not pain from splint• Elevate, ice & rest injured extremity• Keep splint dry• Splints are non/partial weight bearing, use crutches• If fingers become tingly or blue, re-wrap the bandage • If splint hurts, or there is increasing pain, TAKE THE SPLINT
OFF! Seek medical attention
• “Posterior Arm”• Used for stable elbow injuries• Width: ½ arm circumference• Length: dorsal aspect of mid-
upper arm down ulnar side to distal palmer flexion crease
• “Sugar Tong”• Can be applied both proximally or
distally or both at the same time• When in doubt, use the sugar tong• Width: slightly overlap radial and
ulnar edges of arm• Length: dorsal aspect of knuckles
around elbow to volar palmer flexion crease
• Can place patient prone for easy installation• Must keep arm in 90° flexion• Don’t let the splint slide up or down
• “Gutter”• Metacarpal and/or proximal
phalnageal fractures• Ulnar immobilizes 5th & 4th digits,
radial 2nd & 3rd • Width: wrap to midline of hand on
dorsal and volar surfaces• Length: nail base to proximal forearm
• “Volar”• Distal forearm or wrist
fractures• Don’t use in small children• Width: fully cover volar
aspect of forearm• Length: from proximal
fingers to proximal forearm
• “Thumb Spica”• Non-displaced fractures of
1st metacarpal bone, proximal phalanx of thumb, scaphoid fracture
• Length: nail base to proximal forearm
• “Posterior Leg”• Distal Tibia and/or fibula
injuries, ankle, foot• Width: at least ½ leg
circumference, but NON-circumferential
• Length: level of fibular neck to base of digits
• Shape splint into neutral position, 90° flexion
• These are partial/non weight bearing splints
• “Buddy Tape”• Padded metal strip
may go dorsal or volar
• “Stirrup”• Provides lateral support, may
use with Posterior Leg splint for added stability (aka Cadillac Splint)
• Width: at least ½ leg circumference, but NON-circumferential
• Length: level of fibular head around heel and back up the leg
• Shape splint into neutral position, 90° flexion
• These are partial/non weight bearing splints
Thumb Spica
Volar
Long Arm & Short
Posterior leg
Sugar Tong & Stirrup