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ALL YOU NEED TO KNOW ABOUT SPLINTING

ALL YOU NEED TO KNOW ABOUT SPLINTING. Konstantinos Gus Agoritsas, MD. Initial Approach. ABC’s Evaluate involved limb for: Neurovascular compromise Open fractures/compartment syndrome Fractures with increased risk for significant bleeding- Pelvic/Femur Fxs Consider associated injury

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ALL YOU NEED TO KNOW ABOUT SPLINTING

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  1. ALL YOU NEED TO KNOW ABOUT SPLINTING Konstantinos Gus Agoritsas, MD

  2. Initial Approach • ABC’s • Evaluate involved limb for: • Neurovascular compromise • Open fractures/compartment syndrome • Fractures with increased risk for significant bleeding- Pelvic/Femur Fxs • Consider associated injury • Pain Management • Radiographic evaluation • Splinting

  3. GOAL OF A SPLINT • IMMOBILIZATION and COMFORT • Decreases pain • Prevents further injury • Controls bleeding • Decreases risk of converting a minor injury to a major injury

  4. Indications for Splinting • Not just for Fractures • Sprains • Joint Infections • Tenosynovitis • Lacerations over joints • Puncture wounds and animal bites of the hands and feet

  5. Complications • Neurovascular compromise • Pressure sores • Contact dermatitis

  6. Preparation • Define injury and what splint is required • Splint in position of function • Clean and repair skin lesions prior to splint application • Document neurovascular examination before splint application • Anticipate ability for child to remove clothes after splint is applied

  7. Splinting Equipment • Plaster of paris • Orthoglass • Stockinette • Padding- Webril • Ace wraps

  8. Splinting Materials

  9. Splinting Equipment • Plaster of Paris • Gypsum- calcium sulfate dihydrate • exothermic reaction when wet • warm water faster set but increases risk of burns • Fast drying- 5-8 min to set • Extra fast drying 2-4 min to set thus less time to mold • Can take up to one day to reach maxinum strength

  10. Splinting Equipment • Ready Made Splinting Material • Othoglass (fiberglass) • Cures rapidly (20 min) • Less messy • Stronger, lighter • Less moldable • Stockinette • protects skin, looks nifty • cut longer than splint • several size widths

  11. Padding- Webril • 2-3 layers, more if anticipate lots of swelling • Extra over elbows, heels, and other joints • Be generous over bony prominences • Always pad between digits when splinting hands/feet or when buddy taping • Avoid wrinkles • Do not tighten • Ace wraps

  12. General Principles • Stockinette applied to extend about 2-3 inches beyond plaster • Use opposite arm to measure length. • 2-3 layers of webril are applied and smoothed • Plaster or orthoglass applied • 8-10 layers for UE • 12-14 layers for LE • Ace wrap applied over plaster • Mold the plaster/orthoglass as it dries

  13. RULES OF SPLINTING • Check distal circulation before you splint. • Pad, pad and pad. • Your splint must be long enough, strong and wide ENOUGH. • Immobilize the joints above and below the injury. • Check splint for tightness • Check and document distal pulse, sensation and motor function after splint is applied

  14. Upper Extremity Splints • Sugar tong splint • Ulna gutter splint • Volar splint • Long arm posterior splint • Digit splint • Thumb spica splint

  15. Lower Extremity Splints • Posterior short leg splint • Stirrup splint (Sugar tong) • Knee immobilizer • Long leg splint

  16. Fractures of elbow Fractures of forearm Flex elbow at 90’ Forearm in neutral position Slight dorsiflexion at wrist Distal palmar flexion crease Up ulnar forearm Across olecranon Dorsal mid upper arm Collar and cuff initially LONG ARM POSTERIOR SPLINT

  17. Fractures of Forearm Distal palmar flexion crease to the elbow Elbow to dorsum hand proximal to MCP Must use sling Elbow flexed at 90’ and wrist in neutral position SUGAR TONG

  18. Fractures of 4th and 5th digits (metacarapal and/or proximal phalangeal ) Flex MCP 35-40’(70’) Flex IP 20-30’ Extend wrist 20-30’ ULNAR GUTTER

  19. Fractures of the hand Fractures of fingers Extend wrist 30’ VOLAR SPLINT

  20. Fractures of scaphoid Fractures of thumb Holding a BEER/SODA can Radial forearm 1st tail across thenar eminence to distal palmar crease 2nd tail around thumb THUMB SPICA

  21. Fractures of fingers Flex MCP 90’ Flex PIP 45’ Foam padded aluminum splints Tape to “buddy” and dorsum of hand FINGER SPLINTS

  22. Fractures of the foot Fractures of the ankle Flex ankle to 90’ From level of fibular neck, over the heel of the foot, to the base of the digits May use with a sugar tong splint for more support Posterior Splint Short Leg

  23. Distal femur Proximal tibia/fibula Soft tissue and/or ligament injuries of the knee Below the buttock to the heel of the foot Knee in slight flexion and ankle in neutral position Knee in full extension if knee injury LONG LEG SPLINT

  24. Keep injured limb elevated Apply ice often for the next 36 hrs Keep splint dry Pain management Instructions to return immediately for pain or sensory changes distal to the splint or pain under the splint Provide orthopedic follow up Discharge Instructions

  25. Common Splints in Ped’s Fractures • Pad bony prominences • Use appropriate: • Material • Shape • Size • Not too tight and not too loose • Adequate instructions

  26. Webril roll over stockinette

  27. Splint applied

  28. Ace wrap

  29. Now its time to play!!!!!!

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