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Splinting

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. Tell patients and family that.

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Splinting

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  1. Splinting • Dan Hirsh, MD • Emory PECC Orientation • June 19, 2008 Hughes Spalding Children’s Hospital

  2. A splint is a non-circumferential immobilization device to treat fractures, lacerations of skin or tendon, and sprains.

  3. Tell patients and family that • Splint material will get warm when it hardensFiberglass 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)

  4. Stockinette Ace wrap Webril / wadding

  5. 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

  6. Use cold water May use NO water, just ambient humidity (this will take much longer to harden) Hot water will cause the fiberglass to harden very quickly If you use water, keep padding as dry as possible

  7. Protect the skin. If cotton padding is wet, dry it.

  8. 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.

  9. 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.

  10. Keep joint in a protective position. Keep hand slightly extended at the wrist, ‘thumb-up’, fingers curved around an object

  11. 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

  12. “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

  13. “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

  14. “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

  15. “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

  16. “Thumb Spica” • Non-displaced fractures of 1st metacarpal bone, proximal phalanx of thumb, scaphoid fracture • Length: nail base to proximal forearm

  17. “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

  18. “Buddy Tape” • Padded metal strip may go dorsal or volar

  19. “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

  20. Sugar Tong & Stirrup Long Arm & Short Posterior leg Thumb Spica Volar

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