Splinting basics

1. Splinting basics

2. Introduction • Selected extremity splinting techniques • Misty Wright, PA-C

3. Topics of Discussion • Upper extremity • Lower extremity • Finger splinting

4. Upper extremity splinting • Volar splints used mostly for sprains of the wrist, tendonitis, or any inflammatory process at the the wrist level. • A Volar splint is placed volarly on the forearm from the palmar crease to the proximal 1/3 forearm, allowing movement of the thumb, and the metacarpal phalangeal joints.

5. Volar splint

6. Velcro splint

7. More UE Splints • A thumb spica splint is a volar splint with the thumb immobilized in neutral, and used for thumb injuries, and suspected scaphoid fractures.

8. Thumb Spica

9. One More UE Splint • The Coaptation splint extends from the axilla medially, and runs laterally around the elbow to the acromioclavicular joint. It is used to immobilize mid to distal humerus fractures. • Sarmiento Fracture cuff- midshaft humerus fractures, circumferential support

11. Coaptation splint

12. Sarmiento fracture brace

13. The Best Upper Extremity Splint • The Sugar tong or stirrup splint for the forearm and wrist goes from the palmer crease, around elbow, and ends at the dorsal MP joints. It prevents pronation/supination of the forearm, and is used for distal radius and forearm fractures.

16. Another Upper Extremity Splint • The posterior splint is used for elbow injuries and fractures, and goes from the proximal 1/3 of the humerus, posteriorly, and can stop at the wrist, or extend to the MP joints, as needed.

18. Posterior Splint

19. Lower Extremity Splints • Short leg splints are used for foot and ankle injuries. • The posterior splint is used for foot and soft tissue injuries, or to prevent equinous contracture. • The three way, trauma, stirrup, or lower extremity sugar tong splint is for ankle joint injuries.

20. Air Splint

23. Components of 3-way

24. Cam Walker Boot

25. Lower Extremity Splints • Any Bony injury above the ankle level should be immobilized with a long leg splint, or knee immobilizer. • Hip Reductions can go in knee immobilizers, or an abduction brace, to prevent re-dislocation.

28. Long leg cast

29. Abduction Pillow

30. Knee Immobilizer

31. Finger Splints • Use stack splints, or malleable metal splints to splint digits in position of comfort or reduction. Splint Mallet, or avulsion fractures in extension, and do not allow the patient to remove.

32. Mallet finger

33. Mallet splint

35. Splinting pitfalls • Do not apply splints too tight. Use Bias wrap for upper extremity splints, and do not stretch elastic when applying ace wrap.

36. Too Much splinting Is not good • Over splinting can lead to stiff joints, and should be avoided. • Adults older than 40 at risk for frozen shoulder/elbow syndromes. • Geriatric patients must be closely monitored for skin breakdown.

37. Questions • Check your splints • Bill for any special applications, molding, and splint checks. - AHCCCS no longer pays for any prefab splints, just FYI.

38. Common fracture patterns Is it broken or fractured?

39. A word about peds fracture patterns

40. Thurston Holland fragment Salter harris fracture- Type 2

41. Supracondylar fracture- Type 1

42. Supracondylar fracture- Type 2

43. Supracondylar fracture- Type 3

44. Common Upper Extremity Fractures

45. Monteggia fracture

46. Galeazzi fracture

47. Scaphoid fracture

48. Terry thomas sign Scapholunate widening

49. Perlinuate dislocation

50. Perilunate dislocation