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Posterior Long Arm Splinting Technique

  • Author: Lisa Jacobson, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Oct 12, 2015
 

Application of Posterior Long Arm Splint

The posterior long arm splint should extend from the axillary crease to the wrist joint but should not include the metacarpals. It should cover the posterior surface of the arm behind the elbow.[7] The steps in splinting are as follows.

Apply the stockinette like a sleeve over the affected limb (see the video below).

Measuring and placing sleeve.

Wrap the cast padding around the stockinette (see the video below). Use padding that is wider and longer than the plaster (or fiberglass) will be. Apply minimal extra padding to bony prominences and pressure points. Apply in a distal-to-proximal fashion.

Applying cast padding.

Measure the appropriate length of plaster (see the video below). The simplest way to measure is to drape the stockinette over the appropriate part of the upper extremity and cut 5 cm extra on either side. Make the plaster slightly shorter than this template.

Measuring plaster.

Tear 10 sheets of plaster. Submerge the plaster in water until no more bubbles appear. Squeeze the water out by running fingers along the length of the plaster three times. Laminate the plaster by running the palm over the plaster on a flat surface. Lay the plaster onto the padding, and fold the padding over the edges of the plaster (see the video below).

Preparing and applying splint.

Apply the splint to the patient in the desired position. In the application of the splint, positioning depends on the injury. Typically, the posterior long arm splint maintains 90° of flexion at the elbow with neutral forearm and wrist positioning. The elbow, however, may be immobilized between 45° and 90°; the forearm may also be pronated or supinated, and the wrist may be flexed or extended.

Once the splint is in position, secure it with an elastic bandage. The splint is permanently molded within 10 minutes. Recheck the patient’s neurovascular status. Place the patient’s arm in a sling.

Provide appropriate discharge and follow-up instructions. These include instructions on resting, icing, and elevating the injured extremity and on keeping the splint clean and dry. If the patient received any sedation or opioids, advise against driving or alcohol consumption. Arrange timely follow-up in 1-5 days. Provide appropriate pain medication. If itching develops, consider prescribing an antihistamine (eg, diphenhydramine). If the itching persists or worsens, evaluate the splint for complications.

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Complications

Complications of posterior long arm splinting include the following:

  • Thermal burns [8, 9] - Plaster hardens through an exothermic reaction, in which the amount of heat liberated is directly proportional to the setting process, which is based on the water temperature at which the splint is prepared; this reaction can cause burns if extremely hot water is used or if a barrier layer is not placed between the plaster and the patient’s skin
  • Pressure ulcers [8, 10] - This complication can be minimized by applying extra (thin) layers of padding at bony prominences
  • Contact dermatitis [8] - This complication can be minimized by ensuring full coverage of a clean dry extremity with the stockinette and providing adequate padding between the patient’s skin and the splinting material
  • Neurovascular compromise [8] – This complication can be minimized by documenting an intact neurovascular examination both before and after splinting; the patient should be reminded to seek immediate medical attention if he or she notices any decline in function or sensation of the extremity
  • Decreased range of motion - This complication can be minimized by encouraging timely orthopedic follow-up to prevent joint fusion
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Contributor Information and Disclosures
Author

Lisa Jacobson, MD Attending Physician, Department of Emergency Medicine, Washington Hospital Center

Lisa Jacobson, MD is a member of the following medical societies: American College of Emergency Physicians, Physicians for Social Responsibility, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jessica Freedman, MD Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Consulting Staff, Department of Emergency Medicine, Mount Sinai Hospital

Jessica Freedman, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Vaishali Patel, MD Assistant Clinical Professor, Co-director of Quality Assurance/Continuing Quality Improvement, Department of Emergency Medicine, Mount Sinai School of Medicine; Consulting Staff, Department of Emergency Medicine, Mount Sinai Medical Center; Director of ED PAs, Department of Emergency Medicine, Mount Sinai Medical Center

Disclosure: Nothing to disclose.

Suzanne Bentley, MD Assistant Professor, Departments of Emergency Medicine and Medical Education, Elmhurst Hospital, Mount Sinai School of Medicine

Suzanne Bentley, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Womens Association, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Acknowledgements

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Roberts JR, Hedges JR, Chanmugam AS, et al. Splinting techniques. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: Saunders; 2004. chap 51.

  2. Cuomo AV, Howard A, Hsueh S, Boutis K. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?. Pediatr Emerg Care. 2012 Nov. 28 (11):1150-3. [Medline].

  3. Moraleda L, Valencia M, Barco R, González-Moran G. Natural history of unreduced Gartland type-II supracondylar fractures of the humerus in children: a two to thirteen-year follow-up study. J Bone Joint Surg Am. 2013 Jan 2. 95 (1):28-34. [Medline].

  4. Naik AA, Xie C, Zuscik MJ, Kingsley P, Schwarz EM, Awad H, et al. Reduced COX-2 Expression in Aged Mice is Associated with Impaired Fracture Healing. J Bone Miner Res. 2008 Oct 10. [Medline].

  5. Matsumoto MA, De Oliveira A, Ribeiro Junior PD, Nary Filho H, Ribeiro DA. Short-term administration of non-selective and selective COX-2 NSAIDs do not interfere with bone repair in rats. J Mol Histol. 2008 Aug. 39(4):381-7. [Medline].

  6. Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. 2008 Jan. 102(1):10-4. [Medline].

  7. Reichman E, Simon RR, eds. Emergency Medicine Procedures. New York: McGraw-Hill; 2004. chap 68-9, 75-6.

  8. Tintinalli JE, Kelen GD, Stapczynski JS, et al. Injuries to the elbow and forearm. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw Hill; 2004. chap 270.

  9. Halanski MA, Halanski AD, Oza A, Vanderby R, Munoz A, Noonan KJ. Thermal injury with contemporary cast-application techniques and methods to circumvent morbidity. J Bone Joint Surg Am. 2007 Nov. 89(11):2369-77. [Medline].

  10. Halanski M, Noonan KJ. Cast and splint immobilization: complications. J Am Acad Orthop Surg. 2008 Jan. 16(1):30-40. [Medline].

 
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Measuring and placing sleeve.
Applying cast padding.
Measuring plaster.
Preparing and applying splint.
 
 
 
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