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Posterior Long Leg Splinting Technique

  • Author: Suzanne Bentley, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Jul 29, 2015
 

Application of Posterior Long Leg Splint

With the patient in position, measure the proposed splint length, which should extend from the crease of the buttocks to approximately 5-8 cm above the malleoli.[1] Cut the stockinette to the appropriate length, and apply it to the dry, clean lower limb (see the video below).

Measuring and applying stockinette.

Measure the padding and plaster (see the video below). Use padding that is wider and longer than the plaster. The padding should extend over the entire length of the leg (1-3 cm longer than the splint length). Wrap sufficient layers of padding around the stockinette in a distal-to-proximal direction. Apply minimal extra padding to bony prominences and pressure points.

Measuring padding and plaster.

The posterior long leg splint is made with 12-15 layers of plaster. Prepare 12-15 single layers of 6-in. plaster or fiberglass (a smaller width should be used in pediatric patients) of the appropriate length. The plaster strips should be slightly shorter than the template (see above). Submerge the plaster in warm water until no further bubbles appear. Squeeze the water out by running the fingers along the length of the plaster three times. To laminate the splint, run the palm of the hand over the plaster on a flat surface.

Lay the plaster onto the padding in such a way that at least a few centimeters of padding extends underneath the plaster and may be folded over the edges of the plaster. Direct contact between the plaster edge and unprotected skin may result in abrasion and pain. Apply the splint to the posterior leg (see the video below).

Preparing and applying splint.

Once the splint is in position, secure it with elastic wrap in a distal-to-proximal direction. Reexamine the patient. Assess neurovascular status, evaluate patient comfort, and look for any areas of pressure that may require additional padding. Ensure that plaster edges are sufficiently covered with padding. Splints take approximately 10 minutes to set completely; the patient should be instructed not to move the limb during this time.

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Complications

Complications of posterior long leg splinting include the following:

  • Thermal burns [5, 6] - Splinting material 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; to prevent severe burns, use warm water rather than hot or boiling water to moisten the plaster, and be aware that splinting material becomes hotter once wet and during drying
  • Pressure ulcers [5, 7] - This complication can be minimized by applying extra (thin) layers of padding at bony prominences and pressure points
  • Contact dermatitis [5] - 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 [5] - This complication can be minimized by documenting neurovascular status 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 decreased function, improper healing, and joint fusion
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Contributor Information and Disclosures
Author

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.

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.

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.

Specialty Editor Board

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.

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. Chanmugam AS, Chudnofsky CR, Custalow CB, Dronen SC. Splinting techniques. Roberts JR, Hedges J. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: WB Saunders Company; 2003. chap 51.

  2. Arkader A, Warner WC Jr, Horn BD, Shaw RN, Wells L. Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop. 2007 Sep. 27(6):703-8. [Medline].

  3. Gravlee JR, Van Durme DJ. Braces and splints for musculoskeletal conditions. Am Fam Physician. 2007 Feb 1. 75(3):342-8. [Medline].

  4. 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].

  5. Tintinalli JE, Gabor D, Kelen J, Stapczynski S. Initial evaluation and management of orthopedic injuries. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw Hill; 2003. 1657-63.

  6. 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].

  7. 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 applying stockinette.
Measuring padding and plaster.
Preparing and applying splint.
 
 
 
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