Splinting techniques are used to treat musculoskeletal system abnormalities. The main indications for splinting are to temporarily immobilize a limb for pain and spasm, to decrease swelling, and to minimize further potential soft tissue or neurovascular injuries associated with contusions, sprains, lacerations, fractures, dislocations, or painful joints due to inflammatory disorders. [1, 2, 3, 4]
Indications for splinting include the following:
Temporary immobilization of sprains, fractures, and reduced dislocations
Control of pain
Prevention of further soft tissue or neurovascular injuries
There are no absolute contraindications to the use of splints in the emergent setting or in the field to stabilize for transport. For use as a temporary immobilizing device either until follow-up (eg, for stable fractures) or until definitive treatment can be performed (eg, ankle fractures), relative contraindications include the following:
Use either 3- or 4-inch rolls. Measure the length necessary to immobilize the limb from the rolls and keep layering until approximately 12-15 layers thick. Measure a slightly longer splint out of cotton cast padding that is approximately 3-4 layers thick.
Alternatively, the limb could be circumferentially wrapped with cotton cast padding to achieve proper padding. However, there is a potential risk of compartment syndrome with any circumferential padding, so the extremity needs to be carefully monitored. If compartment syndrome is suspected, the splint must then be opened down through the circumferential padding.
Wet the stack of plaster splints thoroughly and wring out excess water. Place the wet plaster on the cotton cast padding splint and apply to the limb with the padding side facing the patient’s skin. Next, wrap with cotton cast padding over the plaster to hold the splint in place and avoid adherence to the elastic bandage wrap. Overwrap the whole splint with an elastic bandage.
Forearm splints should go up to the metacarpophalangeal joint, allowing full mobility of the fingers. Ankle splints should go no higher than at least 4 inches below the fibular head to avoid peroneal nerve injury.
The advantages to using plaster rolls include correct sizing and fit in each case, but a potential disadvantage is the time involved in rolling out the material and cotton cast padding.
Plaster strips are manufactured precut splint sheets of varying lengths and widths. The common dimensions used in emergency rooms and clinics are 15 × 3 inches, 15 × 4 inches, 30 × 4 inches, and 30 × 5 inches.
Plaster strips are easily conformable to the limb being immobilized. The only disadvantage is a potential deficiency of material for a large or tall individual. Excess material for a petite individual can easily be fixed by tearing out the excess.
For prepadded fiberglass splints, first cut out a strip of premeasured length. Make sure to reseal the edge or the material will dry out. Wet the strip and wring out excess water. Apply to limb and overwrap with an elastic bandage. See the images below.
These splints are quick to apply, with the padding already built into the splint material. However, they are not easily conformable to the limb. In addition, the edges can be raw if the cut is not made carefully and edges well padded.
Use prefabricated splints as directed by the manufacturer for the intended body part (see the image below).
These splints are quick and easy to use, but availability and cost may be issues. They also are not intended for use with manipulated fractures or dislocations because they are one-size-fits-all splints and are not customizable.
Hare Traction Splints
Hare traction splints are used in the field or emergency room for stabilization of femur fractures or subtrochanteric hip fractures and for transport to centers for definitive care. The device has a traction unit at the ankle that should be applied first, before placement of the actual splint under the patient.
Tighten the uppermost strap, taking care to pad the greater trochanter well. The traction is now applied to the ankle strap and slowly increased until the proper length is achieved. This can be estimated by the restoration of length comparable to the contralateral side or more normal size of the thigh if there are bilateral injuries.
Make sure to avoid placing too much traction by ensuring that the toe circulation is intact. This can be done by having the patient move the toes comfortably; in an obtunded patient, check for capillary refill and distal circulation. When satisfied with the amount of traction, tighten the remaining straps.