Posterior Long Arm Splinting Periprocedural Care

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

Equipment

Equipment employed in posterior long arm splinting includes the following:

  • Bucket
  • Water source
  • Cast padding (eg, Webril [Covidien, Mansfield, MA]) that is wider and longer than the casting material used
  • Plaster or fiberglass casting material (~10 layers of plaster are recommended for upper-extremity splints)
  • Stockinette
  • Elastic bandage (eg, Ace wrap)
  • Sling
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Patient Preparation

Anesthesia

Ensure adequate analgesia for the patient throughout the splinting procedure and afterward. Patients often experience significant improvement in pain symptoms after a splint is placed. With the administration of any analgesic agent or the initiation of a formal sedation protocol, care should be taken to avoid oversedation. A complete neurovascular examination should be performed before and after the splint has been applied.

Acceptable analgesic techniques include the following:

  • Administration of a hematoma block or nerve block
  • Procedural sedation, administered by an experienced practitioner with appropriate monitoring in place
  • Administration of oral or intravenous (IV) pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid analgesic agents

Controversy exists regarding whether NSAIDs delay bone healing. [4, 5] To date, studies have been inconclusive on this point; however, most orthopedists and emergency medicine practitioners continue to use NSAIDs in the treatment of fractures. Because of the potential risk of delayed healing and other complications, the clinician may want to choose non-NSAID analgesics in cases of confirmed fractures.

In 2008, Vuolteenaho et al noted that “the clinical significance of the effect in various patient groups needs to be carefully assessed and further investigations are needed to characterize the patients at the highest risk for NSAID-induced delayed fracture healing and its complications. In the meantime, use of NSAIDs in fracture patients should be cautious, keeping in mind the benefits of pain relief and inhibition of ectopic bone formation on one hand, and the risks of non-union and retarded union on the other hand.” [6]

Positioning

Prepare the patient. Remove all jewelry and clothing on the affected extremity. Place the patient in a comfortable position. Drape the patient with a sheet to ensure cleanliness. Completely expose the affected limb.

Complete and document a thorough examination both before and after splinting. Document the neurovascular examination, as well as the wound/skin examination.

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