Posterior Long Leg Splinting Technique

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).

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.

The posterior long leg splint is made with 12-15 layers of plaster. Prepare 12-15 single layers of 6-in. (15-cm) 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).

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.

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 injuries ^{[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