Background
Splints are primarily used to stabilize injuries to bones until the patient can be evaluated by a consultant, such as an orthopedic surgeon, [1] as well as to achieve immobilization for primary healing or in the preoperative period. All patients with injuries that are splinted should be referred for evaluation by a consultant in a timely fashion (usually within 2-3 days). In general, ankle splints are applied to minimize movement and provide support and comfort by stabilizing an injury at that joint.
Indications
A posterior ankle splint is primarily used for the following injuries:
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High-grade ligamentous sprain of the ankle
Ankle splinting has sometimes been employed for immobilization after operative fixation of an ankle fracture; however, the multicenter Post-operative Ankle Splinting Trial (PAST) did not find routine ankle splinting to add any significant benefit to the postoperative course. [3]
Contraindications
There are no absolute contraindications for ankle splinting. The following conditions demand immediate evaluation or intervention by a consultant (eg, an orthopedic surgeon), in that treatment by splinting alone is inadequate:
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Complicated fracture
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Open fractures
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Injuries with associated neurovascular compromise
Technical Considerations
Anatomy
The ankle joint is a hinged synovial joint with primarily up-and-down movement (plantarflexion and dorsiflexion). However, when the ranges of motion (ROMs) of the ankle and the subtalar joints (talocalcaneal and talocalcaneonavicular) are taken together, the complex functions as a universal joint (see the image below).
The combined movement in the dorsiflexion and plantarflexion directions is greater than 100°; bone-on-bone abutment beyond this range protects the anterior and posterior ankle capsular ligaments from injury. The anterior and posterior ankle capsular ligaments are relatively thin compared with the medial and lateral ankle ligaments.
For more information about the relevant anatomy, see Ankle Joint Anatomy.
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Equipment for splint. Image courtesy of Kenneth R Chuang, MD.
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Position the patient prone, with knee flexed to 90 degrees. Cover the patient appropriately. Video courtesy of Kenneth R Chuang, MD.
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Stockinette application for posterior ankle splint. Video courtesy of Kenneth R Chuang, MD.
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Cotton padding application for posterior ankle splint. Video courtesy of Kenneth R Chuang, MD.
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Measuring dry plaster for posterior ankle splint. Video courtesy of Kenneth R Chuang, MD.
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Wetting the plaster for posterior ankle splint. Video courtesy of Kenneth R Chuang, MD.
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Applying wet plaster for posterior ankle splint. Video courtesy of Kenneth R Chuang, MD.
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Applying bandage wrap for posterior ankle splint. Video courtesy of Kenneth R Chuang, MD.
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Molding the posterior ankle splint. Video courtesy of Kenneth R Chuang, MD.
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Anatomy of the lateral ankle ligamentous complex and related structures.
