Equipment
Materials employed in posterior elbow splinting include the following:
-
Stockinette
-
Padding (eg, Webril)
-
Ready-made plaster or fiberglass splinting material (eg, plaster of Paris), eight to 10 sheets, 15 cm wide (10-cm-wide plaster can be used for smaller patients)
-
Bandage or wrap (eg, Bias bandage or Ace wrap), 7.5-10 cm wide
-
Clean, room-temperature water in a basin
-
Trauma shears or a pair of medical scissors without pointed ends
-
Chux pads and bed sheet
-
Tape (if Bias bandage is used) or bandage clips (if non-Velcro Ace wrap is used)
-
Sling
-
Plaster or prefabricated fiberglass splint material (see the image below)
Posterior elbow splinting. Equipment for splint. Image courtesy of Kenneth R Chuang, MD.
Patient Preparation
Anesthesia
Splinting is usually tolerated without the use of anesthesia. However, if significant manipulation or reduction of the injury is required during the splinting process, anesthetic techniques may be used. Acceptable techniques include the following:
-
Administration of a hematoma block or nerve block
-
Procedural sedation with appropriate monitoring and administration by an experienced practitioner [9]
-
Administration of oral or intravenous pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid analgesic agents
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.
Positioning
Place the patient in a comfortable position (eg, seated or reclined). The elbow should be flexed to 90º, the wrist slightly extended at 10-20º, and the forearm in the neutral position with the thumb up.
Cover the patient with a sheet to avoid splatter from the wet plaster (see the image below).
Completely expose the injured limb. Remove any tight-fitting clothing on the affected extremity that would otherwise have to be removed with scissors after the splint is placed. Jewelry should be removed. In particular, rings can cause constriction and ischemia of the fingers with delayed swelling of the soft tissues. If unable to remove a ring, try using soap as a lubricant or consider a ring cutter. (See the image below.)
-
Posterior elbow splinting. Equipment for splint. Image courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Cover patient appropriately. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Remove jewelry and rings to avoid ischemia from swelling. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Stockinette application. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Cotton padding application. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Measuring dry plaster. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Wetting plaster. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Applying wet plaster. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Applying bandage wrap. Video courtesy of Kenneth R Chuang, MD
-
Posterior elbow splinting. Molding of splint. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Testing of neurovascular function and capillary refill. Video courtesy of Kenneth R Chuang, MD.
-
Posterior elbow splinting. Completed splint. Image courtesy of Kenneth R Chuang, MD.
