Posterior Elbow Splinting Periprocedural Care

Updated: Nov 01, 2017
  • Author: Lynne McCullough, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

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 (can use 10-cm plaster 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 using Bias bandage) or bandage clips (if using non-Velcro Ace wrap)
  • Sling
  • Plaster or prefabricated fiberglass splint material (see the image below)
Equipment for splint. Image courtesy of Kenneth R Equipment for splint. Image courtesy of Kenneth R Chuang, MD.
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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 [8]
  • 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).

Cover patient appropriately. Video courtesy of Kenneth R Chuang, MD.

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.)

Remove jewelry and rings to avoid ischemia from swelling. Video courtesy of Kenneth R Chuang, MD.
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