Splinting and Casting

Splint / Cast
– Principle:
 To immobilize / stabilize joint above and joint below the site of injury.

– Objectives:
 To hold broken bone anatomically to prevent malunion.
 To reduce excessive movements to prevent non union.
 Relieves pain.
 To get early function
Splinting
– Lightweight, rigid device
– Immobilizes & maintains a specific position
of a bone or joint
– Metal, plastic, synthetics, Plaster of Paris
– Held on by external binding agents
– Easily removed & reapplied
Casting
– Rigid encasement surrounding fracture area
– Extends on either side of the fracture to
ensure immobility
– Plaster of Paris or synthetic materials, ie,
fiberglass or thermoplastics
– Molds precisely to fit contours
Cast & Splint Materials
– Skin protection:
– cotton or synthetic padding
– Secure the splint:
– straps/gauze/tape/elastic bandages
– applied away from the injured area
Plaster of Paris Splints
– Impregnated bandages
– rolls, precut lengths, slabs
– Advantages
– porous, highly conformable
– inexpensive
– low risk of irritation/allergic dermatitis
– Disadvantages
– radiopaque/heavy/messy to apply
– breaks down when wet
General Principles of Splinting and Casting

– Prior to applying a splint / cast :

– assess skin condition, esp. bony prominences
– assess circulation
– full extent of swelling may take up to 72 hrs.
– explain/demonstrate extremity positioning
– discuss the purpose of the splint & special care
considerations
– provide adequate analgesia
General Principles of Splinting and Casting

– Applying a splint / cast :

– place body part in good functional alignment
– use padding to separate skin surfaces
– do not allow hard splints and casts to end
directly on metacarpal or metatarsal heads
– leave distal end of extremity uncovered, when
possible
Patient Care after Splinting and Casting

– After splint / cast has set, assess patient for:

– Neurovascular status
– Pain
– ROM of nearby unaffected joints
– Circulation
Potential Complications

– Neurovascular Compromise
– Prevent by:
– taking care when splinting & padding over superficial
nerves & arteries
– If pain/pallor/paresthesia/pulselessness develops:
– remove splint or cast
– check motor & sensory function
– monitor distal pulses on affected side
 Potential Complications
– Allergic Reactions:
– Plaster allergies are rare:
– avoid fiberglass in atopic individuals
– Dermatitis-like conditions from:
– synthetic padding
– fiberglass
– Treatment:
– replace synthetics with plaster & cotton padding
Potential Complications
– Pressure Sores:
– Warning signs:
– burning pain
– sleep disturbance
– fever
– recurrent swelling
– offensive odor from splint
– staining of splint
– localized heat on the splint
 Potential Complications
– Instruct patient to seek immediate attention:
– great increase in pain
– change in skin color (blueness or paling)
– coldness
– numbness or tingling
– excessive swelling
– inability to move neighboring joints
Casting Tips

Activation
• Use room temperature water
• Submerge tape
• Squeeze
• Remove

*longer working time = more water

*shorter working time = less water

Weight Bearing
Cast cures to functional strength
in 20 minutes.
Long Arm Splint Indications
– Supracondylar Fractures
– Elbow Sprains/Strains/Dislocations
– Fracture of the Olecranon
– Fracture of the Ulnar Shaft – ‘Night stick’ fracture

Olecranon Fracture
 Long Arm Splint

– measure
– extent: axilla to MCPs
– stockinette & pad
– 10cm or 15cm poP
– elbow at 90 degrees
– apply 2 additional short slabs to
reinforce elbow, medially and
laterally
Long Arm Splint

– quickly mould to contour

– apply pre-soaked retention bandage
– maintain 90 degree elbow angle
– support with sling or collar and cuff
Short arm Splint Indications
– Metacarpal Base Fractures
– Wrist Sprains
– Carpal Tunnel Syndrome
– Triquetral Fractures
– Lunate Fractures
– Hamate Fractures

International Training Module C1

Double Sugar Tong Indications

Distal Radius Fractures Monteggia’s Fracture

Double Sugar Tong
 Humeral Indications

– Midshaft fractures of the humerus

– Distal fractures of the humerus
 U – Slab/Humeral Splint

– humerus in line with body

– elbow at 90 degrees
– palm facing chest
– patient shoulders remain square
– stockinette, pad, felt
– extent: axilla to over acromioclavicular
– fan slab over shoulder
 U – Slab/Humeral Splint

– mould over shoulder for close fit

– apply pre-soaked retention bandage
– support with collar and cuff
– allow arm to hang
– make function and neurovascular checks
Distal Phalanx &Tuft Fractures
– Splinting
∗ Cage splint or Stack splint with DIP
in extension.
∗ F/U in 1-2 weeks. Then an
additional 1-2 weeks in splint until
finger is no longer sensitive
– Subungual hematomas
∗ Decompress
∗ If nail is avulsed, repair any nail
bed lac and replace the nail.
 Below Knee / Short Leg Indications

– Distal Tibia Fractures

– Distal Fibula Fractures
– Ankle Sprains
– Metatarsal Fractures
– Severe Ankle Sprains/Strains
– Non-Displaced Ankle Fractures
– Hairline (Fatigue) Fractures
– Navicular Fractures
– Cuboid and Cuneiform Fractures
 Below Knee/Short Leg Splint

– extent: just below knee to the toes

– allow functional movement of knee and toes
– position is injury dependent, normally 90
degrees at ankle
– stockinette and pad
 Below Knee/Short Leg Splint

– maintain position
– fan out main slab to fit calf area
– cut a medial and lateral slab to reinforce
the ankle
– alternatively cut a stirrup slab to use in
combination
 Below Knee/Short Leg Splint

– mould over malleoli

– ensure slabs do not overlap anteriorly
– apply pre-soaked retention bandage
– hold until initial set is achieved
 Short Arm Cast

– For fracture at distal

radius and ulna
 Short Leg Cast

– For fracture at pedis and ankle

 Thumb Spica Cast

– For fracture at 1st metacarpal and carpal bone

Thank You