MANAGEMENT SPLINTING AND CASTING

FOR LOWER EXTREMITIES

Bambang Gunawan, MD
ANATOMY
Lower Extremity Injuries
• Femoral shaft fracture
• Knee liggaments injury
• Patellar fracture
• Tibial plateau fracture
• Tibial shaft fracture
• Ankle fracture
• Ankle joint injury
• Foot fracture
Fracture Management

•4R:
• Recognition
• Reduction
• Retaining
• Rehabilitation
Splinting
Why do we need to do splinting ?

• To prevent displacement of fracture fragments or joints.

• To decrease the risk of soft tissue injury surrounding the
fracture site or joint.
• To reduce the bleeding and swelling.
• To prevent shock condition.
• To reduce pain.
Types of Splinting
• Rigid splint
• Traction splint
• Circumferential splint
• Improvisation splint
How do you splint the patient ?
• Personal Protective Equipment
• Manual stabilization before splinting
• Do not put the protruding bone fragment back to the
wound.
• Remove all the clothes and accessories before applying
the splint.
• Pressure bandage on an open fracture wound.
• Splinting across the proximal and distal joint.
How do you splint the patient ?
• Joint dislocation  fixate the distal and proximal bones.
• Blood circulation disturbances  realign before
splinting and check the pulse.
• Protect the prominent bones with padding.
• Check the pulse before and after application of the
splint.
• Support and relaxing the patient.
Slab application by using POP
• Hold the injured leg position by the assistant.
• Measure the length of POP is needed.
• Prepared the thickness of the POP around 8-12 layers.
• Immerge it into the water until all of the POP is wet.
• Make sure all of the POP layer is merging.
• Put some layer of padding to protect the skin.
• Apply the POP to the leg and bandage it by elastic
bandage.
• Contour it following the shape of the skin surface.
• Keep the position of the leg until the POP is dry.
Splinting complications
• Pressure to the nerve, vessels and other soft tissue.
• If the fixation is not stable enough, the edge of the bone
fragments can injured the surrounding tissue.
• Ischemia or decreasing blood supply if the bandage is too
tight.
• Time of transportation become longer if the splinting
process is to slow.
 BG, Splinting BSN,Hyatt 26.4.08 11

Circulation problems
Splinting and Casting for
Lower extremities
• Below knee slab
• Below knee cast
• Patellar tendon bearing cast
• Cylinder cast
• Long leg cast
• Spica cast
Splinting

12/05/2021 13
Immobilizations !

12/05/2021 14
 BG, Splinting BSN,Hyatt 26.4.08 15

Lower Leg Splint

Materials and Instrumentations
• POP or fiberglass cast ~ sizes and amount
• Padding
• Stockinet
• Water
• Rubber mat
• Scissors
• Elastic bandage

• Assistant
POP vs fiberglass
Lower Leg Splint application
LOWER LEG CAST
BELOW KNEE CAST
PTB CAST
LONG LEG CAST
WINDOW in a CAST
 BG, Splinting BSN,Hyatt 26.4.08 24

Summary
• Splinting is a procedure to immobilize part of the body that injured so
it can reduce the pain, further injuries and its complications.

• Application of the splint should done in a correct way to give a good

immobilization and safety.

• Evaluation of neurovascular condition before and after the procedure

are very important to prevent the disturbances.

• Understanding and also practicing the skill will give competency

in helping the injured people.
Thank you