Splinting 101

Carl Kaplan, MD
Assistant Professor of Clinical Pediatrics and Emergency Medicine
Stony Brook University School of Medicine
Overview


Basic principles


Materials


Types of splints


Aftercare
Basic Principles


Indications

Immobilization of acute orthopedic fractures or dislocations


Immobilization of ligamentous or tendinous injuries


Immobilization of wounds near mobile joints
Basic Principles


Joint proximal/Joint distal immobilization


Avoid compartment syndrome


Avoid pressure necrosis


Properly address underlying wounds
Materials


Cast padding (Webril) 
Shears


Splinting material 
Cloth tape


Fiberglass, Plaster, Aluminum/Foam, 
Water (as needed for activation of
etc... certain materials)


Elastic wrap (ACE, Coban) 
Assistance
Short Arm Splints

Hand - Position of function (neutral position)


25-30 degrees wrist extension


60-90 degrees MCP flexion


10-30 degrees PIP flexion


5-15 degrees DIP flexion
Volar Splint


Indications


Single forearm bone buckle (torus) fracture


Multiple Metacarpal fractures


Wrist Sprain
Radial Gutter Splint


Indications


2nd or 3rd Metacarparpal fractures or dislocations


Significant 2nd or 3rd Proximal phalanx fractures


Known or suspected tendon injuries of 2nd or 3rd digits
Ulnar gutter splint


Indications


4th or 5th Metacarparpal fractures or dislocations


Significant 4th or 5th Proximal phalanx fractures


Known or suspected tendon injuries of 4th or 5th digits
Gutter splints
Thumb Spica splint


Indications


Thumb fractures or dislocations


Thumb sprains or tendon injuries


Suspected scaphoid (navicular) fractures
Finger splints


Buddy Taping or Aluminum/Foam


Indications


Phalangeal fractures


PIP or DIP dislocations


Sprains


Tendon injuries (Aluminum/Foam only)
Long Arm splints


Sugar Tong (ST) or Posterior (P)


Indications


Radius or Ulna fractures of forearm (ST)


Dislocations at wrist (ST) or elbow (P)


Distal humerus fractures (P)
Sugar tong splint
Posterior long arm splint
Short leg splints


Indications


Select distal Tibia and Fibula fractures


High grade ankle sprains


Achilles tendon injuries


Mid-foot or metatarsal fractures
Posterior Short Leg splint
Stirrup or ‘U’ splint
Combination short leg splint
Posterior Long Leg splint


Indications


Tibia or Fibula fractures or dislocations


Patella fracture, dislocation, or tendon injuries


Distal Femur fractures
Aftercare

Rest, Ice, Elevation (2-3 days)


Loosen splint if paresthesias or digital color changes develop


Analgesia


Crutches or Slings as indicated


Do not get wet


Arrange follow up
Documentation (Fracture/ Dislocation
Procedure *ED)
Questions???