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Presentation on theme: "ALL YOU NEED TO KNOW ABOUT SPLINTING"— Presentation transcript:

Konstantinos Gus Agoritsas, MD



4 Initial Approach ABC’s Evaluate involved limb for:
Neurovascular compromise Open fractures/compartment syndrome Fractures with increased risk for significant bleeding- Pelvic/Femur Fxs Consider associated injury Pain Management Radiographic evaluation Splinting

5 SH 1 fracture with tenderness at distal radius..
Seperation of metaphysis from the epiphysis and dx is difficult without displacement Benign Little chanve of growth disturbance When radiographs are neg, but there is tenderness at physism,you must treat as a SH1 and immobilize and follow up.

6 Salter Harris II Transverse fracture of Ulna with 15 degrees angulation apex radial (lateral) Most common Good prognosis

7 Slater III Juvenile Tillaux External rotation of foot yields avulsion of the anteriolateral corner of the tibia by the anterior tibiofibular ligament. Intraarticular Anatomic position must be reestablished Increased incidence of growth disturbance, altered joint mechanics, and functional disability so must consult orthopedics

8 Salter Harris IV Intraarticular Anatomic position must be reestablished Increased incidence of growth disturbance, altered joint mechanics, and functional disability so must consult orthopedics

9 9 yr old supracondylar type 3 with posterior displacement
Where is the fracture? What type? Ant/Posterior


Prevents further injury Controls bleeding Decreases risk of converting a minor injury to a major injury

12 Indications for Splinting
Not just for Fractures Sprains Joint Infections Tenosynovitis Lacerations over joints Puncture wounds and animal bites of the hands and feet

13 Complications Neurovascular compromise Pressure sores
Contact dermatitis

14 Preparation Define injury and what splint is required
Splint in position of function Clean and repair skin lesions prior to splint application Document neurovascular examination before splint application Anticipate ability for child to remove clothes after splint is applied

15 Splinting Equipment Plaster of paris Orthoglass Stockinette
Padding- Webril Ace wraps

16 Splinting Materials

17 Splinting Equipment Plaster of Paris Gypsum- calcium sulfate dihydrate
exothermic reaction when wet warm water faster set but increases risk of burns Fast drying- 5-8 min to set Extra fast drying 2-4 min to set thus less time to mold Can take up to one day to reach maxinum strength

18 Splinting Equipment Ready Made Splinting Material Stockinette
Othoglass (fiberglass) Cures rapidly (20 min) Less messy Stronger, lighter Less moldable Stockinette protects skin, looks nifty cut longer than splint several size widths

19 Padding- Webril Ace wraps
2-3 layers, more if anticipate lots of swelling Extra over elbows, heels, and other joints Be generous over bony prominences Always pad between digits when splinting hands/feet or when buddy taping Avoid wrinkles Do not tighten Ace wraps

20 General Principles Stockinette applied to extend about 2-3 inches beyond plaster Use opposite arm to measure length. 2-3 layers of webril are applied and smoothed Plaster or orthoglass applied 8-10 layers for UE 12-14 layers for LE Ace wrap applied over plaster Mold the plaster/orthoglass as it dries

21 RULES OF SPLINTING Check distal circulation before you splint.
Pad, pad and pad. Your splint must be long enough, strong and wide ENOUGH. Immobilize the joints above and below the injury. Check splint for tightness Check and document distal pulse, sensation and motor function after splint is applied

22 Upper Extremity Splints
Sugar tong splint Ulna gutter splint Volar splint Long arm posterior splint Digit splint Thumb spica splint

23 Lower Extremity Splints
Posterior short leg splint Stirrup splint (Sugar tong) Knee immobilizer Long leg splint

24 9 yr old supracondylar type 3 with posterior displacement
Where is the fracture? What type? Ant/Posterior

Fractures of elbow Fractures of forearm Flex elbow at 90’ Forearm in neutral position Slight dorsiflexion at wrist Distal palmar flexion crease Up ulnar forearm Across olecranon Dorsal mid upper arm Collar and cuff initially


27 SUGAR TONG Fractures of Forearm
Distal palmar flexion crease to the elbow Elbow to dorsum hand proximal to MCP Must use sling Elbow flexed at 90’ and wrist in neutral position

28 14 yr old with Boxers Fracture

29 ULNAR GUTTER Fractures of 4th and 5th digits (metacarapal and/or proximal phalangeal ) Flex MCP 35-40’(70’) Flex IP 20-30’ Extend wrist 20-30’


31 VOLAR SPLINT Fractures of the hand Fractures of fingers
Extend wrist 30’

32 THUMB SPICA Fractures of scaphoid Fractures of thumb
Holding a BEER/SODA can Radial forearm 1st tail across thenar eminence to distal palmar crease 2nd tail around thumb

33 FINGER SPLINTS Fractures of fingers Flex MCP 90’ Flex PIP 45’
Foam padded aluminum splints Tape to “buddy” and dorsum of hand



36 Posterior Splint Short Leg
Fractures of the foot Fractures of the ankle Flex ankle to 90’ From level of fibular neck, over the heel of the foot, to the base of the digits May use with a sugar tong splint for more support

37 LONG LEG SPLINT Distal femur Proximal tibia/fibula
Soft tissue and/or ligament injuries of the knee Below the buttock to the heel of the foot Knee in slight flexion and ankle in neutral position Knee in full extension if knee injury

38 Discharge Instructions
Keep injured limb elevated Apply ice often for the next 36 hrs Keep splint dry Pain management Instructions to return immediately for pain or sensory changes distal to the splint or pain under the splint Provide orthopedic follow up

39 Common Splints in Ped’s Fractures
Pad bony prominences Use appropriate: Material Shape Size Not too tight and not too loose Adequate instructions

40 Webril roll over stockinette

41 Splint applied

42 Ace wrap

43 Now its time to play!!!!!!


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