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ALL YOU NEED TO KNOW ABOUT SPLINTING Konstantinos Gus Agoritsas, MD.

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Presentation on theme: "ALL YOU NEED TO KNOW ABOUT SPLINTING Konstantinos Gus Agoritsas, MD."— Presentation transcript:

1 ALL YOU NEED TO KNOW ABOUT SPLINTING Konstantinos Gus Agoritsas, MD

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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

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11 GOAL OF A SPLINT IMMOBILIZATION and COMFORT –Decreases pain –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 –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 –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 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

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25 LONG ARM POSTERIOR SPLINT 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

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27 SUGAR TONG Fractures of ForearmDistal 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

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

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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 1 st tail across thenar eminence to distal palmar crease 2 nd tail around thumb

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

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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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