1. ALL YOU NEED TO KNOW ABOUT SPLINTING
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

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 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

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

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!!!!!!