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, etc... Elastic wrap (ACE, Coban) Shears Cloth tape Water (as needed for activation of certain materials) 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???