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ALL YOU NEED TO KNOW ABOUT SPLINTING. Konstantinos Gus Agoritsas, MD. 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 - PowerPoint PPT Presentation
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ALL YOU NEED TO KNOW ABOUT SPLINTING
Konstantinos Gus Agoritsas, MD
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
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
Indications for Splinting
• Not just for Fractures
• Sprains
• Joint Infections
• Tenosynovitis
• Lacerations over joints
• Puncture wounds and animal bites of the hands and feet
Complications
• Neurovascular compromise
• Pressure sores
• Contact dermatitis
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
Splinting Equipment
• Plaster of paris
• Orthoglass
• Stockinette
• Padding- Webril
• Ace wraps
Splinting Materials
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
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
• 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
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
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
Upper Extremity Splints
• Sugar tong splint
• Ulna gutter splint
• Volar splint
• Long arm posterior splint
• Digit splint
• Thumb spica splint
Lower Extremity Splints
• Posterior short leg splint
• Stirrup splint (Sugar tong)
• Knee immobilizer
• Long leg splint
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
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
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’
VOLAR SPLINT
• Fractures of the hand• Fractures of fingers
• Extend wrist 30’
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
FINGER SPLINTS
• Fractures of fingers • Flex MCP 90’• Flex PIP 45’• Foam padded
aluminum splints• Tape to “buddy” and
dorsum of hand
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
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
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
Common Splints in Ped’s Fractures
• Pad bony prominences• Use appropriate:
– Material
– Shape
– Size
• Not too tight and not too loose
• Adequate instructions
Webril roll over stockinette
Splint applied
Ace wrap
Now its time to play!!!!!!