Splinting

Original Editor - Shwe Shwe U Marma Top Contributors - Shwe Shwe U Marma, Naomi O'Reilly, Nikhil Benhur Abburi, Tarina van der Stockt, Kim Jackson, Amanda Ager and Lucinda hampton

Introduction

Arm Splint

A splint is a rigid support made from metal, plaster, or plastic. It's used to protect , support, or immobilize an injured or inflamed part of the body.

Purpose

Splints have various purposes. Including:

• Immobilization

• Support to Promote Healing
• Positioning or supporting during function
• Pain Relief
• Substitute for Weak Muscles
• Prevention and Correction of Contracture & Deformity
• Restoration or Maintenance of Range of Motion
• Edema Control

Different Types of Splints

Thomas's Splint

Splints are classified based on the movement permissible as

• Static
• Dynamic
• Serial Static
• Static Progressive

Regional Splints

1. Splints for Upper Extremity

Table.1 Splints for Lower Extremity

Region	Type of Splint
Ulnar Side of Hand	Ulnar Gutter Splint
Radial Side of Hand	Radial Gutter Splint
Thumb, First Metacarpal, and Carpal Bones	Thumb Spica Splint
Finger Injuries	Buddy Taping Aluminium U-shaped Splint Dorsal Extension-block Splint Mallet Finger Splint Mallet finger splint
Wrist / Hand	Volar/dorsal forearm splint Short arm cast
Forearm	Single Sugar-tong Splint
Elbow, proximal forearm, and skeletally immature wrist injuries	Long Arm Posterior Splint Long Arm Cast Double Sugar-tong Splint

2. Splints for Lower Extremity

Table.2 Splints for Lower Extremity

Region	Type of Splint
Ankle	Posterior Ankle Splint Stirrup Splint Ankle Stirrup Splint
Lower Leg, Ankle and Foot	Short Leg Cast
Knee and Lower Leg	Posterior Knee Splint
Foot	Short Leg Cast with Toe Plate Extension

Indications of Splinting

Swollen sprained ankle, an indication for splinting

Splints are used to immobilize musculoskeletal and nerve injuries, support healing, and to prevent further damage. The indications for splinting are broad, but commonly include:

• Temporary stabilization of acute fractures, sprains, strains or nerve injuries before further evaluation or definitive operative management
• Immobilization of a suspected occult fracture (such as a scaphoid fracture)
• Severe soft tissue injuries requiring immobilization and protection from further injury
• Definitive management of specific stable fracture patterns
• Peripheral neuropathy requiring extremity protection
• Partial immobilization for minor soft tissue injuries
• Treatment of joint instability, including dislocation

Contraindications of Splinting

No specific contraindications to splinting exist. However, certain injuries and patient-specific co-morbidities require special attention:

• Injuries that Violate the Skin or Open Wounds:
  • Antibiotic administration should be considered for these patients depending on the severity of the lesion. These patients also require additional soft tissue care, which may necessitate tissue debridement and skin closure before splint application.
• Injuries that Result in Sensory or Neurological Deficits:
  • The complications of splint placement such as compartment syndrome, pressure injuries, or malreduction may go unnoticed if the patient has a concurrent nerve injury. These patients should undergo evaluation by a surgeon before splint application as neurologic findings may be a sign of a surgical emergency.
• Injuries to the Vasculature:
  • This requires special attention by vascular surgeons, as these may require urgent operative intervention. Furthermore, evaluation of the vasculature is essential both before and after splint application, as the reduction of some fractures may result in acute arterial injury or obstruction if trapped between the fracture fragments.
• Patients with Peripheral Vascular Disease or Peripheral Neuropathy:
  • Special care should be taken when applying lower extremity splints in these patients since their baseline sensation may be altered. These patients have difficulty detecting pressure sores, skin irritation, and possible vascular compromise.

Side Effects of Splinting

• Excessive use of splints can lead to chronic pain, stiff joints or weak muscles
• Skin irritation
• Discomfort

Advantages of Splinting

Splint use offers many advantages over casting.

• Splints are faster and easier to apply.
• They may be static (i.e., prevent motion) or dynamic (i.e., functional; assist with controlled motion).
• Splints are non-circumferential, allowing for natural swelling that occurs during the initial inflammatory phase of the injury.
• A splint may be removed more easily than a cast, allowing for regular inspection of the injury site.

Disadvantages of Splinting

Disadvantages of Splinting include;

• Poor Patient Compliance
• Excessive Motion at the Injury Site
• Limitations in their usage, as in unstable or potentially unstable fractures

Complications of Splinting

Compartment Syndrome

• Compartment Syndrome
• Ischemia
• Heat Injury
• Pressure Sores and Skin Breakdown
• Edema
• Infection
• Dermatitis
• Joint Stiffness
• Altered Range of Motion
• Decreased Strength
• Altered Sensation
• Neurological injury

Considerations for Effective Splinting

• Creases provide for landmarks in splint fabrication
• Bony prominences may cause pressure
• Ensure three points of pressure
• Custom made splints to fit the contours of the body rather than ready-made splints
• Patient education for better compliance