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Orthopedic splinting

This power point slide show is developed for the sole purpose to assist in providing a basic education to orthopedic splint application and identification of the various splints as well as their uses. This is particularly helpful when a hands-on approach is taken during each graphic illustration and is demonstrated via a live setting with appropriate materials available. This slide show illustration is also designed to educate the learner on various types of splinting materials, splint padding and patient preparation as well as instruct them at a very basic level to the hazards of inadequately applied splints.

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Orthopedic splinting

  1. 1.  Purpose of splinting  Pre-splinting Requirements  Selecting the appropriate splint  Type of splinting material  Where the splint is to be placed  Type of injury  Hands-on splinting  Short arm thumb-spica splint  Short arm radial gutter splint  Short arm volar splint  Short arm sugar tong splint  Long arm posterior splint  L and U splint (TriPod)  Instructor demos  Short arm fiberglass cast  Bulky Jones MAC splint
  2. 2.  Attain a basic knowledge as to what orthopedic injury gets what type of splint  Develop an understanding of proper splint application to avoid the hazards associated with improper splinting technique(s)
  3. 3.  Demonstrate an understanding of learned objectives as to which splint goes to which injury by  giving correct answers to questions asked by your presenters  Demonstrate learned objectives with a hands-on (beginners level) application of upper and lower extremity splinting  Show an ability to discern the difference between a splint with appropriate padding and placement vs. one that would cause irritation through improper application
  4. 4.  A splint should be defined as an object or body part that is utilized to support or immobilize an injured limb or other body part.  A splint can be premanufactured or custom fabricated with material that is rigid or semi- rigid in design and have in it’s construction some sort of softer padding that will be a barrier between the skin and splint to prevent further injury, chafing or other discomfort.
  5. 5. Some examples of immediate action splints utilizing available materials:
  6. 6.  To provide immobilization to the injured area  To protect the injured area  To prevent further injury  To help reduce pain  To provide a means for the injury to have room for swelling  To offer a sense of security
  7. 7.  Introduce yourself to your patient; try to build a rapport  Inspect circulation  Check for neurovascular continuity  Use the 5 P’s (pain, pallor, pulse, paresthesia, paralysis)  Treat wounds and slow/stop any bleeding  Remove jewelry!  Ideally, if the injury is an acute fracture, immobilize the joint proximal to the injury and the joint distal the injury (if possible)  Before application of splint, gather ALL materials first!  Don’t leave your patient alone to go get more stuff!  Give the patient a brief description of the process and what to expect. If you leave them anxious, you may be picking them up off the floor.
  8. 8.  Upper Extremity Splints  Volar splint  Thumb Spica splint  Radial Gutter splint  Ulnar Gutter splint  Short Arm Sugar Tong splint  Long Arm Double Sugar Tong splint  Long Arm Posterior splint  Coaptation splint  Lower Extremity Splints  Short Leg Posterior splint  Short Leg L and U splint  Long Leg Posterior splint  Long Leg Posterior w/ Medial and Lateral Slabs
  9. 9. The Rigid Dressing Materials:  Plaster of Paris  Casting tape roll  Pre-cut splinting slabs  Fiberglass  Casting tape roll  Pre-cut splinting slabs Soft Underpadding:  Synthetic cast padding  Cotton Webril  Stockinette Overwrap:  Bias-cut stockinette  ACE bandage  CoBan
  10. 10. The Volar Splint a.k.a. Carpal Tunnel Splint, Cock-up Splint (non- DME) and Wrist Splint Application/Location: Applied on volar aspect of the arm and circumvents the thumb proximally to the Thenar eminence, proximally approaches both the proximal and distal palmer creases and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees. Utilization: Used for wrist sprains/strains and fractures, post-surgical fracture repairs as well as carpal tunnel releases. With appropriate splint modification, this splint can be used to treat metacarpal and phalangeal issues as well. Thoughts before application: Is this a removable or non-removable splint? Will this splint need a modification? If so, what? Is this for treating a patient for an initial injury or is this for post-operative treatment?
  11. 11. The Thumb Spica Splint Also known as Radial Gutter Spica Splint Application/Location: Applied on radial aspect of the arm and includes the thumb from its most distal tip and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees and thumb in direct opposition of the index finger (as if holding a soda can). Utilization: Used for thumb sprains/strains and fractures, post-surgical fracture repairs as well as DeQuervains Tendonitis/Tenosynovitis and Scaphoid injuries/fractures. Thoughts before application: Is this a removable or non-removable splint? Will this splint need a modification? If so, is it IP free or IP frozen? Is this for treating a patient for an initial injury or is this for post-operative treatment?
  12. 12. The Radial Gutter Splint Application/Location: Applied on radial aspect of the arm circumventing the thumb from it’s web space crease to it’s base and includes the 1st and 2nd digits from their most distal tip and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees and fingers flexed from 70 – 90 degrees of intrinsic position (position of function) at the MPJs. Utilization: Used for 1st and 2nd metacarpal fractures and/or finger fractures, post-surgical fracture repairs as well as tendon repair. Thoughts before application: Is this a removable or non-removable splint? Will this splint need a modification? If so, what? What digits will be necessary to include in splint? Is this for treating a patient for an initial injury or is this for post-operative treatment? 70◦ - 90◦ Flexion at MPJ’s 0◦ - 30◦ Extension of Wrist
  13. 13. The Ulnar Gutter Splint Also known as Boxer’s Fracture Splint Application/Location: Applied on ulnar aspect of the arm and includes the 5th and 4th digits from their most distal tip and completes approximately one inch distal the Antecubital Fosse. Usually applied with wrist dorsally extended from 0 - 30 degrees and fingers flexed from 70 – 90 degrees of intrinsic position (position of function) at the MPJs. Utilization: Used for 4th and 5th metacarpal fractures, post-surgical fracture repairs as well as tendon repair. (Initial Boxer’s fracture treatment of choice). Thoughts before application: Is this a removable or non-removable splint? Will this splint need a modification? If so, what? What digits will be necessary to include in splint? Is this for treating a patient for an initial injury or is this for post-operative treatment? 70◦ - 90◦ Flexion of MP’s 0◦ - 30◦ Extension of Wrist
  14. 14. The Short Arm Sugar Tong Splint Application/Location: Applied on the dorsum and volar aspects of the arm from proximal the palmer creases volarly, around the elbow posteriorly and completes proximal the metacarpal heads dorsally. Usually applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow. The finish product resembles a “sugar tong” which is used to pick up sugar cubes from a dish. Utilization: Used for various radial and ulnar fractures, post-surgical fracture repairs as well as tendon repair. Quite often the pre-casting treatment of choice for Colle’s, Smith’s and Galeazzi’s fractures because it allows for swelling. This splint usually requires an arm sling. Thoughts before application: Will this splint need a modification? Will the wrist need supination or pronation? Is this for treating a patient for an initial injury or is this for post-operative treatment?
  15. 15. The Long Arm Double Sugar Tong Splint Application/Location: A Short Arm Sugar Tong is applied first, then a second “sugar tong” will start approx. 2” distal from the Axilla, continue around the elbow and finish laterally on the head of the biceps. Usually applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow. The finish product resembles two intersecting “sugar tongs”. Utilization: Used for various radial and ulnar fractures, post-surgical fracture repairs as well as tendon repair. Quite often the pre-casting treatment of choice for Monteggia’s and various radial head fractures because it allows for swelling. The bicipital Sugar Tong may even go above the biceps and become a Coaptive-type splint. This splint usually requires an arm sling. Thoughts before application: Will this splint need a modification? Will the wrist need supination or pronation? Is this for treating a patient for an initial injury or is this for post-operative treatment?
  16. 16. The Long Arm Posterior Splint Application/Location: Applied on posterior aspect of the arm from proximal the distal palmer crease ulnarly and completes approximately two inches distal the Axilla posteriorly. Usually applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow. Utilization: Used for various radial and ulnar fractures, elbow fractures, post-surgical fracture repairs as well as tendon repair. This splint usually requires an arm sling. Thoughts before application: Is this a removable or non-removable splint? Will this splint need a modification? Will the wrist need supination or pronation? Ask what digits to be included in splint. Is this for treating a patient for an initial injury or is this for post-operative treatment?
  17. 17. The Coaptation Splint Also referred to as a “Sarmiento” splint Application/Location: Usually applied by starting about 2-3 inches distal the Axilla medially upon the humeral aspect of the upper arm, continue around the elbow and finish anteriorly over the humeral head to include as much of the shoulder as possible without encroaching upon the neck. Applied with wrist dorsally extended from 0 - 30 degrees (a.k.a. neutral position) and 90 degrees of flexion at the elbow. This splint can also become a “long arm sugar tong coaptive splint by simply adding the sugar tong splint. Utilization: Used primarily for various proximal humerus fractures, post-surgical fracture repairs as well as tendon repair. This splint usually requires an arm sling, cuff-n- collar or shoulder immobilizer. Thoughts before application: Will this splint need a modification? What type of fracture is being treated? Sling, shoulder immobilizer or Cuff-n-Collar?
  18. 18. The Short Leg Posterior Splint a.k.a “L” splint or Short Leg Splint Application/Location: Usually applied slightly distal to the most prominent of the digits on the plantar aspect bending posteriorly around the heel and terminating distally 2 - 3 inches of the Popliteal Fosse. Usually applied with foot in neutral position of the ankle and the ankle is at 90 degrees. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance! Utilization: Used for foot and/or ankle sprains/strains and fractures, post-surgical fracture repairs as well as tendon repair. With appropriate splint modification, can be used to treat acute Achilles tendon injuries. Thoughts before application: Is this a removable or non-removable splint? Will this splint need a modification? If so, what? Is this for treating a patient for an initial injury or is this for post-operative treatment?
  19. 19. The Short Leg Posterior w/Sugar Tong Splint a.k.a “L & U” splint, an AO (German) Splint, Short Leg Posterior with Stirrup and a “Jones” or “Bulky Jones” Splint Application/Location: Usually a Short Leg Posterior Splint is applied first. At this time a “sugar tong” is applied by centering casting material under the midfoot and occupying both the medial and lateral aspects of the ankle to the most proximal end of the previous splint bilaterally or slightly less than and without closing the anterior aspects of the extremity. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance! Utilization: Used for foot and/or ankle sprains/strains and fractures, post-surgical fracture repairs as well as tendon repair. Usually applied with bulky cotton to treat severely swollen acute foot and/or ankle fractures. Thoughts before application: Is this a removable or non-removable splint? Will this splint need a modification? If so, what? Is this for treating a patient for an initial injury or is this for post-operative treatment?
  20. 20. The Long Leg Posterior Splint Also known as Long Leg Extension Splint Application/Location: Usually applied slightly distal the most prominent of the digits on the plantar aspect bending posteriorly around the heel and terminating distally 2 - 3 inches of the Gluteal Sulcus (Fold of the Buttock). Usually applied with foot in neutral position of the ankle and the ankle is at 90 degrees and the knee at 0 – 10 degrees of flexion. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance! Utilization: Used for midshaft and/or high tib/fib fractures, tibial plateau fractures, acute femur fractures and knee injuries/fractures. Thoughts before application: Is this a removable or non-removable splint? Is there a preference on the type of casting material? Will this splint need a modification? If so, what? Is this for treating a patient for an initial injury?
  21. 21. The Long Leg Posterior Splint With Medial/Lateral Slabs Application/Location: Usually a Long Leg Posterior Splint will be applied first. The “slabs” are then applied by centering casting material under the midfoot and occupying both the medial and lateral aspects of the ankle to the most proximal end of the previous splint bilaterally or at least above the knee without closing the anterior aspects of the extremity unless required. ALWAYS NON-WEIGHT BEARING! Patient will need Crutches or other ambulatory assistance! Utilization: Used for midshaft and/or high tib/fib fractures, tibial plateau fractures, acute femur fractures and knee injuries/fractures. Thoughts before application: Is there a preference on the type of casting material? Will this splint need a modification? If so, what? Is this for treating a patient for an initial injury?
  22. 22.  Before and after every splint: check for distal circulation!  All rings and bracelets should be removed from the affected limb.  All wounds, rashes and other skin compromises should be treated prior to splinting  Splint should go from joint to joint from the epicenter of the injury  Affix an appropriate amount of padding (whether to the splint or to the skin) to prevent splint rub and pad extra over boney prominences as well as obvious irritations  Pay special attention to the ends of the splint to ensure that all rough and sharp edges are well padded  Avoid all wrinkles in padding as well as in the splinting material as these can cause skin irritations  Avoid using fingers to form any molding into the splint as your fingers will leave “a lasting impression” that may not be well tolerated  Ensure if fingers or toes are secured together, a padding is placed between them before securing them
  23. 23.  Don’t just dunk your plaster and then quickly laminate with the “two finger slide” technique that many do  This removes most of the plaster from the splint  Splint hasn’t been properly moistened for needed lamination strength  Don’t use too many layers  As a general rule:  Upper Extremity splints 10 – 15 layers  Lower Extremity splint 15 – 25 layers  You lose working time for the needed mold  Don’t over work the lamination!  Over worked plaster is weak  You lose working time for the needed mold  Don’t use overly hot water! (keep water temp between 70-75 F)  Exothermic reaction is exponentially increased with hotter temp water – this can cause the splint to be too hot to apply to the patient  Set time is increased; the plaster may not be usable if set time is compromised  Change water between splint applications  Exothermic reaction is exponentially increased due to the salts from the previous plaster in the water – this can also cause the splint to be too hot to apply to the patient  Set time is increased; the plaster may not be usable if set time is compromised (knowing this can be to your advantage)  Saline water will speed up set time and LR water will slow set time  While allowing the splint to dry, ensure that adequate ventilation around the splint has been made  Plastic, naugahyde, vinyl and like materials will reflect heat back to the patient and can cause severe burns  Terry cloth towels, linens and like materials work best for letting the splint cool down from its reactive process ˚
  24. 24.  Use room temperature water to allow for longer molding time  Do not let fiberglass spend longer than a few seconds (about 5 secs) in the water, then squeeze and ready yourself to apply it  If the fiberglass is cut, ensure that all fiberglass frays are concealed in some sort of padding or edging material  The cut edges of fiberglass splints can cut into a patient’s skin  The small frays can break off into the splint and cause a great deal of itching and other discomfort  Take care to not laminate with too many layers  Upper Extremity: 5 – 10 layers  Lower Extremity: 8 – 12 layers  Do not allow splint to become stuck to itself in a manner that encircles or encloses the extremity (this goes for any splint) unless it is absolutely necessary  Doing so makes it extremely difficult to remove the splint later  Could cause vascular compromise or even muscular compartment issues  Ensure to place a protective barrier between patient and the area being splinted  Fiberglass resin does not come out of clothes  Fiberglass resin on skin requires immediate action to remove which can compromise splinting process  Always wear gloves as a protective measure to prevent fiberglass resin from getting onto your skin
  25. 25. The Short Arm Sugar Tong Splint And The L and U Splint
  26. 26. • What a splint is • What purpose a splint serves in treating injuries • What materials can be considered for splinting • How to conduct pre-splinting procedures • How to select the appropriate splint for the injury • What precautions and hazards are associated with improper splinting • With hands-on application, the objectives for training were clearly illustrated through individual experience
  27. 27. Benny just fell off his mountain bike and sustained a nasty forearm injury. He is 19 years old in good shape and healthy. Which splint would be most appropriate if you suspect a forearm fracture? Short arm thumb spica splint Coaptation splint Long arm posterior splint Short arm volar splint Short arm sugar tong splint
  28. 28. Which splint would you fabricate on an octogenarian with a radiologically confirmed distal humerus fracture? Short arm thumb spica splint w/ cuff-n-collar Short arm sugar tong splint Long arm posterior splint Short arm volar splint w/ sling Coaptation Splint w/ cuff-n-collar
  29. 29. Which splint would be most appropriate for an unknown status of a status post MVA Left ankle injury with deformity? DME Ankle lace-up DME Air splint Long leg posterior splint Short leg posterior splint Short leg L and U splint
  30. 30. A plaster splint sets slower with sugar in the water and faster with salt in the water.
  31. 31. If a person has a 20 layer plaster short leg posterior splint that has been allowed to set upon a naugahyde covered exam table, a 3rd degree burn is possible.
  32. 32. Which splint is most appropriate for most all ankle and foot injuries?
  33. 33. Which splint is most appropriate for most all wrist, forearm and elbow injuries?
  34. 34. What is the very first and last assessment that should be made prior to and after applying a splint?
  35. 35. Match the splint to its most appropriate injury treatment: Short Leg Posterior Splint Volar Splint Ulnar Gutter Splint Short Leg L and U Splint Thumb Spica Splint DeQuervain’s Tenosynovitis Boxer’s Fracture Ankle Sprain Carpal Tunnel Symptoms Bi-malleolar Fracture
  36. 36. Jim “Buzz” Land, CSA, OT jland@opaak.com Or Robbie “Robo” Fenton, OT rsfenton@opaak.com

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