The SplintER series is back with its fourth installment! In this series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize some of the most commonly deployed splints in the ED. Peer-reviewed by sports medicine experts (Dr. Kori Hudson and Dr. Anna Waterbrook), these injury-splint summary tables provide information on the origin, insertion, and positioning for each splint, along with the recommended number of layers of plaster.

Learning Objectives

  1. Review splint techniques associated with injuries commonly managed in the ED.
  2. Learn some basic tips to help with successful placement of these splints.

Upper Extremity1,2

Humerus

FractureSplintTechnique
Proximal humerusCuff and collar (or sling)
Humeral shaftCoaptation
SupracondylarLong arm posterior or double sugar tong

Forearm

FractureSplintTechnique
Olecranon/coronoidLong arm posterior
Radius or ulna – proximal or midshaftLong arm posterior, or double sugar tong (if fracture is unstable or complex)

Radius – distal, isolatedThumb spica or volar

Radius or ulna – distal, complexSingle or double sugar tong

Ulna – styloidSingle sugar tong

Wrist and Hand

Fracture or InjurySplintTechnique
Scaphoid, trapezium, or lunate fractureThumb spica
Lunate dislocationSugar tong
Triquetrum, pisiform, trapezoid, capitate, or hamate fractureVolar
Ulnar collateral ligament injury,
thumb MCP dislocation,
De Quervain’s tenosynovitis
Thumb spica
1st metacarpal fractureThumb spica
2nd or 3rd metacarpal fractureVolar or radial gutter

4th or 5th metacarpal fractureUlnar gutter
1st phalanx fractureThumb spica
2nd or 3rd proximal or middle phalanx fractureRadial gutter or buddy taping
4th or 5th proximal or middle phalanx fractureUlnar gutter, or buddy taping (acceptable if the injury is a non-displaced fracture through the phalangeal shaft)

Distal phalanx fractureAluminum U-shaped splint

Lower Extremity1

Tibia, Fibula, Ankle, and Foot

Fracture or InjurySplintTechnique
Distal tibia or distal fibula fracturePosterior short leg (stirrup splint can be applied for additional stability)
Ankle sprain: Grade 2 or  3Stirrup
Talus, calcaneus, navicular, cuboid, cuneiform fracturePosterior short leg
Metatarsal fracture**Posterior short leg
Lisfranc fracturePosterior short leg

 

Expert Peer Review: Kori Hudson, MD


Associate Professor, Emergency Medicine, Georgetown University
Team Physician for Georgetown University
Consulting Physician for the Washington Capitals 

Understanding proper splinting technique is a critical skill for all emergency Pphysicians. Though many facilities have nurses and patient care technicians who may assist with splint application, the ultimate responsibility for proper splint application lies with the physician.

Critical Basics:

  1. Protect the skin: Head from splint activation can cause burns. Wrinkles in layers can cause friction, blisters, or infection.
  2. Ensure patients understand splint care: showering, weight bearing, unwrapping and re-wrapping if the splint feels too tight. Proper follow-up is critical.

Tricks of the Trade:

  1. Makeshift Cuff and Collar: Use a disposable wrist restraint to create this splint.
  2. How to avoid the mess of plaster: Before activation, layer plaster and place in a sleeve (stockinette). Place the sleeve into lukewarm water, and remove excess water by sliding the sleeve between your index and long finger. Mold the sleeve to the affected body part.
  3. Remember the equinus position: Utilize this for Dancer’s fractures and Achilles ruptures.

The most important advice: Practice splinting! Make your own splints and check the ones that nurses and  technicians make for your patients. If it isn’t right, try making it again. In some cases, a bad splint may be worse than no splint at all!

Thanks to Dr. Anisha Molholtra for the professionally sketched splint images!

References

1.
Boyd A, Benjamin H, Asplund C. Splints and casts: indications and methods. Am Fam Physician. 2009;80(5):491-499. [PubMed]
2.
EBSCOhost Login . Metacarpal head fracture – emergency management. http://www.dynamed.com/login.aspx?direct=true&site=DynaMed&id=903302. Published April 5, 2018. Accessed July 1, 2018.
William Denq, MD

William Denq, MD

Clinical Assistant Professor
Department of Emergency Medicine
University of Arizona
William Denq, MD

@willdenq

Clinical Assistant Professor Emergency Medicine and Sports Medicine University of Arizona George Washington University '18 University of Pittsburgh '14 and '10
William Denq, MD

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Max Hockstein, MD

Max Hockstein, MD

Emergency Physician
Critical Care Fellow
Department of Anesthesiology
Emory University School of Medicine
Max Hockstein, MD

@MaxHockstein

DC sports fan, car enthusiast, and tech n3rd. Mediastinal madman. Fan of DiffyQ's. Emergency Medicine | Critical Care. I'm a Mac #3 kinda guy.