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.
Review splint techniques associated with injuries commonly managed in the ED.
Learn some basic tips to help with successful placement of these splints.
Cuff and collar (or sling)
Long arm posterior or double sugar tong
Long arm posterior
Radius or ulna – proximal or midshaft
Long arm posterior, or double sugar tong (if fracture is unstable or complex)
Radius – distal, isolated
Thumb spica or volar
Radius or ulna – distal, complex
Single or double sugar tong
Ulna – styloid
Single sugar tong
Wrist and Hand
Fracture or Injury
Scaphoid, trapezium, or lunate fracture
Triquetrum, pisiform, trapezoid, capitate, or hamate fracture
Ulnar collateral ligament injury, thumb MCP dislocation, De Quervain’s tenosynovitis
1st metacarpal fracture
2nd or 3rd metacarpal fracture
Volar or radial gutter
4th or 5th metacarpal fracture
1st phalanx fracture
2nd or 3rd proximal or middle phalanx fracture
Radial gutter or buddy taping
4th or 5th proximal or middle phalanx fracture
Ulnar gutter, or buddy taping (acceptable if the injury is a non-displaced fracture through the phalangeal shaft)
Distal phalanx fracture
Aluminum U-shaped splint
Tibia, Fibula, Ankle, and Foot
Fracture or Injury
Distal tibia or distal fibula fracture
Posterior short leg (stirrup splint can be applied for additional stability)
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 physicians. 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.
Protect the skin: Head from splint activation can cause burns. Wrinkles in layers can cause friction, blisters, or infection.
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:
Makeshift Cuff and Collar: Use a disposable wrist restraint to create this splint.
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.
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!
Boyd A, Benjamin H, Asplund C. Splints and casts: indications and methods. Am Fam Physician. 2009;80(5):491-499. [PubMed]