1. Splinting
• Dan Hirsh, MD
• Emory PECC Orientation
• June 19, 2008
Hughes Spalding
Children’s Hospital

2. A splint is a non-circumferential
immobilization device to treat
fractures, lacerations of skin or
tendon, and sprains.

10. Complications Prevention
Risk of ischemia
Compartment Syndrome
Possible neurovascular compromise
Keep splint snug
Check distal neurovascular status
after placement
Skin breakdown
Keep splint dry
Use minimal water necessary and dry thoroughly
before placement
Use padding
Avoid ‘kinks’
Pain or Ineffective
Immobilization
Check splint after placement
If either of these too, replace the splint

11. Tell patients and family that
•Splint material will get warm when it hardens
Fiberglass cures in :
~15 minutes with ambient humidity
~5 minutes with cold water
~1 minute with warm water
•Should be snug, not tight (fingers shouldn’t tingle)

12. Ace wrap
Webril /
wadding
Stockinette

13. Optional: Apply
stockinet to extremity
Extend it past the proximal and distal
ends of where the splint will end
Cut out any areas that bunch up that
could damage the skin
Create thumb hole

16. Hot water will cause the
fiberglass to harden very
quickly
Use cold water
May use NO water, just
ambient humidity (this
will take much longer
to harden)
If you use water, keep padding
as dry as possible

17. Protect the skin. If
cotton padding is wet,
dry it.

18. Some fiberglass material
comes with a thick padded
side and a thin side.
Protect the skin. Always
place the thick-side to the
skin-side.

19. Wrap the splint in
place—not too loose
or too tight. Protect
the skin. Do not apply
pressure with finger
tips, use a curved
palm.

20. Keep joint in a protective
position.
Keep hand slightly
extended at the wrist,
‘thumb-up’, fingers
curved around an object

21. Discharge Instructions
• Make sure neurovascular intact & in not pain from splint
• Elevate, ice & rest injured extremity
• Keep splint dry
• Splints are non/partial weight bearing, use crutches
• If fingers become tingly or blue, re-wrap the bandage
• If splint hurts, or there is increasing pain, TAKE THE SPLINT
OFF! Seek medical attention

22. • “Posterior Arm”
• Used for stable elbow injuries
• Width: ½ arm circumference
• Length: dorsal aspect of mid-
upper arm down ulnar side to
distal palmer flexion crease

23. • “Sugar Tong”
• Can be applied both proximally or
distally or both at the same time
• When in doubt, use the sugar tong
• Width: slightly overlap radial and
ulnar edges of arm
• Length: dorsal aspect of knuckles
around elbow to volar palmer
flexion crease
• Can place patient prone for easy installation
• Must keep arm in 90° flexion
• Don’t let the splint slide up or down

24. • “Gutter”
• Metacarpal and/or proximal
phalnageal fractures
• Ulnar immobilizes 5th & 4th digits,
radial 2nd & 3rd
• Width: wrap to midline of hand on
dorsal and volar surfaces
• Length: nail base to proximal forearm

25. • “Volar”
• Distal forearm or wrist
fractures
• Don’t use in small children
• Width: fully cover volar
aspect of forearm
• Length: from proximal
fingers to proximal
forearm

26. • “Thumb Spica”
• Non-displaced fractures of
1st metacarpal bone,
proximal phalanx of thumb,
scaphoid fracture
• Length: nail base to proximal
forearm

27. • “Posterior Leg”
• Distal Tibia and/or fibula
injuries, ankle, foot
• Width: at least ½ leg
circumference, but NON-
circumferential
• Length: level of fibular
neck to base of digits
• Shape splint into neutral
position, 90° flexion
• These are partial/non weight
bearing splints

28. • “Buddy Tape”
• Padded metal strip
may go dorsal or
volar

29. • “Stirrup”
• Provides lateral support, may
use with Posterior Leg splint for
added stability (aka Cadillac
Splint)
• Width: at least ½ leg
circumference, but NON-
circumferential
• Length: level of fibular head
around heel and back up the
leg
• Shape splint into neutral
position, 90° flexion
• These are partial/non weight bearing
splints

31. Thumb
Spica
Volar
Long Arm &
Short Posterior
leg
Sugar Tong &
Stirrup