Basic techniques for splinting of musculoskeletal injuries
- Andrea Stracciolini, MD
Andrea Stracciolini, MD
- Assistant Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The basic principles, method of application, and description of specific splints for the upper and lower extremities will be discussed here. Closed reduction and casting for distal forearm fractures in children are discussed separately. (See "Closed reduction and casting of distal forearm fractures in children".)
Splinting plays a major role in the management of musculoskeletal injuries, including treatment of overuse and soft tissue injuries (eg, tendonitis and sprains), as well as for traumatic injuries like extremity fractures and joint dislocations. Immobilization of the extremity through splinting may serve to decrease pain and bleeding, and prevent further soft tissue, vascular, or neurologic compromise [1-7]. Splinting may also provide definitive treatment for some injuries [8-10].
Compared with casts, splints permit swelling and may prevent neurovascular compromise. Timely splinting as soon as possible after the injury is recommended in most cases. Close attention to detail and familiarization with proper splinting technique can increase patient comfort and decrease the likelihood of further injury.
However, preliminary evidence suggests that many splints are applied incorrectly with the potential for causing unnecessary injury. As an example, in a prospective, observational study that evaluated 275 splints applied for pediatric fractures in emergency departments or urgent care centers, 93 percent were deemed to have been applied incorrectly, with 77 percent of the splints having the application of the elastic bandage directly to the skin, 59 percent noted to have improper positioning, and 52 percent with an inappropriate splint length, most commonly too long and not permitting free range of motion at the metacarpal joint . Skin or soft tissue complications occurred in 40 percent of patients; excessive swelling was most frequent (28 percent).
Splints have traditionally been made of plaster of Paris, but in recent years many different types of splinting materials have become available. These include pre-formed plaster, fiberglass, pre-padded fiberglass, malleable aluminium, air splints, vacuum splints, and pre-formed "off-the-shelf" splints for nearly every body part.
- Kovan J, McKeag D. Ankle splinting, taping, and casting. In: Procedures for Primary Care Physicians, Pfenninger J, Fowler G (Eds), Mosby, St. Louis 1994. p.1004.
- Steele, P, Bush-Joseph, C, Bach, B Jr. Office management of trauma – management of acute fractures around the knee, ankle, and foot. Clin Fam Pract 2000; 2:661.
- Chudnofsky C. Splinting techniques. In: Clinical Procedurs in Emergency Medicine, Roberts J, Hedges J (Eds), WB Saunders, Philadelphia 1998. p.852.
- Geideman J. Orthopedic injuries: General principles. In: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed, Marx J, Hockberger R, Walls R (Eds), Mosby, Philadelphia 2002. p.486.
- Klig J. Splinting procedures. In: Textbook of Pediatric Emergency Procedures, Henretig F, King C, Joffe M (Eds), Lippincott, Williams & Wilkins, Baltimore 2008. p.919.
- Howes DS, Kaufman JJ. Plaster splints: techniques and indications. Am Fam Physician 1984; 30:215.
- Paras, R. Office management of trauma – upper extremity fractures. Clin Fam Pract 2000; 2:637.
- Boutis K, Willan AR, Babyn P, et al. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics 2007; 119:e1256.
- Plint AC, Perry JJ, Correll R, et al. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics 2006; 117:691.
- Stewart HD, Innes AR, Burke FD. Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster casts. J Bone Joint Surg Br 1984; 66:749.
- Abzug JM, Schwartz BS, Johnson AJ. Assessment of Splints Applied for Pediatric Fractures in an Emergency Department/Urgent Care Environment. J Pediatr Orthop 2017.
- Ruddy RM. Illustrated techniques of pediatric emergency procedures. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott, Williams & Wilkins, Philadelphia 2006. p.1861.
- Boyd AS, Benjamin HJ, Asplund C. Principles of casting and splinting. Am Fam Physician 2009; 79:16.
- Shaw DC, Heckman JD. Principles and techniques of splinting musculocutaneous injuries. Emerg Med Clin North Am 1984; 2:391.
- Harrison BP, Hilliard MW. Emergency department evaluation and treatment of hand injuries. Emerg Med Clin North Am 1999; 17:793.
- Kaplan SS. Burns following application of plaster splint dressings. Report of two cases. J Bone Joint Surg Am 1981; 63:670.
- Boyd AS, Benjamin HJ, Asplund C. Splints and casts: indications and methods. Am Fam Physician 2009; 80:491.
- Carruthers KH, O'Reilly O, Skie M, et al. Casting and Splinting Management for Hand Injuries in the In-Season Contact Sport Athlete. Sports Health 2017; :1941738117700133.
- Bong MR, Egol KA, Leibman M, Koval KJ. A comparison of immediate postreduction splinting constructs for controlling initial displacement of fractures of the distal radius: a prospective randomized study of long-arm versus short-arm splinting. J Hand Surg Am 2006; 31:766.
- Levy J, Ernat J, Song D, et al. Outcomes of long-arm casting versus double-sugar-tong splinting of acute pediatric distal forearm fractures. J Pediatr Orthop 2015; 35:11.
- Fitch MT, Nicks BA, Pariyadath M, et al. Videos in clinical medicine. Basic splinting techniques. N Engl J Med 2008; 359:e32.
- GENERAL PRINCIPLES
- Preformed splints
- Manufactured splints
- BASIC TECHNIQUES
- COMPLICATIONS OF SPLINTING
- SPLINT APPLICATION
- Customized plaster splints
- Fiberglass splints
- UPPER EXTREMITY SPLINTS
- Sling and swathe splint
- Velpeau bandage
- Sugar tong splints
- Long arm splint
- Colles splint
- Dorsal and/or volar splint
- Gutter splint
- - Thumb spica splint
- Finger splints
- Bulky hand compression dressing
- Figure-of-eight splint
- LOWER EXTREMITY SPLINTS
- Knee splint
- Jones compression dressing
- Posterior leg splint
- Stirrup splint
- Bulky foot compression dressing
- Buddy taping
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS