Splinting plays a major role in the management of musculoskeletal injuries, particularly those involving extremity fractures and joint dislocations. Immobilization of the extremity through splinting decreases pain and bleeding and prevents further soft tissue, vascular, or neurologic compromise [1-7]. Splinting may provide definitive treatment for some injuries [8-10].
Compared with casts, splints permit swelling and may prevent neurovascular compromise. The clinician should perform splinting immediately after the injury and maintain splinting or casting until the injury has healed completely.
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".)
Splints have traditionally been made of plaster of Paris, but in recent years many different types of splinting materials have become widely 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.
Preformed splints — The choice between pre-formed splints and custom splints is largely one of convenience and compliance. Commercial pre-formed splints are typically made of Velcro and hard plastic. They are very convenient and come in a variety of sizes to fit most patients. However, since these splints are not custom-molded, they do not provide the same level of immobilization as custom built splints. Additionally, patients can easily remove commercial splints, potentially causing delayed healing, fracture displacement, or re-injury. Hence, custom splinting with plaster, fiberglass or similar materials may be preferred when precise and continuous immobilization is required.