Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Splinting of musculoskeletal injuries

INTRODUCTION

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".)

EQUIPMENT

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.

                            

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Jan 24, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. 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.
  2. 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.
  3. Chudnofsky C. Splinting techniques. In: Clinical Procedurs in Emergency Medicine, Roberts J, Hedges J. (Eds), WB Saunders, Philadelphia 1998. p.852.
  4. Geideman J. Orthopedic injuries: General principles. In: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th, Marx J, Hockberger R, Walls R. (Eds), Mosby, Philadelphia 2002. p.486.
  5. Klig J. Splinting procedures. In: Textbook of Pediatric Emergency Procedures, Henretig F, King C, Joffe M. (Eds), Lippincott, Williams & Wilkins, Baltimore 2008. p.919.
  6. Howes DS, Kaufman JJ. Plaster splints: techniques and indications. Am Fam Physician 1984; 30:215.
  7. Paras, R. Office management of trauma – upper extremity fractures. Clin Fam Pract 2000; 2:637.
  8. 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.
  9. 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.
  10. 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.
  11. Ruddy RM. Illustrated techniques of pediatric emergency procedures. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott, Williams & Wilkins, Philadelphia 2006. p.1861.
  12. Boyd AS, Benjamin HJ, Asplund C. Principles of casting and splinting. Am Fam Physician 2009; 79:16.
  13. Shaw DC, Heckman JD. Principles and techniques of splinting musculocutaneous injuries. Emerg Med Clin North Am 1984; 2:391.
  14. Harrison BP, Hilliard MW. Emergency department evaluation and treatment of hand injuries. Emerg Med Clin North Am 1999; 17:793.
  15. Kaplan SS. Burns following application of plaster splint dressings. Report of two cases. J Bone Joint Surg Am 1981; 63:670.
  16. Boyd AS, Benjamin HJ, Asplund C. Splints and casts: indications and methods. Am Fam Physician 2009; 80:491.
  17. Fitch MT, Nicks BA, Pariyadath M, et al. Videos in clinical medicine. Basic splinting techniques. N Engl J Med 2008; 359:e32.