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Basic techniques for splinting of musculoskeletal injuries

Author
Andrea Stracciolini, MD
Section Editors
Karl B Fields, MD
Anne M Stack, MD
Allan B Wolfson, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

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".)

GENERAL PRINCIPLES

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 [11]. Skin or soft tissue complications occurred in 40 percent of patients; excessive swelling was most frequent (28 percent).

EQUIPMENT

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.

                              
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Literature review current through: Sep 2017. | This topic last updated: May 08, 2017.
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References
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