Injuries of the upper extremity are a common complaint seen by pediatrics residents in the emergency department, and splinting is a skill that residents receive limited training on prior to practice in a clinical setting. After surveying the current residents rotating in the ED, most residents felt a review of upper extremity splinting would be useful.
Why do I need to splint a fracture?
Limiting mobility of a fracture will decrease further injury and reduce risk of vascular and/or neurologic compromise. Splinting may also help promote healing in the correct alignment and reduce pain.
Why do we not cast frequently in the ED setting?
This is a very common question asked by parents in the ED. Splints permit swelling that will inevitably occur in the first 24-48 hours after injury, unlike casting which leaves little room for swelling. There are some occasions where a cast may be safe on day one, such a simple buckle fracture of the radius. Ultimately however, casting is more labor intensive and not always an available option. Some recent recent reports may also lead to us to use removable velcro splints for certain non displaced fractures. This is an area of ongoing study.
What do I need for supplies?
- Cotton stockinette
- Cotton bandage; i.e. Webril
- Orthoglass or plaster cut to predetermined length
- Pick a size large enough (enough to cover ~1/2 the circumference of the extremity)
- Traditionally, plaster of Paris has been used but now there are many additional options including fiberglass, which is what we used in many EDs
- Access to a sink or water to wet orthoglass
- Ace bandage(s)
What are the basic steps that I need to know when applying a splint?
- Stretch stockinette over the affected extremity. Make sure that it’s long enough to extend beyond the proximal and distal edges of the area you’re splinting.
- Wrap Webril around the extremity making sure to avoid wrinkles because this can lead to pressure sores. Extend the padding 2 to 3 cm beyond the area to be splinted.
- Cut orthoglass to correct length depending on type of splint you are applying.
- Place orthoglass under room-temperature water and use a towel to remove excess water
- Mold orthoglass on to the extremity and fold back the ends to make a smooth edge. Then, fold stockinette over the edge.
- Wrap an elastic bandage around the site. Ensure the wrap is not too tight to cause constriction.
- Make sure to keep the limb in the desired position until the orthoglass hardens.
See this video, from the AAP’s PediaLink site for more details