Overview of Splinting
Injuries affecting our muscles, joints, and bones are quite common. If you have such an injury, you might go to an emergency room, an urgent care facility, your regular doctor, or a specialist. The first steps they will take to treat you will involve getting a detailed medical history from you and conducting a physical examination. They’ll be especially interested in checking the blood flow and nerve function in the injured part of your body.
If the injury has made the affected area unstable, they’ll look at ways to keep it still to avoid further damage, protect soft tissue, reduce pain, and help healing. This instability may be due to damage to the bones, joints or muscles. Applying a splint may be the best immediate solution; in some cases, it may be the only treatment needed.
A splint is a simple external device that is used to keep an injury or a joint still. It can be made from materials like plaster or fiberglass. Doctors choose the type of splint and the way it’s applied based on the location of the injury and how to best immobilize it. The goal of splinting is to restore the body part to its proper length, rotation, and orientation.
Splinting, even though it is simple, must be done correctly. If a splint is applied poorly, it can cause unnecessary pain, improper alignment of the injury, and skin breakdown. If not fitted right, a splint will need to be replaced. Indeed, complications from poorly applied splints are the second most common reason people are referred to plastic surgeons. Unfortunately, inadequate splinting is quite common; one study found that 93% of patients had splints that weren’t applied properly.
Understanding when and how to use splints properly is very important for medical professionals who treat patients with acute injuries to muscles, joints, and bones.
Anatomy and Physiology of Splinting
When a doctor creates a splint for a patient, they need to consider the patient’s specific body structure. The goal is to restore the natural resting position of the patient’s joint so as to prevent further complications. Plaster or fiberglass splints are commonly used options for immediate joint immobilization after an injury. Pre-made foam splints or braces, on the other hand, are more often used for long-term treatment of ongoing injuries. They offer structural support and help manage pain, but aren’t usually a first choice for fresh fractures.
Plaster is favored as it can be shaped to fit the specific need to hold a body part in a precise position. However, its drawbacks are the time it takes to set, the expertise required to properly apply it, and that the amount of mold is determined by the provider. Fiberglass splints have their own benefits – they are lighter, easier to put on, and allow air to pass through – but they are costlier and the mold might not be as precise.
An important thing that your doctor will check before and after placing a splint is the blood and nerve supply to the body part that’s been injured. The splint should not press too much on the tissues underneath because this can reduce blood flow to the skin, cause irritation and even tissue death. This is especially critical over bony parts like the elbow, knee or back of the heel. While applying the splint, your doctor may put extra layers of cushioning in these areas for better protection.
For upper body injuries, a splint covering the wrist should keep it level. In kids who have a specific type of elbow fracture, the arm should be splinted with the elbow bent at an angle between 60 and 90 degrees. It’s important that the elbow isn’t flexed more than 90 degrees as this could lead to a condition that can stiffen and deform the forearm.
In case of lower body injuries, a splint crossing the ankle should maintain a relaxed position without bending the foot too much towards the sole as this can cause the Achilles tendon to stiffen.
If the splint is too loose, it might not limit movement as needed and the injury might not heal in the right alignment. If the splint is meant to be the primary treatment, the fracture or injury should be stable. In cases where a fracture is hard to set back in place, too shortened, or is broken into many small bits, the patient will typically require surgery. However, if surgery is delayed for any reason, a splint might be temporarily placed to prevent further damage, keep the fracture stable and support the healing process.
Why do People Need Splinting
A splint is a device used for supporting and immobilizing a part of the body that is injured. Doctors usually use a splint for the following important reasons:
– To keep still and prevent moving the injured area to help healing, such as in cases of acute fractures, sprains, or strains. This is done temporarily until a more complete check-up can be done or until the final surgical treatment.
– To immobilize and protect parts that have an unconfirmed, but suspected, breakage, say for example, in one of your wrist bones (specifically known as a scaphoid fracture).
– To provide support and prevent further damage to areas with severe soft tissue injuries. Soft tissues are the tissues in your body that aren’t bone, like muscles, tendons, ligaments, and skin.
– To manage definite healing of specific stable fracture patterns. A stable fracture is a type of bone break where the broken pieces of bone do not move out of place before they heal.
– To protect an extremity (an arm or leg) if you have a condition called peripheral neuropathy. This condition causes weakness, numbness, and pain from nerve damage, usually in the hands and feet.
– To partly restrict movement for minor soft tissue injuries which can help speed up the healing process.
– To treat joint instability, including cases when a joint is dislocated or moved out of its natural position. A splint helps by holding the joint in place until it heals.
When a Person Should Avoid Splinting
Using a splint doesn’t typically have any specific issues. But, for certain injuries and health conditions of the patient, special care may be needed.
If a patient has open wounds or freshly injured skin, they may need some special attention to their soft tissues. This care could range from removing any damaged tissue to stitching up the wound. Before a splint is used, these steps must be taken. Sometimes, if the wound is severe, antibiotics may be recommended to prevent infection.
In situations when injuries have affected the sense of touch or caused loss of sensation, a splint may not be suitable. This is because splints can increase the risk of internal build-up of pressure (compartment syndrome), injuries caused by pressure, or incorrect healing of the injury. These types of injuries require medical examination, as loss of sensation could signal a medical situation that needs immediate surgery. Patients with a nerve disorder in the body’s extremities (peripheral neuropathy) might use a leg or arm splint, but only based on their individual condition. This disorder can also make it hard for patients to notice any irritation, injury, or impaired blood flow caused by the splint.
Immediate and fresh injuries to the blood vessels require an expert surgical evaluation and may need immediate final treatment. Also, before and after setting a bone and putting on a splint, the blood flow of the injured limb must be checked. Moving the broken bone back into place could potentially damage or block a blood vessel if it gets caught in the bone fragments. Similar to the case of peripheral neuropathy, patients with chronic peripheral vascular disease (a condition that narrows down the arteries, reducing blood flow) may also use a leg or an arm splint, but these patients are at an increased risk of pressure injuries.
Equipment used for Splinting
If a doctor needs to provide support to your bone or joint, they might choose to use a splint. A splint can be made of plaster or fiberglass. Before the doctor starts making your splint, they need to make sure they have all the supplies they need. This is because the material used for splinting can harden quickly, so it’s important to have everything ready before starting.
The supplies that a doctor needs for splinting include:
- A sheet or towel to cover your clothes and protect them.
- A soft material called a stockinette or some fabric underpadding. This is put on first to protect your skin from the splint.
- More padding, usually made of cotton. This is wrapped around the stockinette to add even more protection.
- Plaster or fiberglass that’s padded. This is what the actual splint is made from. Wider pieces are better for splints on the upper arm or legs, while narrower pieces are better for forearm splints.
- A bucket filled with cool water. This is used to dampen the plaster or fiberglass, allowing it to be molded and shaped to fit your body properly.
- An elastic bandage to secure the splint in place.
- If you have an injury on your upper body, like your arm or shoulder, you may also need a sling to help support it.
Who is needed to perform Splinting?
A splint, which is something that keeps a broken bone or other injury in place so it can heal, can be put on by anyone on the healthcare team who has had the right training. This could be doctors, highly skilled healthcare providers, medical assistants, technicians, or even first responders like paramedics. Although it is possible for one person to put the splint on all by themselves, it’s typically easier when another person helps. The person helping can gather the necessary materials, assist in setting the broken bone back in place, and help hold the injured area steady while the splint is being put on and shaped to fit.
Preparing for Splinting
Before a splint is applied, all the necessary materials for the process must be prepared. This is to prevent unwanted early hardening of the plaster or fiberglass that will be used in the splint.
Medical professionals will need to perform and record an examination of a patient’s motor reflexes, sensory functions, and blood supply prior to applying the splint. This step is critical in ensuring that no further injury is caused and to ensure the best possible care.
Any wounds or injuries to the skin or soft tissues should be taken care of during the preparation stage. This may involve getting antibiotics, cleaning the wounds, removing any dead or damaged tissues (debridement), or stitching up (tissue closure) the wounds.
The materials to be used in the splint should be pre-measured, cut, and arranged according to the order they will be used. The stockinette, a type of stretchy fabric, should be cut 8 to 10 cm longer than needed to cover the area where the splint will be applied. The plaster or fiberglass should also be measured and cut so that it covers the injured area. Plaster must be stacked between 8 to 10 sheets to make sure the splint is strong enough. In certain cases, such as larger joints or pediatric patients, the number of layers may need to be adjusted.
Pain relief medication taken orally or administered through an intravenous line may be necessary. In some situations, especially with children, mild sedation may be required to help patients stay calm and comfortable during the process.
How is Splinting performed
Maintaining a Splint:
Before we start, we’ll make sure you are comfortable and your pain is managed, which will assist in relaxing your muscles, and ease the realignment of any broken bones. We’ll take care of any wounds or skin problems around the area first.
We’ll wrap a soft stocking-like material (stockinette) around the affected part of your body. This will go a bit beyond the area where the splint will be. For any bony parts like elbows or knees, we put down some extra soft padding, about half an inch to an inch thick, which will be customized based on your body shape.
We then cover the whole area to be splinted with 2 to 3 layers of extra cast padding. If any fractures need to be reduced (which means putting broken bones back into their right place), we’ll do this carefully, and use x-rays to make sure we’ve got it just right.
Next, we’ll activate the splinting material; that means we’ll soak it in water until it’s properly saturated. We’ll then press it together to make it strong and sticky.
The splint material is then shaped around the injured area to resist any bending or tweaking. We’ll make sure it doesn’t completely encircle the area and will cut off any excess once it’s dry. The stockinette, is then folded back over the ends of the splint, to protect your skin. To keep the splint in place while it hardens, we wrap an elastic bandage around it. This helps mold the splint to your injury. It’s important to remember that the bandage should not be placed directly on your skin. Seeing this is a common mistake.
After the splint is on, we’ll check to make sure the blood flow and nerve signals to your hand or foot are still in good shape. If we see any changes that concern us, we’ll quickly take the splint off and take another look at your injury.
Splint Types
There are many types of splints we can use depending on the location of your injury. Commonly used splints on the arm include the coaptation splint, sugar tong splint, posterior long arm elbow splint, ulnar or radial gutter splint, volar or dorsal short arm splint, and thumb spica splint.
Lower-body splints often include the posterior short or long leg splints and the posterior short leg splint with stirrups.
Details of these specific types of splints are provided elsewhere.
Possible Complications of Splinting
Splints are often used to support hurt muscles or bones, but they can sometimes be put on wrong or not do enough to help. It’s important for patients to know what warning signs to look out for, which should be a cue to go back to see your doctor. Negative effects of splinting can involve a setback in healing your broken bone, skin issues, or stiffness in your joints. But if your splint fits you well, is padded correctly, and keeps as few joints as possible from moving, then it should limit these negative effects.
Sometimes, the splinting material can actually cause a thermal injury, similar to a burn, because of the heat it gives off. To decrease the chance of burns, doctors use cool or room-temperature water when working with the splinting material and protect your skin underneath with extra padding. They should also check your skin thoroughly after putting the splint on.
Two serious, but rare, complications from using a splint include compartment syndrome and neurovascular compromise. Compartment syndrome is a painful condition that can happen if the splint is too tight and blocks blood flow, and is more commonly caused by putting a cast on too tightly. Neurovascular compromise is a condition where blood flow to a part is blocked by the splint. Examples include the development of acute carpal tunnel syndrome following the splinting of a dislocated wrist, and blockage of the brachial artery following a fractured elbow. In both of these situations, the splint would need to be removed immediately and the affected limb checked again.
What Else Should I Know About Splinting?
Splints are often used to keep injuries, like sprains, broken bones, or injuries to softer tissue, from moving while they heal. Sometimes, a splint is all that’s needed for these injuries to get better. To make sure your splint works like it’s supposed to, it’s important to understand how to take care of it and know what problems to watch for.
It’s also key to understand that a splint is different from a cast, even though they’re both used to stop movement of an injured area. A splint is a semi-flexible material like plaster or fiberglass that doesn’t cover the whole way around an injury. This allows for any swelling that may happen because of the injury. A cast, on the other hand, wraps fully around an injury, keeping it completely still. Because swelling can be a problem right after an injury, casts usually aren’t used immediately after it happens.
It’s also important to know that using a splint isn’t risk-free. Putting one on improperly can lead to problems. One study found that nearly half of people who got a splint in the emergency room had issues with the soft tissues under the splint, including 6% who developed ulcers. There are still questions about whether casts or splints are better for some specific injuries in kids, like fractures above the elbow.
Applying a splint correctly helps prevent unnecessary pain, complications, and added healthcare costs. It’s crucial to carefully watch for symptoms that can mean serious issues, like compartment syndrome, nerve or blood vessel problems, and skin damage or death. If a person with a splint has numbness or a tingling feeling in the splinted limb, skin that’s gone pale, or increased pain and swelling, they should get medical help right away to check for these possible complications.
