Overview of Long Arm Splinting
A longarm splint is a type of support used to stabilize injuries to the upper part of your arm, which includes your elbow and wrist. It’s used in different scenarios, commonly for broken bones or injuries to the soft tissues – like muscles and ligaments. It’s designed in such a way to limit the movement of your elbow and your wrist. This means you can’t easily bend or straighten your elbow and wrist, or rotate your forearm.
This splint is often the first step in treatment right after an injury. It keeps the arm secure while allowing any swelling to go down. Once the swelling is under control, doctors will figure out the next steps. This could involve putting on a cast or even undergoing surgery, depending on the severity of the injury.
Anatomy and Physiology of Long Arm Splinting
Long arm splints, which are supports for the arm, need to be a good fit for each patient’s unique anatomy. They shouldn’t be too tight or too loose anywhere on the device. The materials should be shaped to fit comfortable around the bony parts of the arm, and the splint should be formed in a way that keeps the arm in the desired resting position.
Why do People Need Long Arm Splinting
A long arm splint is a type of cast used to help heal certain injuries, usually to the bones in the arm or elbow. It works by keeping the injured arm or elbow from moving, which helps the bone heal. Below are some conditions when a doctor might use a long arm splint:
- When the humerus bone (the bone in your upper arm) is broken.
- When the olecranon (the pointed bone at the tip of your elbow) is broken.
- When the radial head (the top of the radial bone, which is one of the long bones in your forearm) is broken. Although, in most cases, just using a sling to support the arm is preferred.
- When there’s a fracture in the capitellum (the round knob on the end of the humerus), especially if there’s a lot of swelling.
- When the bones in the elbow are broken and dislocated (moved out of place), after the doctor had put them back in the correct place.
There’s also something known as a Monteggia fracture/dislocation. In this type of injury, the ulna (the other long bone in your forearm) is broken close to the elbow, and the head of the radius is also dislocated. Health professionals sometimes use a simplified term, “MUGR,” to remember this injury.
- “M” stands for Monteggia fracture.
- “U” stands for the Ulna bone fracture which happens closer to the elbow (also proximally relative to the two bones in the forearm).
- “G” stands for Galeazzi fracture.
- “R” stands for the Radius bone fracture which happens closer to the hand (also distally relative to the forearm).
Long arm splints can also be useful in treating serious soft tissue injuries, where the tissues around the bones (like muscles and ligaments) are damaged. However, in many situations, a simple sling can provide enough support and comfort to the patient.
Collateral ligament injuries or UCL (Ulnar collateral ligament) injuries, which involve damage to the ligaments in the elbow, can also be treated using long arm splints.
Equipment used for Long Arm Splinting
When creating a long arm splint, which is a support for the arm, choosing the right materials is really important. The healthcare provider can use either plaster or fiberglass.
Plaster is a good choice because it fits very well to the shape of the patient’s arm. The downside is it isn’t as strong as fiberglass and might wear out faster.
Fiberglass, on the other hand, is tougher and can resist wear and tear for a longer time, but it’s harder to shape and might not fit the patient’s arm as well. Also, fiberglass sometimes needs a tighter bandage which can be uncomfortable if not loosened. Another thing to know is that fiberglass looks more consistent on X-ray images than plaster, so it could potentially make a fracture easier to spot.
Who is needed to perform Long Arm Splinting?
When it’s time to put on a long arm cast, it’s most effective if there’s someone else there to assist the doctor. This helper can keep the patient’s arm in the right position while the cast is being made and shaped. Doing this can help ensure the materials are correctly placed and reduce any discomfort or awkwardness that might come up if the cast needs adjusting later on. For instance, it can help avoid issues with the front part of the elbow (also known as the anterior cubital fossa).
Preparing for Long Arm Splinting
Putting on a long arm cast involves a few steps. The doctor will choose the size of the cast material, either plaster or fiberglass, that fits the patient’s arm best. For adults, they usually use a cast material that is around 3 inches wide. For children, a slightly smaller size, around 2 inches, is often used. The doctor will measure the length of the cast ahead of time to make sure it fits properly.
If they are using plaster, they will usually need eight to 10 layers to make the cast strong enough. If they use fiberglass, the cast comes ready-made in most cases. They will also use a special type of padding for comfort. In some cases, they might use a soft, stretchy material called a stockinette under the cast for extra comfort.
The final step is to wrap the cast with an elastic bandage. All these steps ensure the cast fits securely and comfortably on the patient’s arm.
How is Long Arm Splinting performed
To start making the splint, the patient should be in a comfortable position. The splint begins at the wrist, extends past the elbow, and is then placed on the upper arm. The number of splint layers depends on how much swelling is expected, but usually, it ranges from two to four layers. It’s important to make sure the end of the splint allows for the thumb and joints close to it to move freely.
Extra care should be taken at the elbow, the splint needs to be carefully applied to ensure enough padding for the sharp point part of it, which is called the olecranon. Most times, the doctor can tear pieces of the splint to lay on the back part of the elbow to provide padding without making the area in front of your elbow too bulky. The splint should extend to the upper third part of your arm. And remember, it’s very important to put the splint on with 50% overlap to ensure even padding without any irregularities, which could irritate your skin.
Next, the sugar tong, which is the part of the splint that goes around your elbow to both sides of your wrist, will be prepared using plaster or fiberglass soaked in cold water. It’s important that this part of the splint stops about a half inch short of the end of the padding to make sure it doesn’t rub against the soft part of your hand or limit the motion of your hand joints.
After the sugar tong is applied, it is wrapped again with one layer of the padding, this way, when the next part of the splint is applied, it will not stick to it. Afterwards, the posterior mold, which is the part that goes on the back side of the splint from the bottom to the top, is applied. Like the sugar tong application, it’s very important to accurately place this so as not to restrict movement in joints that don’t need immobilization.
Lastly, an elastic bandage is wrapped around the splint starting from the bottom and ending at the top. But care should be taken so there is enough room for your thumb to move freely.
If we are using fiberglass instead of plaster for your splint, the steps are the same, but there is no need to wrap the fiberglass with a padding layer provided it comes in a synthetic cover. And for your comfort, a small portion of the fiberglass is usually cut back from the synthetic cover to create a soft end to the splint material.
After accurately and efficiently applying the materials, the splint is comfortably shaped to hold the injured area in place for better healing. When the plaster or fiberglass hardens, we would instruct you on how to take care of the splint.
Possible Complications of Long Arm Splinting
Just like any other treatment method, using a splint can come with some difficulties or side effects.
* If the splint does not have enough padding, the skin on the part of the body where the splint is worn might start to break or crack.
* Wrapping the splint too tightly might make the patient feel uncomfortable, and it might also cut off the blood flow to the body part that’s been splinted.
* When the splint starts to set and harden, it may give off some heat, which might cause discomfort.
* Plaster, a material commonly used to make splints, might irritate your skin if it comes into direct contact with it.
* On the other hand, if the splint has too much padding, it might become loose and may not stabilize the injury effectively.
* A splint that has been applied too tightly or pressed too hard on one area can cause skin damage.
What Else Should I Know About Long Arm Splinting?
A long arm splint is a helpful tool when treating various injuries to the upper part of your body, like your arm. The benefit of this type of splint is that it keeps the injured part of your body still, while still allowing room for any swelling that might occur because of the injury. Usually, a long arm splint is the first step in the treatment. After a while, this splint is removed, and the patients move onto the next stage of treatment, which usually involves a cast.
It’s important for the healthcare professional to take time to get to know the materials and techniques needed to create a comfortable, well-padded splint. Why? Because it’s crucial that the patient is positioned properly in the splint to maintain the reduction (realigning the bones), and it has to be roomy enough to allow for any possible swelling of the soft tissue around the injury.
