ED 103: splinting basics
Thao M Nguyen, MD
Daniel A Hirsh, MD
Pediatric Emergency Medicine
Emory University
Children’s Healthcare of Atlanta
Objectives
 Indications & Contraindications
 Basic Principles
 Common Mistakes
 Prepare patient/parent
 Step-by-step instructions
 Complications
 Discharge Instructions
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Indications
 Temporary immobilization
 Protection
 Pain control
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Contraindications
 Compartment syndrome
 Need for open reduction
 Skin at high risk for infection
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Basic Principles
 Temporary
 Non-circumferential
 Non-weight bearing
 Protect the skin
• Pad bony prominences
• Place a dry splint
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Common Mistakes
 Placement of a Circumferential splint
 Placement a Wet splint
 Placement of a Tight Splint
 Not allowing time for the fiberglass to adequately
harden
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Patient/Parent Expectations
 Placement should not hurt
 Most injuries feel significantly better with splinting
alone
 Splint material will get warm when it hardens
 Should be snug, not tight
• Fingers & toes shouldn’t tingle or turn deep
purple
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Step 1: Choose your splints
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Choosing the splint types:
upper extremities
 Volar
• Distal radius/
ulna & wrist fx
 Sugar Tong
• Distal radius/
ulna & wrist fx
 Long Arm
• Elbow &
forearm injuries
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- Fleisher, 2006 -
Choosing the splint types:
upper extremities
 Ulnar Gutter
• Boxer’s fx and
uncomplicated
4th & 5th
phalangeal fx
 Radial Gutter
• 2nd & 3rd MCP
or phalangeal fx
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- Fleisher, 2006 -
Choosing the splint types:
upper extremities
 Thumb Spica
• Nonrotated,
nonangulated,
nonarticular fx of
the thumb MCP
or phalanx;
gamekeeper’s
thumb; scaphoid
(navicular fx)
 Buddy Tape
- Fleisher, 2006 11
Choosing the splint type:
lower extremities
 Posterior leg
• Foot, ankle & distal fibula fx
• Ankle sprains
 Stirrup
• Foot, ankle & distal
tibia/fibula fx
 Cadillac Splint
- Fleisher, 2006 12
Step 2: Gather all of your supplies
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Splinting
Material
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Stockinette
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“Cotton Wadding”
“Cast Padding”
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Ace wrap
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Shears
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Step 3: Protect the skin
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Apply stockinette to extremity
Extend it past the proximal and
distal ends of where the splint
will end
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Cut out any areas that bunch
up that could damage the skin
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Create thumb hole
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Protect bony
prominences
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Cut splint material
to proper size
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Protect the skin by creating
~1.5 cm border of cotton
by cutting the fiberglass
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Step 4: Activate the Fiberglass
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 Approximate initial hardening times
• Ambient Humidity: 15 min
• Cold Water: 5 min
• Hot Water: 2 min
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Hot water will cause the
fiberglass to harden very quickly
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Cold water
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Keep padding as dry as possible
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Protect the skin. If cotton
padding is wet, dry it.
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Some fiberglass material comes with
a thick padded side and a thin side.
Protect the skin. Always place the
thick-side to the skin-side.
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Step 5: Apply the Splint
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Wrap the splint in place—not
too loose or too tight. Protect
the skin. Do not apply
pressure with finger tips, use
a curved palm.
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Allow time for the fiberglass
to cure
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Step 6: Check splint placement
 Make sure patient has normal sensation distal to
splint
 Make sure there is normal capillary refill after splint
placement
 Make sure the splint does not cause any pain
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Splint Complications
Complications
Prevention
Risk of ischemia
Keep splint snug
Compartment Syndrome
Possible neurovascular compromise
Check distal neurovascular status
after placement
Skin breakdown
Keep splint dry
Use minimal water necessary and dry
thoroughly before placement
Pain or Ineffective
Immobilization
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Use padding
Avoid ‘kinks’
Check splint after
placement
If either of these, replace the splint
Discharge Instructions
 Protect the skin. Keep splint dry
 If extremities become tingly or blue, re-wrap the
bandage
 Don’t allow weight bearing on the splint
 If splint hurts, or there is increasing pain, TAKE
THE SPLINT OFF! Seek medical attention
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Case 1
12 yo female
s/p bike
accident, fell
and landed on
wrists
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Case 2
3 yo male fell while
running and landed
on leg
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Case 2
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Case 3
16 yo female with
left wrist injury ~
6 wks ago.
Extremity was
splinted w/o
reduction; unable
to F/U with
orthopedics
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Suggested Reading
 Fleisher, GR. Textbook of Pediatric Emergency
Medicine, 5th ed, 2006
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