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Subject: Lower Extremity Splinting
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Elastic bandage (e.g., Ace bandage)
To improve pain, decrease blood loss, reduce the risk for fat emboli, and minimize the potential for further neurovascular injury associated with fractures
To improve pain associated with sprains
To immobilize tendon lacerations
To immobilize extremities associated with deep lacerations across joints
To immobilize painful joints associated with inflammatory disorders
Fractures that meet indication for emergent orthopedic surgical evaluation
PEARL: Having the patient lie in the prone position on the examination table will make placing the splint an easier task.
PEARL: Make sure to add extra cast padding at the most distal and proximal ends to avoid irritation to the ankle and buttock.
PEARL: Use extra padding at sites of bony prominences and ends of splint to decrease the chance of pressure sores.
PEARL: Cast padding should be rolled with the bulk of the material on top of the sheet adjacent to the skin. The rolling should be effortless.
PEARL: Alternatively, when using fiberglass material, simply measure the extremity to be splinted. Unroll a length of fiberglass material, and accordion fold the material to the correct length. Then use scissors to cut the accordion fold away from the remaining roll.
PITFALL: Never use hot water, which can cause an excessive thermochemical reaction and extremely rapid setting of the cast material. The cast material should never be wrung out.
PITFALL: Always use the palms of your hands to smooth and mold the splint. Excessive use of the fingers can cause indentions in the splint, which can lead to pressure sores.
PITFALL: Wrapping the elastic bandage too tightly could lead to vascular compromise and not allow for swelling.
PEARL: Always allow for ankle and hip range of motion to prevent joint stiffness.
PITFALL: Failing to place the ankle in 90 degrees of dorsiflexion will make it more difficult for your patient to regain range of motion once the splint is removed.
PEARL: When immobilizing Achilles tendon injuries, the ankle should always be splinted in plantar flexion. Failing to splint an Achilles rupture in plantar flexion could allow tracking of the proximal portion of the tendon high into the leg, making surgical repair more difficult.
PITFALL: Never use hot water, which can cause an excess thermochemical reaction and extremely rapid setting of the material. The splint material should never be wrung out.
PEARL: For unstable ankle fractures, this splint should be used in combination with a stirrup splint.
PEARL: This part of the splint is to prevent inversion and eversion of the ankle.
PEARL: In some patients, the long splint material (5 inches × 30 inches) may not be long enough to reach from one side of the knee to the other. In this situation, you can measure and tear the material to cover from the medial side of knee to the lateral heel. Then measure and tear another piece to cover from the lateral side of the knee to the medial heel. When placing the splint, the two pieces should overlap at the undersurface of the heel.
Pressure sores result from insufficient padding over bony prominences or indentions in plaster from improper use of fingers to mold the splint or improper support of splint while hardening.
Compartment syndrome occurs less commonly with splints than casts. Presenting signs of compartment syndrome include pain, pallor, paresthesias, paralysis, and lack of pulse. Avoid this by wrapping cotton padding with minimal pressure and minimize swelling with ice and elevation. Immediate splint removal and orthopedic consultation is required if compartment syndrome is suspected.
Infection may occur if the patient places sharp instruments down the splint for scratching (e.g., a coat hanger). It is more common with open wounds present prior to splinting. The provider may prevent this complication by cleaning wounds well before splinting.
Heat injury may result from plaster-generated heat during crystallizing. Reduce the risk of thermal injury by applying an appropriate amount of cotton padding and using room-temperature water.
Joint stiffness may occur. Splinting the extremities in their position of function will reduce joint stiffness and make it easier to get range of motion back once the splint is removed. Avoid prolonged immobilization if possible.
BSN medical. Web site: http://www.bsnmedical.com
Specialized Medical Supplies Co. Ltd. Web site: http://www.specialized-medical/Plaster-of-Paris-slabs.htm
3M Health Care Professionals. Web site: http://www.3m.Com/product/information/scotchcast-custom-length-splint.html