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Subject: Upper Extremity Short Arm 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 (e.g., de Quervain tenosynovitis)
Fractures that meet indications for emergent orthopedic surgical evaluation
PITFALL: Do not cut the patient’s thumb while cutting the stockinet.
PEARL: Make sure to add extra cast padding at the most distal and proximal ends to avoid irritation to the fingers and elbow.
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.
PITFALL: Never use hot water, which can cause an excess 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 will not allow for swelling.
PEARL: Always allow for finger and elbow range of motion.
PEARL: It may helpful to cut a slit in the stockinet between the ring and middle finger so that the splint only incorporates the little and ring finger, leaving the other three fingers free for motion.
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: Creating a slit in the plaster before wetting will make it easier to form a mold around the ring and little finger.
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 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
1) 3M Health Care Professionals. Web site: http://www.3m.Com/product/information/scotchcast-custom-length-splint.html