Associate Professor, Emergency Medicine, Georgetown University
Team Physician for Georgetown University
Consulting Physician for the Washington Capitals

Understanding proper splinting technique is a critical skill for all emergency physicians. Though many facilities have nurses and patient care technicians who may assist with splint application, the ultimate responsibility for proper splint application lies with the physician.

Critical Basics:

1. Protect the skin: Head from splint activation can cause burns. Wrinkles in layers can cause friction, blisters, or infection.
2. Ensure patients understand splint care: showering, weight bearing, unwrapping and re-wrapping if the splint feels too tight. Proper follow-up is critical.

Tricks of the Trade:

1. Makeshift Cuff and Collar: Use a disposable wrist restraint to create this splint.
2. How to avoid the mess of plaster: Before activation, layer plaster and place in a sleeve (stockinette). Place the sleeve into lukewarm water, and remove excess water by sliding the sleeve between your index and long finger. Mold the sleeve to the affected body part.
3. Remember the equinus position: Utilize this for Dancer’s fractures and Achilles ruptures.

The most important advice: Practice splinting! Make your own splints and check the ones that nurses and technicians make for your patients. If it isn’t right, try making it again. In some cases, a bad splint may be worse than no splint at all!