The SplintER Series is back with its second installment! In the first post, Splint 101, we discussed the indications and relative contraindications to splinting. In this post, we focus on the materials used in splinting and some key steps in splint application.
- List the materials that are required to place a splint.
- Be able to discuss some basic principles about the application of a splint.
The Bottom Line
A splint consists of 3 layers:1
- Deep layer = padding
- Middle layer = splint material
- Outer layer = compressive dressing
There are 2 types of traditional splinting material – plaster and fiberglass. Plaster allows for more malleability, whereas fiberglass is more lightweight and easier to apply. There are also prefabricated splints such as Ortho-Glass®.
To apply a splint:
- Place your stockinette (optional) and padding loosely.
- Submerge your material in water to generate an exothermic reaction that will harden your splint.
- Use your palm to conform the material to the extremity.
- Wrap the elastic bandage from distal to proximal and form the desired shape of your splint.
Although it is important that a splint fits to the extremity, it is equally important that it is not so tight that it obstructs venous outflow. Recall that a splinted limb is at risk for compartment syndrome. Be sure to perform a neurovascular exam before and after placing a splint.
For a concise instructional summary, the EMRA Splint Guide is extremely useful.
More Detailed, Step-Wise Instruction on Splint Application
- Splint material: plaster or fiberglass
- Stockinette and/or splint padding
- Bucket of water
- If plaster: Tepid water
- If fiberglass: Cool water
- Elastic bandage, such as ACE or Kerlix wrap
- Trauma shears
Before You Splint
Neurovascular Exam: Before applying a splint, perform a neurovascular exam, findings should be the same before and after splint application.
|Expert: Dr. Elizabeth Delasobera
||Tips on the Neurovascular Exam
Sports Medicine Fellowship Director
- Check and document all pulses in the region
- Check and document capillary refill on the affected and contralateral side
- Check and document sensation on the affected and contralateral side
Stockinette, Padding, and Splint Material
The patient’s stockinette, padding, and splint material all need to be measured out and cut to the appropriate length.
Stockinette: Using your shears, cut the length to be 2-3 cm longer than the expected splint length.
Padding: Using your shears, cut the length to be the same as your expected splint length.
Splint material: Prepare 6-10 layers for the upper extremities and 12-15 layers for lower extremities. These layers will vary depending on the size of the affected limb. Your splint material length should be 1-2 cm longer than the length of your projected splint as splinting material shrinks when it hardens .
Any wounds that are on the affected limb need to be thoroughly assessed, cleaned, and appropriately dressed prior to splint application. Avoid using tape with the dressing; instead secure it with a rolled gauze being careful to avoid excessive compression.
Splinting Application Instructions
- Brown S, Radja F, eds. Orthopaedic Immobilization Techniques. Urbana, IL: Sagamore Publishing; 2015.
- Browner B, Jupiter J, Krettek C, Anderson P. Skeletal Trauma: Basic Science, Management, and Reconstruction. 5th ed. Philadelphia: Elsevier Saunders; 2015.
- Tintinalli J, Stapczynski J, Ma J, Yealy D, Meckler G, Cline D. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Edition. 8th ed. McGraw-Hill Education / Medical; 2015.
- Boyd A, Benjamin H, Asplund C. Principles of casting and splinting. Am Fam Physician. 2009;79(1):16-22. [PubMed]
- Roberts J R, Custalow C B, Hedges J R, Thomsen T W, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 6th ed. Saunders; 2014.