The SplintER series is back with its fourth installment! In this series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize some of the most commonly deployed splints in the ED. Peer-reviewed by sports medicine experts (Dr. Kori Hudson and Dr. Anna Waterbrook), these injury-splint summary tables provide information on the origin, insertion, and positioning for each splint, along with the recommended number of layers of plaster.
Learning Objectives
- Review splint techniques associated with injuries commonly managed in the ED.
- Learn some basic tips to help with successful placement of these splints.
Upper Extremity1,2
Humerus
| Fracture | Splint | Technique |
|---|---|---|
| Proximal humerus | Cuff and collar (or sling) |  |
| Humeral shaft | Coaptation |  |
| Supracondylar | Long arm posterior or double sugar tong |
|
Forearm
| Fracture | Splint | Technique |
|---|---|---|
| Olecranon/coronoid | Long arm posterior | |
| Radius or ulna – proximal or midshaft | Long arm posterior, or double sugar tong (if fracture is unstable or complex) |
|
| Radius – distal, isolated | Thumb spica or volar |
|
| Radius or ulna – distal, complex | Single or double sugar tong |
|
| Ulna – styloid | Single sugar tong | |
Wrist and Hand
| Fracture or Injury | Splint | Technique |
|---|---|---|
| Scaphoid, trapezium, or lunate fracture | Thumb spica | |
| Lunate dislocation | Sugar tong | |
| Triquetrum, pisiform, trapezoid, capitate, or hamate fracture | Volar |  |
| Ulnar collateral ligament injury, thumb MCP dislocation, De Quervain’s tenosynovitis |
Thumb spica | |
| 1st metacarpal fracture | Thumb spica | |
| 2nd or 3rd metacarpal fracture | Volar or radial gutter |
|
| 4th or 5th metacarpal fracture | Ulnar gutter |  |
| 1st phalanx fracture | Thumb spica |  |
| 2nd or 3rd proximal or middle phalanx fracture | Radial gutter or buddy taping |
 
|
| 4th or 5th proximal or middle phalanx fracture | Ulnar gutter, or buddy taping (acceptable if the injury is a non-displaced fracture through the phalangeal shaft) |
|
| Distal phalanx fracture | Aluminum U-shaped splint |  |
Lower Extremity1
Tibia, Fibula, Ankle, and Foot
| Fracture or Injury | Splint | Technique |
|---|---|---|
| Distal tibia or distal fibula fracture | Posterior short leg (stirrup splint can be applied for additional stability) |  |
| Ankle sprain: Grade 2 or 3 | Stirrup |  |
| Talus, calcaneus, navicular, cuboid, cuneiform fracture | Posterior short leg | |
| Metatarsal fracture | Posterior short leg | |
| Lisfranc fracture | Posterior short leg | |
| Expert Peer Review: Kori Hudson, MD |
|
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:
Tricks of the Trade:
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! |
Thanks to Dr. Anisha Molholtra for the professionally sketched splint images!
References
- Boyd A, Benjamin H, Asplund C. Splints and casts: indications and methods. Am Fam Physician. 2009;80(5):491-499. [PubMed]
- EBSCOhost Login . Metacarpal head fracture – emergency management. http://www.dynamed.com/login.aspx?direct=true&site=DynaMed&id=903302. Published April 5, 2018. Accessed July 1, 2018.
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