Principles of Splinting

Core Clerkship in Emergency Care

University of ColoradoSchool of Medicine

Teaching team overview:

This module should take about one hour to complete. The most important objective is to let each student have a chance to actually make a splint. The easiest way to do this is to have the students divide into pairs, then each student can place a splint on his/her partner. Have the pairs show their splints to the rest of the group, so every student has a chance to see what each of the splints looks like. There will usually be six students (three pairs), so one suggestion is as follows:

1. three-way lower extremity

2. thumb spica using plaster

3. thumb spica using orthoglass

4. three way upper extremity

5. ulnar gutter

6. volar/dorsal of wrist

Please note that Orthoglass is very expensive. Have the students make their splints from plaster, except for one small upper extremity splint (see above).

The following is from the student handout. They will also have a handout with pictures of each of the splints.

  1. Indications for splinting
  1. Decrease pain from infection, inflammationor injury
  2. Protect extremity from further injury
  3. Maintain bony alignment (fractures, dislocations, severe ligament or tendon injury)
  4. Decrease stress on repaired tendon, deep laceration, laceration under tension (e.g., across a joint)
  5. Reduce edema
  1. Common splinting materials
  1. Plaster of Paris (gypsum)
  2. Prefabricated splint rolls (plaster or fiberglass)
  3. Premade splints

  1. Equipment and supplies for plaster splinting
  1. Plaster of Paris
  2. Stockinette
  3. Padding (Webril)
  4. Elastic bandage or cotton bias
  5. Adhesive tape
  6. Bandage scissors
  7. Bucket or basin
  8. Mess reduction gear (gloves, sheets/towels)
  1. Plaster splinting procedure
  1. Patient preparation: skin should be clean, any skin wounds dressed
  2. Application of stockinette
  3. Application of padding material:

--Fingers and toes, bony prominences

--2” for hands, feet

--3-4” for arm

--4-6” for lower extremity

  1. Plaster preparation:

--warm water sets faster than cold

--8-10 layers upper extremity

--12-15 layers lower extremity

  1. Splint application
  2. Splint curing: avoid stressing splint for 24 hours
  1. Complications of splints
  1. Ischemia
  2. Heat injury: peak temp 5-15 minutes
  3. Pressure sores:

--inadequate padding

--excess or wadded padding

--ridges or bumps in the plaster

  1. Infection
  2. Dermatitis
  3. Joint stiffness
  1. Splint care and discharge instructions
  2. Keep plaster dry
  3. Useless to apply ice over plaster/fiberglass splint
  4. Elevate, minimize weight bearing
  5. Return to ED if increased pain, numbness, pallor, weakness

  1. Common splints used in the Emergency Department and their indications
  1. Finger splint: minor sprains, lacerations, fractures
  2. Ulnar gutter splint: 4th and 5th metacarpal and digit injuries
  3. Radial gutter splint: index and long finger, 2nd and 3rd metacarpal injuries
  4. Thumb spica splint: scaphoid, lunate, thumb injuries
  5. Volar forearm/hand splintor volar/dorsal splint: carpal, metacarpal injuries
  6. Long arm posterior splintor double sugar tong splint: elbow, proximal forearm
  7. Sugar tong splint: distal radius/ulna (prevent pronation/supination)
  8. Posterior leg + stirrup = three-way splint: distal tib/fib, reduced ankle dislocation, tarsal and some metatarsal fractures
  1. Common premade splints in the Emergency Department
  2. Aircast: ankle sprains
  3. Knee immobilizer: ligamentous knee injury
  4. Hard-soled shoe: splint protection, toe fractures, some metatarsal fractures
  5. Shoulder immobilizer/sling: shoulder or proximal humerus injury or inconjunction with long arm splints

Updated April 2007