Splints and Casts
-External immobilization is key for fracture healing and consists of splinting and casting.
Materials
Technique
- Upper Extremity
| Type of splint | Common Indication | Application | Image |
| Coaptation | Humeral shaft # | -elbow flexed at 90 |  |
| Sugar tongue | Distal radius/ulna # | -elbow 90-Wrist 20 extension |  |
| Posterior long arm | Distal humerus, radial head, olecranon #. | -elbow 90-wrist 20 extension or neutral |  |
| Volar splint | Carpal bone # | -wrist extended 20 |  |
| Thumb spica | 1st metacarpal #, scaphoid #. Skier’s thumb (UCL tear) | -wrist 20 extensions-thumb as if holding a can |  |
| Radial gutter | 2nd and 3rd metacarpal # | -forearm neutral-MCP 50 flexion-PIP and DIP 10 flexion |  |
| Ulnar gutter | 4th and 5th (boxer’s) metacarpal # | -MCP 50 flexion-PIP/DIP 10 flexion |  |
| Finger splint | mallet finger, phalangeal # | -DIP in hyper-extension |  |
- Lower extremity
| Type | Indication | Application | Image |
| Posterior Short leg | -Distal tibia/fibula #-All foot bone #- metatarsal displaced # (Lisfranc’s) | -foot 90 to tibia |  |
| Ankle Stirrups | -Ankle sprains grade II/III | -Splint goes up to mid tibia and fibula |  |
Procedure
- Put on a stockinette.
- Apply the cotton padding circumferentially, overlapping each layer by 50%. Generally, 5 layers.
- Cut plaster sheets to size, 10 sheets upper extremity and 15 sheets for lower extremity in thickness.
- Use cold water and soak the plaster. Mold and place on extremity. Takes ~10 min to harden.
- Apply elastic bandage/ACE wrap to finish off.
Video of radial gutter splint from UoT Ortho – https://www.youtube.com/watch?v=fCNoaVVB_t0
Complications
- Pressure Sores – Make sure there is enough padding, especially on bony prominences.
- Compartment syndrome – Any acute fracture with possibility of swelling should not be casted. Worry about 5Ps (pain, paresthesia, pulseless, pallor, paralysis).
- Stiffness – Make sure all other joints can mobilize. Prolonged immobilization causes stiffness specially in hands. Hand physiotherapy is key.
Sources
-Emergency medicine procedures, Eric Reichman – Chapter 91; casts and splints
Copyedited by: Kurt Ebeling, Medical Student, University of Alberta
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