Splints and Casts
-External immobilization is key for fracture healing and consists of splinting and casting.
- Upper Extremity
- Lower extremity
|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|
- 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
- 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.
-Emergency medicine procedures, Eric Reichman – Chapter 91; casts and splints
Author: Ali Khorrami, University of British Columbia