7 reminders for prehospital splinting of long bone and joint injuries

Despite a lack of evidence, applying a splint effectively has been and will likely continue to be a mainstay of EMS practice

Splinting extremity fractures is a traditional field care procedure. From basic first aid to advanced level care providers, much time is spent training on and practicing the myriad of techniques and equipment used to splint broken bones and joints of the arms and legs.

So it might come as a bit of surprise to note that there is very little research supporting the practice of splinting. While there have been a few studies that have compared the different types of splints available on the market, to date there is no evidence that splinting makes a difference in terms of the patient’s outcome.

Nevertheless, because of the purported effects of reducing pain and minimizing further damage, placing a well-sized splint effectively will likely continue to be a mainstay EMS practice.

Check and document circulation after splint application and throughout patient transport. (Photo courtesy of Greg Friese)

There is an art to splinting. Rarely do manufactured splints exactly fit the presenting injury. The splint must often be adapted to provide maximum support to the injured extremity. In turn, this might reduce the pain that results from the soft tissue injury surrounding the fracture.

Here are seven important points to remember when splinting an extremity fracture:

1. Establish the injury’s baseline

Prior to applying a splint, determine if there is adequate circulation, sensation and motor response past the injury site. Circulation can be checked by finding distal pulses or checking for capillary refill on the affected extremity and compare it to the unaffected side. Check for sensation by squeezing a finger or toe and asking if the patient can sense the pressure. Asking the patient to wiggle his fingers or toes can help confirm that motor-neuro pathways are intact.

2. Attempt realignment or repositioning

In an angulated fracture, where the extremity is misshapen, there may be a loss of CSM due to compression or other soft tissue damage at the fracture site. If possible, apply mild traction to the distal extremity and straighten it prior to applying the splint. Doing so may help improve CSM and reduce the chance of further injury. In addition, it will be easier to shape the splint to the injury. A joint such as an elbow or knee may be more difficult to straighten; try to do so carefully if no resistance is felt. Otherwise, you may need to splint the joint in the position it was found.

3. Remember to add padding

Pad the splint so that the voids are filled between the extremity and the splint itself. This makes the splint more secure, improves comfort and may decrease the pain associated with the injury.

4. Make a complete splint

Immobilize the joints above and below the fracture site. This helps to immobilize the break itself and may help the patient reduce accidental movement of the injury.

5. Recheck CSM once the splint is in place

If the patient complains of worsening pain, or there is a loss of CSM, readjust the splint carefully to see if it might have been applied too tightly. Continue to evaluate CSM every few minutes during transport.

6. Extremity fracture may be very painful

Splinting may help reduce the discomfort. Analgesics such as morphine sulfate or fentanyl should be administered by qualified providers and according to protocol.

7. Document

Document your findings and interventions carefully, including the status of CSM before and after applying the splint. Make sure to explain why a splint was indicated for the patient.

What other important findings would you add to this list? We are especially interested in tips and best practices you have for students and new EMS professionals.

Read next:

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This article, originally published in April 2016, has been updated. 

About the author

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at [email protected] and connect with him on Facebook or Twitter.

How to Splint Any Broken Bone

Terry O’Connor

Extremity Splints:

Principles of Splinting

• Visualize the injured body part.
• Continually recheck the patient’s neurovascular status.
• Traction is indicated if the pulse is not palpable.
• Gentle traction involves less than 10 lbs of force.
• Cover open wounds with sterile dressings.
• Immobilize the joints above and below the injury.
• Padding prevents further tissue damage.
• Do not reset open or protruding fractures.
• Splint the extremity in the position in which it was found.
• Splint the patient before transport (if he or she is stable).
• Ice and elevate the injury after immobilization.
  

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Rigid splints

Rigid splints can be improvised from materials such as cardboard, wood, and wire. Proprietary vacuum splints and air splints are commonly used in the field. Rigid splints are attached to the extremity with a variety of fasteners, including tape, straps, gauze, and Velcro. For all splints, ample padding is essential, especially over bony surfaces and swollen tissue to minimize pressure damage and pain.

Soft improvised splint

Soft Splints

A soft splint earns its name from the soft, padded material that is used to secure the injury. Soft splints include sling and swathe splints, pillow splints, and blanket-roll splints. Shoulder, clavicle, upper arm, elbow, forearm, wrist, and even hand injuries are commonly stabilized with a sling and swathe.

Improvised Extremity Splints

Improvised splints can be made from branches, boards, padded pack straps, or rolled-up newspapers or magazines. Slings can also be made from unused clothes.  In these cases, one need not pack additional materials. Disadvantages lie in less effectiveness compared with commercial splinting devices.

Upper Extremity Splints

Shoulder Dislocation

The arm is most comfortable in an abducted position. This can be accomplished with a rolled blanket, a pillow, a jacket, or a SAM splint that has been fashioned into a triangle.

Humeral Shaft Injury

Humeral shaft fracture is often treated with a sling or with a sling and swathe splint alone. For pain control, a splint is often desirable

Elbow Dislocation

A dislocated elbow can be reduced in the field with the appropriate analgesia and experience. The dislocated elbow can also be splinted in place and the patient transported for definitive care

Elbow Fracture

A sugar-tong splint is useful for most elbow injuries. These most commonly include supracondylar, olecranon, and radial head fractures

Photo: sling and swathe and sugar tong splint

Wrist Fracture

The volar wrist or sugar tong splint is used for most wrist fractures, dislocations, sprains, lacerations, and other wrist injuries.

Figure: sugar tong splint

Metacarpal Fractures

Ulnar gutter splints are used for fourth and fifth metacarpal injuries and for corresponding digit injuries.

Figure: ulnar gutter splint

Thumb Injuries

A thumb spica splint is used for suspected scaphoid (navicular) fractures, thumb dislocations and fractures, and ulnar collateral ligament injuries.

Figure: thumb spica

Lower Extremity Splints

Knee injuries

A knee immobilizer splint is used for knee injuries, patella tendon injuries, dislocations, and other severe ligamentous sprains when immobilization is required

Figure: knee immobilizer

Leg Fractures

Long-leg splints are used for tibial and fibular fractures.

Figure: single long leg splint

Ankle and Foot Injuries

Ankle stirrup and figure-8 splints provide for the immobilization of ankle injuries. The ankle stirrup splint can also be used for fractures

Figure: ankle stirrup splint

ADDITIONAL NOTES:

References:

Cassell, O’Connor, Gianotti. Splints and Slings. “Wilderness Medicine, 7^th ed” Elsevier, Philadelphia, PA, 2016.

Schimelpfenig, T.  “Wilderness Medicine, National Outdoor Leadership School.” Stackpole Books, Mechanicsburg PA. 2000

Tilton, B.  “Wilderness First Responder, 2^nd ed. ” The Globe Pequot Press, Guilford CT, 2004.

Wilderson, J et al.  “Medicine for Mountaineering & Other Wilderness Activities” The Mountaineers Books, Seattle WA, 2001.

Splinting teeth for periodontitis | Revda Dental Clinic

Splinting is one of the methods of periodontitis treatment, the purpose of which is to strengthen mobile teeth. This can be achieved in two ways:

– by binding a group of teeth with fiberglass,

– using dentures.

Why is it necessary to splint mobile teeth?

With moderate to severe periodontitis, tooth mobility becomes one of the main symptoms of the disease. Usually, tooth mobility begins with atrophy of bone tissue more than 1/4 of the length of the tooth root. Therefore, there is a direct relationship between the amount of bone atrophy and the degree of tooth mobility.

Exposing the necks of the anterior teeth is one of the visual signs of bone tissue atrophy. On the x-ray in this case, we can see the bone loss. Normally, the bone tissue should reach almost to the neck of the tooth. At the moment when tooth mobility occurs during periodontitis, the rate of destruction (atrophy) of bone tissue accelerates many times over. In turn, the destruction of the bone tissue around the tooth leads to even greater mobility of the teeth. In fact (in the absence of treatment), the process becomes uncontrollable with a constant progression of symptoms of inflammation, including tooth mobility.

Over time, under the influence of chewing load, mobile teeth begin to gradually change their position, tilt in different directions, and also fan out. To prevent all this, splinting of teeth is necessary.

Consider each of these methods.

1. Splinting of mobile teeth with fiberglass.

Splinting of the anterior lower teeth.

If the lower anterior teeth are splinted, in this case, on the inner surface of, for example, 4, 5 or 6 lower anterior teeth, a horizontal groove is first made 1. 5-2 mm high and 2 mm deep. Then a solid fiberglass tape is laid in this groove. After that, the furrow (together with the fiberglass tape in it) is filled with a light-cured composite.

Of course, this method has contraindications, so you need to consult a periodontist. The number of teeth that is taken into the tire will depend on the condition of the entire group of anterior teeth. In addition to the most mobile teeth, fixed teeth (usually fangs) must be taken into the splint. This will unload the moving cutters, because. thanks to a rigid tire, the fangs will take on most of the chewing pressure.

Splinting of the anterior upper teeth.

Splinting of the anterior upper teeth is used when teeth are mobile, at risk or already in the presence of a fan-shaped divergence of teeth. In this case, a groove 1.5-2 mm high and 2 mm deep is also drilled in the teeth. However, most often the groove is drilled on the front surface of the upper teeth, after which a fiberglass tape is placed in it and closed with a photopolymer filling material.

Please note that the filling material can be used to close wide interdental spaces. The number of teeth that will be taken into the splint will depend on the clinical picture.

Splinting of posterior teeth.

If the lateral group of teeth is splinted, then the groove for the fiberglass tape is drilled not on the inner, but on the chewing surface of several teeth. A fiberglass tape is laid in the furrow in the same way and filled with a light composite.

As a result, the effect of splinting is achieved. When a fiberglass tape is illuminated by a photopolymer lamp, it turns into a very hard beam, securely attached to the teeth. The teeth (with the help of such a beam) are linked together and, as a rule, are completely immobile.

A fiberglass beam on the teeth (tire) also allows you to redistribute the chewing load between the teeth. Even biting on one tooth, the load will be evenly distributed over all the teeth included in the tire. This is very important, because with periodontitis, the teeth are not only mobile, but also slightly diverging – they lose contact with each other.

The result of loss of contact between teeth – each tooth bears the maximum load and is not able to distribute the load between adjacent teeth through such contacts. Under these conditions, bone tissue atrophies much faster. Splinting teeth in such conditions will significantly increase the life of such teeth and stop (or slow down) bone atrophy.

2. Splinting of mobile teeth with crowns.

In this case, the teeth are first depulped (the root canals are filled) and then they are turned into crowns. After that, crowns “soldered” to each other, for example, from metal ceramics, are already fixed on them. This splinting option has a significantly longer service life and reliability than fiberglass splinting. However, its cost is higher, and significantly.

3. Splinting of teeth with clasp prostheses.

A big plus of such prostheses is that they allow not only splinting mobile teeth, but also restoring missing teeth at the same time. You can find out more about this type of prosthesis at an appointment with an orthopedist.

Dear patients, when choosing one or another method of splinting, you need to understand the following: — Splinting with fiberglass is a temporary procedure. If the splinting itself is done in accordance with all the rules, the patient observes hygiene, etc., then the service life of such a fiberglass splint can reach 3 years. You only need to show up once a year to polish it. But if the front teeth are splinted, and the patient has no “posterior” chewing teeth, then there is a very high risk of the splint breaking in the very near future due to overload. Those. before splinting with fiberglass, it is very important to replace missing teeth in order to normalize the bite. Splinting with crowns is, of course, more reliable; the service life of metal and ceramic crowns is noticeably higher than that of a fiberglass construction. However, with mild periodontitis, it does not always make sense to grind teeth for crowns (especially in large numbers). Clasp splinting prostheses have many advantages, especially for people who not only need to eliminate tooth mobility, but also fill in a large number of missing teeth.

The article was prepared by: Head of the Department: dentist-therapist Tatyana Sergeevna Loginovskikh

Splinting of the jaw – on the portal 100zubov.ru

Content of the article

• Types of splinting of the jaw
• What is jaw splinting? Detailed description of the

process

• Rehabilitation after a jaw fracture
• How long does a jaw fracture heal?
• Exercises after a broken jaw

Types of jaw splinting

There are several methods of bypassing the jaw for a fracture, which differ in the type of fixation:

• double jaw splinting of teeth in case of bilateral fracture of the jaw with displacement of fragments – used in very difficult cases. To fix the structure, several holes are drilled in the alveolar bone, the jaws are connected by rings clinging to hooks;
• bilateral splinting in case of fracture of the lower jaw – implies the imposition of a more rigid fixing wire on one side. For better fixation, metal hooks or rings can be thrown on the “sixes”;
• one-sided splinting – used for fractures of the halves of the upper or lower jaw. The method involves fixing the bones with copper wire. If there are intact teeth, the tire will be placed on the neck.

Professional dentists work with many types of splints that help to securely immobilize jaw fragments and speed up the process of proper bone fusion.

What is jaw splinting? Detailed description of the

process

The splint is applied by a dental surgeon, and the procedure is preceded by a whole range of preparatory measures:

• panorama image in progress;
• all teeth in the fracture zone are removed;
• fragments of the jaw are connected (according to the “puzzle” principle) and fixed with the help of special devices.

If the splint is single-jawed, the patient is able to open his mouth, the recovery process will not be so difficult.

If the splint is placed on both jaws, unfortunately, the patient will not be able to open his mouth during the period of bone fusion. You will also need to organize food with a straw.

After removing the tires, long-term gymnastics is necessary to develop bones and fully recover from injury.

In the process of splinting, the dentist can also use fiberglass tape, crowns, clasp prostheses, screws and other elements to connect the jaw bones and correct the fusion process.

In parallel with splinting, the patient is prescribed:

• taking antibacterial drugs;
• a course of antibiotics;
• taking anti-inflammatory drugs;
• antifungals;
• vitamins.

Rehabilitation after a jaw fracture

Nutrition after a jaw fracture must be specifically prescribed by a doctor. In most cases, this is liquid food that is fed to the patient through a tube. Useful fermented milk products, cereals in milk, perure compositions. High-calorie protein shakes, vitamin smoothies from fruits and vegetables are well perceived by a weakened body.

The standard amount of protein food (meat) is about 150 grams. Solid fibers can be replaced with mashed baby food, or chopped chicken or turkey soufflé in a blender.

Attention! Particular care must be taken when determining the quality of products. If, for example, these are expired products, or food containing toxins (melon crops of unknown origin), this can provoke nausea and vomiting. Due to the impossibility of opening the mouth, the patient may choke on masses.

Perhaps, in the process of nutrition during recovery, third-party help will be needed (nurse, health worker). Also, in the process of recovery, there is a high probability of weakening the body.

How long does a jaw fracture heal?

On average, the process of wearing a tire takes from two weeks to three months. After removing the splinting structure, the dentist takes a panoramic x-ray to verify the quality of the bone union. If there is a callus on the fracture line, the specialist removes the splint. Followed by period rehabilitation after a mandibular fracture, which can take several weeks. Despite the absence of fixatives, a person must still consume liquid food. To restore mobility, physiotherapy and restorative gymnastics are prescribed.

Exercises after a broken jaw

The basis of therapeutic restorative gymnastics after jaw fractures lies in proper breathing. The main task is to restore the functioning of the respiratory apparatus, and after that to normalize the processes of swallowing and chewing. Also, gymnastic complications will help to avoid complications in the healing process.

The most popular exercises;

• retraction of the lower jaw to the right and left while inhaling;
• raising the lower jaw while inhaling and lowering while exhaling and vice versa – raise the jaw while exhaling and lower it while inhaling;
• yawning inhalation;
• breaths with the pronunciation of the letter “k”;
• slower and more dynamic swallowing of saliva.