Splinting fracture. Splinting Techniques: A Comprehensive Guide to Fracture Immobilization

19.10.202013.07.2023 by alexxlab

What are the key principles of effective splinting. How can healthcare professionals improve their splinting skills. When is splinting preferred over casting for injury management. What are the potential complications of improper splinting techniques.

Содержание

Understanding the Basics of Splinting in Musculoskeletal Injuries

Splinting is a crucial technique in the management of musculoskeletal injuries, providing stability and promoting healing. It involves the application of an external device to immobilize an injury or joint, most commonly made from plaster. The primary goals of splinting are to:

Decrease the likelihood of further damage
Protect soft tissues
Alleviate pain
Accelerate healing

Splinting is particularly useful in cases of instability resulting from:

Fractures (injuries to bones)
Dislocations (injuries to joints)
Strains (injuries to muscles)
Sprains (injuries to ligaments)

Is splinting always the best option for immobilization? While splinting is highly effective in many cases, it’s important to differentiate between splints and casts. Unlike casts, which provide rigid, circumferential immobilization, splints are more flexible and accommodating to soft tissue swelling. This makes splints particularly suitable for acute post-injury settings.

Indications and Contraindications for Splinting

Proper identification of when to use splinting is crucial for effective injury management. What are the primary indications for splinting?

Acute fractures requiring temporary immobilization
Soft tissue injuries with instability
Joint dislocations after reduction
Sprains and strains requiring support
Post-operative immobilization in some cases

Are there situations where splinting should be avoided? Indeed, certain conditions may contraindicate the use of splinting:

Open fractures requiring immediate surgical intervention
Injuries with significant neurovascular compromise
Compartment syndrome or high risk of developing it
Unstable fractures that require more rigid immobilization

Essential Equipment and Preparation for Splinting

Successful splinting requires appropriate equipment and thorough preparation. What materials are typically used in splinting?

Plaster or fiberglass splinting material
Padding material (e.g., cotton padding, foam)
Bandages or elastic wraps
Scissors
Water basin (for plaster splints)
Gloves

How should healthcare professionals prepare for the splinting procedure?

Gather all necessary equipment
Explain the procedure to the patient
Position the patient comfortably
Perform a thorough neurovascular assessment before splinting
Ensure adequate analgesia if needed

Techniques for Proper Splint Application

Mastering the technique of splint application is crucial for optimal outcomes. How should a healthcare professional apply a splint?

Measure and cut the splinting material to the appropriate length
Apply padding to protect bony prominences and skin
Mold the splint to the affected area, maintaining proper anatomical alignment
Secure the splint with bandages or elastic wraps, avoiding excessive pressure
Reassess neurovascular status after splint application

What are some key considerations for different types of splints?

Upper extremity splints: Maintain neutral wrist dorsiflexion when crossing the wrist
Pediatric elbow splints: Avoid flexing the elbow more than 90 degrees in supracondylar fractures
Lower extremity splints: Ensure proper foot positioning to prevent contractures

Common Pitfalls and Complications in Splinting

Despite its benefits, splinting can lead to complications if not performed correctly. What are the potential risks associated with improper splinting?

Pressure sores and skin breakdown
Compartment syndrome
Neurovascular compromise
Joint stiffness or contractures
Malunion or delayed union of fractures

How can healthcare professionals minimize these risks?

Use appropriate padding, especially over bony prominences
Avoid overly tight application of splints or wraps
Regularly reassess neurovascular status
Provide clear patient instructions for monitoring and care
Schedule timely follow-up evaluations

Patient Education and Follow-up Care

Proper patient education is crucial for successful splinting outcomes. What information should be provided to patients with splints?

Instructions for keeping the splint clean and dry
Signs and symptoms that warrant immediate medical attention (e.g., increased pain, numbness, color changes)
Proper positioning and elevation of the affected limb
Activity restrictions and recommended exercises, if applicable
Follow-up appointment schedule

How often should patients with splints be reevaluated? The frequency of follow-up depends on the specific injury and patient factors, but generally:

Initial follow-up within 24-48 hours to assess for any immediate complications
Regular follow-up every 1-2 weeks to monitor healing progress
Additional evaluations as needed based on the patient’s condition and recovery

Advances in Splinting Technology and Materials

The field of splinting continues to evolve with technological advancements. What are some recent innovations in splinting materials and techniques?

3D-printed custom splints
Smart splints with sensors for monitoring healing progress
Biodegradable splinting materials
Hybrid splint-cast combinations for enhanced stability

How might these advancements impact patient care? These innovations have the potential to:

Improve comfort and fit
Enhance healing outcomes
Reduce complications
Provide more detailed data for healthcare providers

The Role of Splinting in Telemedicine

With the rise of telemedicine, how has the approach to splinting changed? While hands-on application of splints requires in-person care, telemedicine has influenced splinting practices in several ways:

Remote assessment of splint-related complications
Virtual follow-up appointments for monitoring healing progress
Telehealth education sessions for patients on splint care
Remote consultations between primary care providers and specialists

Splinting in Special Populations

Certain patient populations require special considerations when it comes to splinting. How should healthcare professionals approach splinting in these groups?

Pediatric Patients

Children present unique challenges in splinting due to their growth and activity levels. Key considerations include:

Using age-appropriate splinting materials and techniques
Frequent reassessment to accommodate growth
Educating both the child and caregivers on proper splint care
Balancing immobilization with the need for continued development

Elderly Patients

Older adults may have comorbidities that affect splinting decisions. Important factors to consider are:

Skin fragility and increased risk of pressure sores
Potential impact on mobility and independence
Cognitive status and ability to follow care instructions
Coordination with other healthcare providers for comprehensive care

Athletes

For athletes, splinting must balance injury management with the desire to return to sport. Considerations include:

Using sports-specific splints when appropriate
Incorporating rehabilitation exercises into the treatment plan
Educating on the risks of premature return to activity
Coordinating with athletic trainers and coaches

The Economics of Splinting

What are the economic implications of splinting in healthcare? Understanding the financial aspects of splinting is crucial for healthcare systems and policymakers:

Cost comparison between splinting and alternative treatments
Impact on healthcare resource utilization
Potential for reducing long-term complications and associated costs
Insurance coverage and reimbursement considerations

Ethical Considerations in Splinting

Are there ethical issues to consider in splinting practice? Several ethical considerations come into play:

Informed consent and patient autonomy in treatment decisions
Balancing immediate comfort with long-term outcomes
Equitable access to quality splinting materials and care
Responsible use of resources in healthcare settings

Future Directions in Splinting Research

What areas of splinting require further research? As the field evolves, several key areas warrant investigation:

Long-term outcomes of different splinting techniques
Development of novel, biocompatible splinting materials
Integration of wearable technology with splinting for real-time monitoring
Comparative studies of splinting versus alternative immobilization methods
Optimization of splinting protocols for specific injury types

Integrating Splinting with Holistic Patient Care

How can splinting be incorporated into a comprehensive treatment approach? Effective splinting should be part of a broader care strategy that includes:

Pain management techniques
Nutritional support for optimal healing
Psychological support, especially for injuries impacting daily life
Occupational therapy to maintain function during recovery
Long-term rehabilitation planning

The Role of Artificial Intelligence in Splinting

Can artificial intelligence improve splinting outcomes? AI has the potential to revolutionize splinting in several ways:

AI-assisted decision support for splint selection and application
Predictive modeling for complications and healing trajectories
Automated monitoring of splint fit and effectiveness
Personalized treatment plans based on patient-specific data

Global Perspectives on Splinting Practices

How do splinting practices vary around the world? Understanding global variations can lead to improved care:

Differences in splinting materials based on resource availability
Cultural influences on patient compliance and splint acceptance
Variations in training and certification for splinting techniques
Impact of climate and environmental factors on splint durability

Splinting in Disaster and Emergency Situations

How does splinting adapt to mass casualty or disaster scenarios? Emergency situations require unique approaches:

Triage systems for prioritizing splinting in multiple injuries
Use of improvised splinting materials when standard supplies are unavailable
Training first responders in basic splinting techniques
Protocols for temporary splinting during patient transport

In conclusion, splinting remains a fundamental skill in the management of musculoskeletal injuries. As healthcare continues to evolve, so too will the techniques, materials, and applications of splinting. By staying informed about best practices and emerging technologies, healthcare professionals can ensure optimal outcomes for their patients requiring splint immobilization.

Splinting – StatPearls – NCBI Bookshelf

Continuing Education Activity

Injuries that result in instability require immobilization, decreasing the likelihood of further damage, protecting soft tissues, alleviating pain, and accelerating healing. Instability may result from direct injury to the bones (fracture), joints (dislocation), or the soft tissues such as the muscles (strain) or ligaments (sprain). Following the diagnosis of an unstable injury, a splint may be the best treatment option and is loosely defined as an external device used to immobilize an injury or joint and is most often made out of plaster. A splint must be differentiated from a cast, to determine the best form of immobilization based on the clinical scenario. This activity remains the role of the healthcare team in assessing and applying splinting immobilization to injuries that will benefit from such a strategy.

Objectives:

Identify the indications, and contraindications of splinting in the acute setting.
Describe the equipment, personnel, preparation, and technique in regards to splinting common musculoskeletal injuries such as sprains, fractures, and soft tissue injuries.
Review the potential complications of splinting for musculoskeletal injuries.
Outline the interprofessional team strategies for improving care coordination and communication to improve splinting outcomes.

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Introduction

Patients commonly present to emergency departments, primary care offices, or specialty clinics with musculoskeletal injuries. The initial management of an acute traumatic limb injury involves a thorough history and physical evaluation of the injury, which includes a motor, sensory, and neurovascular examination. Injuries that result in instability require immobilization, decreasing the likelihood of further damage, protecting soft tissues, alleviating pain, and accelerating healing. Instability may result from direct injury to the bones (fracture), joints (dislocation), or the soft tissues such as the muscles (strain) or ligaments (sprain). Following the diagnosis of an unstable injury, a splint may be the best treatment option and is loosely defined as an external device used to immobilize an injury or joint and is most often made out of plaster. A splint must be differentiated from a cast, to determine the best form of immobilization based on the clinical scenario. Contrary to a splint, a cast is a circumferential application of plaster that rigidly immobilizes a particular joint or fracture. Because of their circumferential restrictive nature, casts are not placed in the acute post-injury setting as they do not accommodate for soft tissue swelling.[1]

Different forms of splints may be fashioned depending on injury location and position of immobilization needed. The goal of splinting is to correct and restore anatomic length, rotation, and angulation of a patient-specific injury. Splints are treatments utilized by a variety of medical personnel as either a temporizing or definitive management strategy for stable fractures.[2][1][3] Proper splint placement is essential since malpositioning can cause undue pain, malreduction, and skin breakdown. Improper splinting not only necessitates replacement, but splint-related soft tissue complications are the second most common iatrogenic cause for referral to plastic surgery.[4] Poor splinting techniques are common, with one study demonstrating inappropriate splinting on 93% of patients.[5] As such, a thorough understanding of the indications, contraindications, and approach to proper splint placement is essential for practitioners that treat patients with acute musculoskeletal injuries.

Anatomy and Physiology

Fashioning a splint takes patient-specific anatomy into account. The splint should be fashioned such that it restores anatomic resting joint position to minimize adverse outcomes. Plaster or fiberglass splints are the mainstays of acute immobilization. Plaster is the preferred malleable material to maintain a position-specific reduction, but it is limited by drying time, user experience, and provider-placed mold. Fiberglass splints are lighter, easier to apply, and more porous, but are more expensive and provide a less-reliable mold. Pre-fabricated splints (such as foam splints or braces) may play a role in chronic injuries necessitating immobilization for structural support or pain control but are less commonly used in the acute fracture setting.

Upper extremity splints crossing the wrist should maintain neutral wrist dorsiflexion, and vascular status should be assessed before and after application to reduce the risk of subsequent complications. In pediatric patients with supracondylar elbow fractures, the arm should never be splinted with the elbow flexed more than 90 degrees, as this increases the risk of Volkman’s ischemic contracture.[6] Lower extremity splints crossing the ankle joint should place the ankle in a resting neutral position without excessive ankle plantarflexion to prevent resultant Achilles flexion contractures. Excess pressure on the soft tissues may decrease the blood flow to the skin surface; this is of particular importance in areas with bony prominences, such as the elbow, knee, and calcaneus, as excess pressure may cause skin irritation and necrosis. Additional layers of protection during the splinting process is of great importance in these regions.

Conversely, excessive splint laxity may permit excessive movement of the injury, and, in cases of fractures, this may result in loss of bony reduction. If a splint is a definitive therapy, there must be a stable injury pattern. Fractures that are difficult to reduce, excessively shortened, or comminuted are not candidates for definitive splinting, as they usually will need operative intervention by an orthopedic surgeon. However, unstable injuries may still benefit from temporary splinting if the patient is not an immediate candidate for surgery due to concurrent medical issues or if there is an anticipated delay before definitive operative fixation. In these cases, temporary splinting is necessary to avoid further injuries, immobilize the fracture, and promote healing.[7]

Indications

Splints are placed to immobilize musculoskeletal injuries, support healing, and to prevent further damage. The indications for splinting are broad, but commonly include:

Temporary stabilization of acute fractures, sprains, or strains before further evaluation or definitive operative management
Immobilization of a suspected occult fracture (such as a scaphoid fracture)
Severe soft tissue injuries requiring immobilization and protection from further injury
Definitive management of specific stable fracture patterns
Peripheral neuropathy requiring extremity protection
Partial immobilization for minor soft tissue injuries
Treatment of joint instability, including dislocation

Contraindications

No specific contraindications to splinting exist. However, certain injuries and patient-specific comorbidities require special attention:

Injuries that violate the skin or open wounds. Antibiotic administration should be considered for these patients depending on the severity of the lesion.[8] These patients also require additional soft tissue care, which may necessitate tissue debridement and skin closure before splint application.
Injuries that result in sensory or neurologic deficits. The complications of splint placement such as compartment syndrome, pressure injuries, or malreduction may go unnoticed if the patient has a concurrent nerve injury. These patients should undergo evaluation by a surgeon before splint application as neurologic findings may be a sign of a surgical emergency.
Injuries to the vasculature require special attention by vascular surgeons, as these may require urgent operative intervention. Furthermore, evaluation of the vasculature is essential both before and after splint application, as the reduction of some fractures may result in acute arterial injury or obstruction if trapped between the fracture fragments.
Patients with peripheral vascular disease or neuropathy. Special care should be taken when applying lower extremity splints in these patients since their baseline sensation may be altered. These patients have difficulty detecting pressure sores, skin irritation, and possible vascular compromise.

Equipment

Obtain and organize all equipment before splint application. The necessary equipment for a plaster or fiberglass splint includes:

Sheet or towel to protect patient clothing
Stockinette (a soft, loosely knitted stretch fabric) or fabric underpadding
Undercast padding, which is typically made out of cotton.
Plaster (8-10 sheets thick) or padded fiberglass. In general, forearm splints require smaller width, and upper arm and leg splints require larger width rolls of material.
Water bucket filled with cool water.
Elastic bandage
Sling for upper extremity injuries
If fracture reduction is attempted, a C-arm X-ray should be used for the evaluation of the fracture reduction.

Personnel

Splints may be applied by physicians, physician assistants, first-responders, medical assistants, and technicians with the proper training. Although a sole individual may apply a splint, assistance is commonly needed for ease of application. A second provider can gather materials, aid in reduction, and secure the injured limb in position so that the primary provider can adequately place and mold the splint.

Preparation

All materials should be obtained before splint application to avoid the premature setup of the plaster/fiberglass. A careful history and physical exam, including a motor, sensory, and neurovascular exams, should be performed before treatment. Open wounds or soft tissue injuries should be addressed during the preparation phase. Depending on the clinical circumstances., wounds may require antibiotics, wound irrigation, debridement, or tissue closure. The patient’s clothing should be covered with a sheet or pad to prevent plaster or fiberglass from being deposited onto them. A bucket of water must be obtained to activate the plaster or fiberglass. The splint materials should be measured to fit the desired area, precut, and laid out in the order of use; specifically, a stockinette should be cut to a size that is 8-10cm longer than necessary to cover the splinted area. The plaster or fiberglass should also be measured and cut to an appropriate length, spanning the entire injured area and then stacked 8-10 sheets thick to ensure adequate strength. Additional layers may be necessary for larger joints or larger body habitus, and similarly, fewer may be required in the setting of pediatric cases. Analgesia may be required either by oral or intravenous (IV) routes. Conscious sedation may be needed for pediatric patients.

Technique or Treatment

General steps may be applied when placing a splint

Ensure adequate analgesia before splint application. This will ensure muscle relaxation and facilitate fracture reduction, if necessary.
Ensure that any soft-tissue injuries are addressed before splint placement.
Apply a stockinette circumferentially to the injured area. This should span both proximally and distal to the injured area, protecting the skin from irritation by the plaster or fiberglass.
Pad bony prominences such as the elbow, knee, or calcaneus with at least 1 cm to 2 cm of soft cast padding. Soft tissue protection is essential to prevent future skin irritation or necrosis. The thickness of this padding will depend on body habitus.
Apply 2-3 layers of cast padding (0.25 cm to 0.5 cm) circumferentially to the remaining area of immobilization.
Reduce any fracture by restoring the bone length, rotation, and alignment. This may require radiographic confirmation before support material application.
Activate the supportive plaster or fiberglass layers by saturating them in the water bucket. Laminate the sheets by pressing them together before application, as this increases the strength and adhesion between the layers.
Mold the supportive material around the area of injury. The specific molding approach will depend on the type of injury; however, as a general rule, the splint should be molded to resist any deforming angulation.
Ensure the supportive material does not circumferentially encase the injured area to accommodate any soft-tissue swelling. If there is circumferential overlap, this should be addressed by cutting the splint once the supportive material has set.
Fold the stockinette over the plaster or fiberglass to protect the patient’s skin from its sharp edges.
Circumferentially apply an elastic bandage around the splint. This aids in the molding of the splint material to the injured area and holds the support material in place until it has hardened. Direct placement on the skin should be avoided and is a commonly observed mistake.[9]
Repeat the physical exam to ensure that there is no significant change in the patient’s neurovascular status. Any change in the physical exam should prompt the rapid removal of the splint and reassessment.
Counsel the patient on proper splint care and follow-up instructions.

Common upper extremity splints include:

Coaptation splint, sugar tong splint, posterior long arm elbow splint, ulnar gutter splint, radial gutter splint, volar or dorsal short arm splint, thumb spica splint

Common lower extremity splints include:

Posterior long leg splint, posterior short leg splint, posterior short leg splint with stirrups

These specific splinting approaches are well described elsewhere.[10]

Complications

While splints are commonly used, they are often applied improperly or inadequately.[11] Patients should be given a list of signs and symptoms that necessitate a prompt return to a medical professional. Complications include:

Loss of fracture reduction
Skin irritation or breakdown
Joint stiffness. Every effort should be made to immobilize the fewest number of joints possible.
Thermal injury – Both plaster and fiberglass support materials exhibit exothermic reactions when activated by water. Avoid skin burns by using room-temperature water when activating the support material and through careful monitoring after splint placement.
Neurovascular compromise – Acute carpal tunnel syndrome is a rare complication following the reduction of a wrist dislocation. Similarly, the reduction of a supracondylar humerus fracture may inadvertently occlude the brachial artery. Both scenarios are exacerbated through splint placement and require prompt splint removal, followed by a possible operative intervention.
Compartment syndrome – Excessive compression may occur through splint placement, mainly if a splint is circumferential, becoming a cast.

Clinical Significance

Splints may be used to effectively immobilize an injury, including a sprain, fracture, or soft tissue injury. In specific scenarios, splints may be used as definitive management to treat these injuries. Educating patients regarding splint care and return precautions aids in a successful outcome.

A splint must be differentiated from a cast, to determine the best form of immobilization based on the clinical scenario. A splint is a non-circumferential application of plaster or fiberglass that is particularly useful in the acute post-injury setting. A splint’s supportive and forgiving structure allows physiologic swelling common to the acute inflammatory phase. In contrast, a cast is a circumferential application of plaster that rigidly immobilizes a particular joint or fracture. Because of the circumferential nature, casts are commonly not placed in the acute post-injury setting.[1]

Splint application is not a completely benign treatment, and improper placement may result in adverse outcomes. One study found that 40% of patients splinted in the emergency department developed soft tissue complications, including skin ulceration in 6% of patients. [5] Proper splint placement avoids unnecessary pain, complications, and excess healthcare costs. Careful monitoring for subsequent compartment syndrome, neurovascular compromise, skin breakdown, or necrosis should be maintained in the early post-injury period. Patients who complain of numbness or tingling in the affected limb, pale skin, numbness or tingling, or increased pain and swelling should be evaluated immediately for potential complications. Patients should be educated on proper splint care, elevating the injured extremity, keeping it clean and dry. Additionally, the patient should be counseled on return precautions, such as an acute increase in pain or any change in motor or sensory functions.

Enhancing Healthcare Team Outcomes

Splints may be applied by medical personnel with a wide range of clinical backgrounds. Regardless of experience, basic knowledge about proper splint application and complications allows teams to work together to care for patients effectively. Following fracture splinting, follow up care should be coordinated for the patient to ensure improving clinical status. Often this coordination occurs between emergency physicians or first responders and primary care physicians or pediatricians for injuries that do not require specialty level care or operative fixation. This is particularly relevant in the case of pediatric forearm fractures, where most patients receive follow-up care with primary care physicians and not orthopedic specialists.[12] In the setting of multi-trauma, fractures with significant displacement, rotation or malalignment, peri-articular fractures, and open injuries, care should be coordinated with an orthopedic surgeon following the initial provider’s evaluation. Additionally, in these patients with an increased risk of adverse events, post-discharge follow-up phone calls should be arranged to ensure the appropriate continuity of care.

Articles and videos have been developed to help educate medical personnel to improve provider splint application. [10][13][14]

Nursing, Allied Health, and Interprofessional Team Interventions

Splints may be applied by appropriately trained physicians, physician assistants, nurses, technicians. A thorough history and physical exam must be obtained before any intervention. Medical professionals may serve as the primary treating clinician or splinting assistant. Regardless of the role assumed, knowledge about the goals of immobilization and proper splinting techniques will improve patient care. Coordination with an orthopedic specialist is necessary for any unstable injuries.

Non-orthopedic medical professionals frequently treat patients with acute injuries that require splinting. However, few of these professionals are comfortable splinting injuries, and many have not received dedicated education on proper technique. Incorporating an inter-residency and interprofessional approach between orthopedic surgeons, emergency medicine physicians, family practitioners, and advanced practitioners can significantly improve these skills. [10]

Nursing, Allied Health, and Interprofessional Team Monitoring

Following the splint application, the patient should be instructed regarding proper splint care, including keeping the splint clean and dry, elevating the injured extremity to minimize swelling and

Strict return precautions include getting the splint wet, change in motor function, sensation, or neurovascular status. Non-operative patients managed in a splint require follow-up care in 1 to 2 weeks after the initial splint placement. Further evaluation may include repeat X-rays, splint change, or conversion to a cast.

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Figure

side view volar splint. Contributed by Tammy J. Toney-Butler, RN, CEN, TCRN, CPEN-Author Unknown

Figure

completed splint. Contributed by Tammy J. Toney-Butler, RN, CEN, TCRN, CPEN/Author Unknown

Figure

Short Leg Splint Example from two views. Contributed by Anthony J. Silva, CCMA, EMT-B

Figure

Rose’s Splint on the left, Splints, Welch’s Splints on the Right, amputation, Fractures, elbow joint. Contributed by Wikimedia Commons, (Public Domain)

References

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2.: Boyd AS, Benjamin HJ, Asplund C. Splints and casts: indications and methods. Am Fam Physician. 2009 Sep 01;80(5):491-9. [PubMed: 19725490]
3.: Leggit JC, McLeod G. MSK injury? Make splinting choices based on the evidence. J Fam Pract. 2018 Nov;67(11):678-683. [PubMed: 30481246]
4.: Lee TG, Chung S, Chung YK. A retrospective review of iatrogenic skin and soft tissue injuries. Arch Plast Surg. 2012 Jul;39(4):412-6. [PMC free article: PMC3408289] [PubMed: 22872847]
5.: Abzug JM, Schwartz BS, Johnson AJ. Assessment of Splints Applied for Pediatric Fractures in an Emergency Department/Urgent Care Environment. J Pediatr Orthop. 2019 Feb;39(2):76-84. [PubMed: 28060178]
6.: Hosseinzadeh P, Hayes CB. Compartment Syndrome in Children. Orthop Clin North Am. 2016 Jul;47(3):579-87. [PubMed: 27241380]
7.: Ryan JR. Fractures and dislocations encountered by the general surgeon: general principles. Surg Clin North Am. 1977 Feb;57(1):197-210. [PubMed: 857333]
8.: Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004;2004(1):CD003764. [PMC free article: PMC8728739] [PubMed: 14974035]
9.: Study: Education, training on proper splint technique needed in EDs, urgent care centers. ED Manag. 2015 Feb;27(2):21-3. [PubMed: 25688416]
10.: Wendling A, Vopat M, Patel O, Wool N, Davis N, Dart B. Enhancing Splinting Confidence through Inter-Residency Education: An Educational Workshop. Kans J Med. 2020;13:29-37. [PMC free article: PMC7053410] [PubMed: 32190184]
11.: Halanski M, Noonan KJ. Cast and splint immobilization: complications. J Am Acad Orthop Surg. 2008 Jan;16(1):30-40. [PubMed: 18180390]
12.: Koelink E, Schuh S, Howard A, Stimec J, Barra L, Boutis K. Primary Care Physician Follow-up of Distal Radius Buckle Fractures. Pediatrics. 2016 Jan;137(1) [PubMed: 26729537]
13.: Fitch MT, Nicks BA, Pariyadath M, McGinnis HD, Manthey DE. Videos in clinical medicine. Basic splinting techniques. N Engl J Med. 2008 Dec 25;359(26):e32. [PubMed: 19109569]
14.: Cheng YT, Liu DR, Wang VJ. Teaching Splinting Techniques Using a Just-in-Time Training Instructional Video. Pediatr Emerg Care. 2017 Mar;33(3):166-170. [PubMed: 25834963]

: Disclosure: Alyssa Althoff declares no relevant financial relationships with ineligible companies.
: Disclosure: Russell Reeves declares no relevant financial relationships with ineligible companies.