Splinting fracture: Splinting – StatPearls – NCBI Bookshelf

14.02.202213.07.2023 by alexxlab

Содержание

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.

Access free multiple choice questions on this topic.

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.

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

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

1.: Boyd AS, Benjamin HJ, Asplund C. Principles of casting and splinting. Am Fam Physician. 2009 Jan 01;79(1):16-22. [PubMed: 19145960]
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.

Splinting – StatPearls – NCBI Bookshelf

Continuing Education Activity

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.

Access free multiple choice questions on this topic.

Introduction

Anatomy and Physiology

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

Preparation

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

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

Enhancing Healthcare Team Outcomes

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

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

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

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

1.: Boyd AS, Benjamin HJ, Asplund C. Principles of casting and splinting. Am Fam Physician. 2009 Jan 01;79(1):16-22. [PubMed: 19145960]
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.

Splinting of the jaw in case of a fracture, how it goes, where it can be done

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Work experience — 22 years

Implantologist, surgeon, orthopedist: specialist in aesthetic and functional dentistry. Work experience — 22 years
Permanent internships in the leading clinics of the European and American community.
Expert in Aesthetic Dentistry – Comprehensive Rehabilitation of Patients with Pathology of the Dental System of Different Degrees of Complexity – Chicago Institute of Modern Dentistry
Expert in neuromuscular dentistry – comprehensive rehabilitation of patients with dysfunction of the Temporomandibular Joint, pathology of occlusion (occlusion) – Boston Institute of Aesthetic Dentistry.

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Sadov Igor Yurievich

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Implantologist, surgeon, orthopedist

Splinting of the jaw after a fracture

Splinting of the jaw after a fracture is not just a key way to provide medical dental care, but the very first and most important. The cause of its occurrence, localization and nature of the damage are not important. Splinting of the damaged jaw in case of a fracture has to be done:

In case of fractures with displacement of the facial bones and injuries not associated with displacement.
For transverse, zigzag, oblique, longitudinal fractures.
For closed and open injuries of the jaw bones.
For a simple fracture in the maxillofacial region.
In the treatment of multiple and comminuted fractures.

The specific method of splinting the jaw for fractures depends only on whether the upper or lower jaw was damaged, what type of damage occurred, how long, according to the dentist, it will take to restore the normal functioning of the teeth. Dentists use 3 types of splinting of the damaged jaw:

One-sided – required when only one half of the top or bottom of the teeth is damaged, with copper wire serving as a splint.
Double-sided – made to fix the dentition on both sides, thicker and stiffer wire, hooks or rings are used as the basis.
Two-jaw – required in case of displacement, debris and other complications as a result of trauma, it involves reliable fastening of both jaws to each other.

Additionally, the procedure is accompanied by the appointment of an X-ray examination, the appointment of painkillers and antibiotic therapy. It is impossible to solve the problem with a fracture of the lower or upper jaw on your own, since it is not just about the need to fix the teeth for the time of complete healing, but also about the exclusion of complications.

Splinting in case of fracture of the lower jaw

Splinting of the lower jaw in case of a fracture is the only possible option for recovery after this kind of damage, which means it is mandatory. This is due to the particular mobility of the lower part of the teeth and possible damage to the vessels, nerves, and muscles located nearby. Injuries are most often located in the chin area, on the side or in the corner of the jaw.

The installation of a splint on the lower jaw involves a surgical intervention, during which the doctor compares the fragments and fixes them in their original place. Most often, fastening is done in the mouth on the bone tissue, but some complex fractures require the installation of special devices from the outside.

The choice of a specific splinting method depends on the type and complexity of the fracture, its location. Incorrect selection of the method of treatment of the lower jaw can lead to serious complications, so it is important to contact a specialist with extensive experience, for example, Dr. Sadov’s Center for Comfortable Dentistry. This must be done immediately, immediately after first aid is provided to the patient, since any attempt to speak or otherwise move the injured jaw can lead to deterioration, bleeding, asphyxia and other undesirable consequences.

Splinting of the upper jaw

Fractures of the upper jaw are much less common than those of the lower jaw. It is less mobile and does not extend, so much more effort is required to cause harm. Most often, a fracture of the upper jaw is accompanied by a fracture of the lower, which means that a special two-jaw fixation is required. The meaning of the procedure is that both jaws are tightly connected to each other, leaving no free space even for eating. The oral cavity is literally “sewn up” for at least 1 month, and often for a longer period. With this method of splinting, a special load is placed on the teeth, since fixation is carried out using traction loops. This leads to additional pain.

Types of fractures of the upper jaw are divided into 3 groups according to the place of damage:

According to the lower level, that is, with breaking off part of the maxillary sinus and nasal septum.
On the average level – may accompany the separation of the jaw from the bones of the skull and nose.
On the upper level – always accompanied by a complete separation from the nose, cheekbones, skull bones and TBI.

As for splinting, there are no differences between the treatment of the upper and lower parts of the jaw and the specific type of device is selected by the attending orthopedic dentist.

Rubber bands for splinting

In some cases, splinting with wire requires additional fastening with special rubber bands to keep the jaws closed. The main task of gum is to move the teeth in the direction in which they were originally. The advantages of the elastic material are:

Elastic bands are easy to cut and remove, which is especially important if the patient has received a TBI and there is a risk of complications in the form of epileptic seizures, fainting and other neurological disorders.
When properly tensioned, the elastic bands allow feeding through a straw, a tighter fit often results in tube feeding.
Damaged rubber bands can be easily replaced, while damage to the metal structure will require serious medical attention.

The decision to install splinting rubber bands should be made by a physician and most often they are used only when the initial healing of the injured jaw has occurred. In the early stages, as a rule, a more rigid fixation is required. In any case, it is necessary to consult a specialist who, based on the condition of the teeth, the nature of the damage, and the general condition of the patient, will be able to determine the most appropriate type of splinting. The clinic of Dr. Sadov in Moscow employs professionals who have completed an internship abroad, who clearly understand the features of dental orthopedics.

How to eat after splinting

Rigid splinting involves difficulties in eating, but at the same time, during this period, it is especially important for the body to receive a large amount of vitamins, minerals, and nutrients required for the speedy regeneration of bone tissue. The patient’s menu after splinting usually includes various nutritious broths, fruit, vegetable and meat purees (children’s can be), semi-liquid and liquid cereals. It is necessary to monitor the content in food of a large amount of protein, calcium, phosphorus, zinc. It is allowed to replace some meals with infant formula or sports nutrition, since in both cases the content of substances necessary for the body is high.

It is strictly forbidden to drink any alcoholic beverages during treatment, especially if there is also a traumatic brain injury in addition to the jaw. In addition, you should not try to eat solid foods that require chewing. First, it can cause severe pain. Secondly, lead to improper fusion of damaged bone tissue.

In case of injuries that have symptoms similar to a broken jaw: severe pain, bleeding, immobilization of the jaw, and so on, you should immediately seek professional help. Attempts at self-treatment or its complete absence cause irreparable harm and lead to loss of tooth functionality.

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

Contents 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 for fracture of the lower jaw – involves 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 is being taken;
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.

Jaw fracture rehabilitation

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.

Splinting fracture: Splinting – StatPearls – NCBI Bookshelf

Splinting – StatPearls – NCBI Bookshelf

Continuing Education Activity

Introduction

Anatomy and Physiology

Indications

Contraindications

Equipment

Personnel

Preparation

Technique or Treatment

Complications

Clinical Significance

Enhancing Healthcare Team Outcomes

Nursing, Allied Health, and Interprofessional Team Interventions

Nursing, Allied Health, and Interprofessional Team Monitoring

Review Questions

Figure

Figure

Figure

Figure

References

Splinting – StatPearls – NCBI Bookshelf

Continuing Education Activity

Introduction

Anatomy and Physiology

Indications

Contraindications

Equipment

Personnel

Preparation

Technique or Treatment

Complications

Clinical Significance

Enhancing Healthcare Team Outcomes

Nursing, Allied Health, and Interprofessional Team Interventions

Nursing, Allied Health, and Interprofessional Team Monitoring

Review Questions

Figure

Figure

Figure

Figure

References

Splinting of the jaw in case of a fracture, how it goes, where it can be done

Splinting of the jaw after a fracture

Splinting in case of fracture of the lower jaw

Splinting of the upper jaw

Rubber bands for splinting

How to eat after splinting

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

Types of jaw splinting

What is jaw splinting? Detailed description of the process

Jaw fracture rehabilitation

How long does a jaw fracture heal?

Exercises after a broken jaw

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