Splinting fracture. Splinting Techniques: Essential Guide for Healthcare Professionals

09.02.202213.07.2023 by alexxlab

What are the key principles of splinting in acute musculoskeletal injuries. How does proper splinting technique contribute to patient recovery and prevent complications. When should healthcare providers choose splinting over casting for immobilization.

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Understanding the Fundamentals of Splinting

Splinting is a crucial technique in the management of acute musculoskeletal injuries. It involves the use of an external device to immobilize an injury or joint, typically made of plaster. The primary goals of splinting are to:

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

Healthcare professionals must be proficient in splinting techniques to ensure optimal patient outcomes. Proper splint placement is essential, as malpositioning can lead to undue pain, malreduction, and skin breakdown.

Indications and Contraindications for Splinting

Splinting is indicated in various scenarios involving musculoskeletal instability. These may include:

Fractures
Dislocations
Muscle strains
Ligament sprains

However, there are situations where splinting may be contraindicated. These include:

Circumferential burns
Severe soft tissue injuries with significant swelling
Suspected compartment syndrome
Open fractures requiring immediate surgical intervention

Healthcare providers must carefully assess each case to determine the appropriateness of splinting as a treatment option.

Differentiating Splints from Casts

While both splints and casts are used for immobilization, they have distinct characteristics and applications. How do splints differ from casts?

Splints are non-circumferential and allow for swelling
Casts are circumferential and provide rigid immobilization
Splints are preferred in acute post-injury settings
Casts are typically used for long-term immobilization after initial swelling has subsided

Understanding these differences is crucial for selecting the appropriate immobilization method based on the clinical scenario and stage of injury.

Anatomy and Physiology Considerations in Splinting

Effective splinting requires a thorough understanding of anatomy and physiology. Healthcare providers must consider the following factors:

Patient-specific anatomy
Anatomic resting joint position
Potential for soft tissue swelling
Neurovascular status of the affected limb

For example, when splinting the wrist, maintaining neutral wrist dorsiflexion is essential. In pediatric patients with supracondylar elbow fractures, the elbow should not be flexed more than 90 degrees to prevent Volkmann’s ischemic contracture.

Materials and Techniques for Splint Application

Various materials are used in splinting, each with its own advantages and limitations. What are the most common materials used for splinting?

Plaster: Preferred for maintaining position-specific reduction, but requires longer drying time
Fiberglass: Lighter and more porous, but more expensive and less reliable for molding
Pre-fabricated splints: Useful for chronic injuries, but less commonly used in acute fracture settings

The choice of material depends on factors such as the type of injury, required immobilization duration, and provider experience. Proper application technique is crucial for ensuring optimal outcomes and minimizing complications.

Preventing Complications in Splinting

While splinting is generally safe when performed correctly, complications can arise due to improper technique or inadequate monitoring. Common complications include:

Skin breakdown
Pressure sores
Compartment syndrome
Joint stiffness
Muscle atrophy

To prevent these complications, healthcare providers should:

Ensure proper padding and molding of the splint
Regularly assess neurovascular status
Educate patients on proper care and warning signs
Schedule timely follow-up appointments

By implementing these preventive measures, healthcare providers can significantly reduce the risk of splint-related complications.

Interprofessional Collaboration in Splinting Care

Effective splinting care requires a collaborative effort from various healthcare professionals. How can interprofessional teams improve splinting outcomes?

Emergency physicians: Initial assessment and splint application
Orthopedic surgeons: Specialized care and follow-up
Radiologists: Imaging interpretation for proper alignment
Nurses: Patient education and monitoring
Physical therapists: Rehabilitation planning

Clear communication and coordination among team members ensure comprehensive care and optimal patient outcomes. Regular case discussions and protocol reviews can help standardize splinting practices across the healthcare team.

Patient Education and Follow-up Care

Patient education is crucial for the success of splinting treatment. Healthcare providers should educate patients on:

Proper splint care and maintenance
Signs of complications to watch for
Activity restrictions and limitations
Follow-up appointment schedules

Regular follow-up care is essential to monitor healing progress, adjust treatment plans if necessary, and ensure timely transition to rehabilitation. How often should patients with splints be followed up? The frequency of follow-up visits depends on the specific injury and individual patient factors, but generally, an initial follow-up within 1-2 weeks is recommended, followed by periodic checks as determined by the treating physician.

Recognizing Signs of Complications

Patients should be educated on recognizing signs of potential complications, such as:

Increased pain or swelling
Numbness or tingling in the affected limb
Discoloration of the skin
Foul odor or discharge from the splint
Loosening or breakage of the splint

Patients should be instructed to seek immediate medical attention if they experience any of these symptoms.

Transitioning from Splinting to Rehabilitation

As the injury heals, patients may transition from splinting to a rehabilitation program. This process typically involves:

Gradual removal of the splint
Assessment of joint mobility and muscle strength
Introduction of gentle range-of-motion exercises
Progressive strengthening and functional training

The timing and specifics of rehabilitation depend on the nature of the injury and individual patient factors. Close collaboration between orthopedic specialists and physical therapists is essential for developing an effective rehabilitation plan.

Advancements in Splinting Technology

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

3D-printed custom splints
Smart splints with embedded sensors for monitoring
Biodegradable splint materials
Adjustable splints for progressive mobilization

These advancements aim to improve patient comfort, treatment efficacy, and monitoring capabilities. As technology continues to progress, healthcare providers should stay informed about new splinting options and their potential benefits for patient care.

3D-Printed Custom Splints

3D printing technology has revolutionized the production of custom splints. Benefits of 3D-printed splints include:

Precise fit to patient anatomy
Improved ventilation and hygiene
Lightweight and durable construction
Potential for incorporating smart sensors

While 3D-printed splints are not yet widely available in all healthcare settings, they show promise for improving patient outcomes and comfort in the future.

Smart Splints with Embedded Sensors

Smart splints equipped with embedded sensors offer several advantages:

Real-time monitoring of pressure and temperature
Detection of potential complications early
Remote monitoring capabilities for healthcare providers
Data collection for research and treatment optimization

As these technologies become more refined and cost-effective, they may become standard tools in splinting care, particularly for complex or high-risk cases.

Splinting in Special Populations

Certain patient populations require special considerations when it comes to splinting. How does splinting differ for these groups?

Pediatric Patients

Splinting in pediatric patients requires careful attention to:

Growth plate considerations
Smaller anatomy and potential for rapid healing
Need for close monitoring and frequent adjustments
Importance of patient and caregiver education

Pediatric splints often need to be changed more frequently to accommodate growth and prevent complications.

Elderly Patients

When splinting elderly patients, healthcare providers should consider:

Fragile skin and increased risk of pressure sores
Potential for underlying osteoporosis
Cognitive impairments affecting compliance
Balance and fall risk with immobilization

Extra padding and more frequent skin checks may be necessary for elderly patients with splints.

Athletes

Splinting for athletes may involve:

Customized splints for specific sports
Consideration of return-to-play timelines
Balancing immobilization with maintenance of conditioning
Coordinating care with athletic trainers and sports medicine specialists

The goal is to provide adequate protection while minimizing the impact on athletic performance and conditioning.

Legal and Ethical Considerations in Splinting

Healthcare providers must be aware of legal and ethical considerations related to splinting. These include:

Obtaining informed consent before splint application
Proper documentation of splint placement and patient education
Adhering to established standards of care
Recognizing limitations and seeking appropriate consultations

Failure to follow proper splinting procedures or adequately educate patients can lead to legal and ethical issues. Healthcare providers should stay updated on current guidelines and best practices to ensure high-quality, ethical care.

Documentation and Informed Consent

Proper documentation is crucial in splinting care. Healthcare providers should document:

Pre- and post-splinting neurovascular status
Type and location of splint applied
Patient education provided
Follow-up instructions given

Informed consent should be obtained and documented, including discussion of potential risks and benefits of splinting.

Continuing Education and Skill Maintenance

To provide optimal splinting care, healthcare providers should:

Regularly participate in continuing education courses
Practice splinting techniques to maintain proficiency
Stay updated on new research and guidelines
Engage in quality improvement initiatives

By maintaining and improving their skills, healthcare providers can ensure they are providing the best possible care to patients requiring splinting.

Future Directions in Splinting Research and Practice

The field of splinting continues to evolve, with ongoing research and development in several areas. What are some future directions in splinting research and practice?

Development of novel materials for improved comfort and efficacy
Integration of wearable technology for real-time monitoring
Exploration of telemedicine applications in splinting care
Investigation of personalized splinting approaches based on genetic and biomechanical factors

As research progresses, healthcare providers can expect to see new tools and techniques that may revolutionize splinting care and improve patient outcomes.

Novel Materials and Designs

Researchers are exploring new materials and designs for splints, including:

Shape-memory polymers that adapt to changing limb contours
Nanocomposite materials with enhanced strength and breathability
Biomimetic designs that better mimic natural joint mechanics
Self-adjusting splints that respond to changes in swelling or range of motion

These innovations may lead to more effective, comfortable, and patient-friendly splinting options in the future.

Artificial Intelligence in Splinting Care

Artificial intelligence (AI) may play a significant role in future splinting practices, including:

AI-assisted diagnosis and treatment planning
Automated splint design optimization
Predictive analytics for complication risk assessment
Virtual reality training for healthcare providers

As AI technologies continue to advance, they may become valuable tools in enhancing the accuracy and efficiency of splinting care.

In conclusion, splinting remains a critical skill for healthcare providers treating musculoskeletal injuries. By understanding the principles of proper splinting technique, staying informed about new developments, and prioritizing patient education and follow-up care, healthcare professionals can ensure optimal outcomes for patients requiring splinting treatment.

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.