First Aid – Splint

What is splint? 

A splint is a supportive device used to keep in place any suspected fracture in one’s arm or leg.

Splint is used to:

• Provide pain relief of the fractured limb.
• Support bone ends of the fracture site. Bones ends of the fracture site are very sharp. A splint helps prevent bone protruding through the skin, soft skin and tissue damage, as well as bleeding.
• Facilitate safe and seamless causality transport.

 What is Splint? 

In emergency cases, anything can be used for splinting, yet there are two types of splints:

1. Flexible
2. Rigid 

Rigid Splint: Any rigid object, such as wood or plastic boards, broomstick, book or a rolled-out newspapers, which can be used to splint a fractured arm or leg.

Flexible Splint: Any flexible object, like a pillow or a bed sheet with several folds. This type is used for foot, ankle and joint fractures.

 What are Medical Sling and Bandage?

 A Medical Sling is a piece of cloth used to immobilize the fractured arm to the rigid splint, in 90° of elbow flexion. The sling usually takes the shape of a big triangle. It can be used along with or instead of a rigid splint. If used alone, the sling should be supported with an additional bandage which is actually a folded drape of 5-6 inches width.

General Principles of Splinting: 

Several ways are adopted for splinting, which may seem highly complicated – at first sight – yet they are very simple. Here are some general principles to be applied when splinting as follows:

• Identify the fracture site.
• Stop the bleeding using bandages, but avoid pressing on the fractured painful and deformed site.
• In case of bone fractures where bone ends protrude through the skin, do not push these ends back in place as this will cause inflammation and acute bleeding.
• Keep the fractured bone (including the joints above and below the fracture site) motionless as indicated hereunder:
• If the lower-arm is fractured, keep the wrist and elbow joints motionless.
• If the upper-arm is fractured, keep the shoulder and elbow joints motionless.
• If the lower-leg is fractured, keep the knee and ankle joints motionless.
• If the upper-leg is fractured, keep the knee and femoral joints motionless.
• Splint should be tied firmly to immobilize the fractured limb, then check for blood circulation to ensure the splinting is not too tight. Correct splinting provides pain relief.
• If the fractured limb is bent with a sharp bone end protruding through the skin, keep it motionless. Splint a limb as you find it to make it as comfortable to the patient as you possible.
• If an ambulance is called and is on its way, do not splint the fractured limb and wait for the ambulance team to use their specialized medical splints.

Why keep upper and lower joints motionless?

Each bone end in limbs is connected to a joint. Moving that joint dislocates the fractured bone. So, joints should remain motionless to immobilize fractured bones.

 What if the joint itself is broken?

This is the most difficult fracture to handle. Yet, follow the same instructions of applying a splint. Make sure to maintain joints, upper and lower bones as well as the fracture site motionless. For example, the elbow joint connects both upper- and lower-arms. If broken, the joint and bones should be immobilized. Hence, both shoulder and wrist joints should remain motionless. 

In most cases, joint fractures are very painful. In this case, never try to relocate the joint least you should damage the nerves and blood vessels around the joint, let alone the acute pain resulting.

You should have an overactive imagination when dealing with such injury. You can splint the joint as you find it.

What Materials are Needed for Splinting?

You will need:

• A splint (rigid or flexible).
• A thick bandage to apply under the splint for maximum comfort. (Optional).
• Robe – or the like – to wrap the splint to the fractured limb.

 What if these materials are not available?

No worries. You can use the patient’s body as a splint as follows:

• You can tie the fractured arm to the patient’s body using a dressing.
• You can tie the fractured leg to the patient’s other leg using a dressing.
• You can tie the fractured finger to the patient’s other fingers using a dressing. 

​

Splinting – Physiopedia

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Original Editor – Shwe Shwe U Marma
Top Contributors – Shwe Shwe U Marma, Naomi O’Reilly, Nikhil Benhur Abburi, Tarina van der Stockt, Kim Jackson, Amanda Ager and Lucinda hampton

Contents

• 1 Introduction
• 2 Purpose
• 3 Different Types of Splints
• 4 Regional Splints
  • 4.1 1. Splints for Upper Extremity
  • 4.2 2. Splints for Lower Extremity
• 5 Indications of Splinting
• 6 Contraindications of Splinting
• 7 Side Effects of Splinting
• 8 Advantages of Splinting
• 9 Disadvantages of Splinting
• 10 Complications of Splinting
  • 10.1 Considerations for Effective Splinting
• 11 References

Arm Splint

A splint is a rigid support made from metal, plaster, or plastic. It’s used to protect ^[1], support, or immobilize an injured or inflamed part of the body. ^[2]

Splints have various purposes. Including:

• Immobilization

• Support to Promote Healing
• Positioning or supporting during function
• Pain Relief ^[3]
• Substitute for Weak Muscles
• Prevention and Correction of Contracture & Deformity ^[4]
• Restoration or Maintenance of Range of Motion ^[5]
• Edema Control ^[6]

Different Types of Splints[edit | edit source]

Thomas’s Splint

Splints are classified based on the movement permissible as

• Static
• Dynamic
• Serial Static
• Static Progressive

1. Splints for Upper Extremity[edit | edit source]

2.

Splints for Lower Extremity[edit | edit source]

Swollen sprained ankle, an indication for splinting

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

• Temporary stabilization of acute fractures, sprains, strains or nerve injuries 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 ^[2]

Contraindications of Splinting[edit | edit source]

No specific contraindications to splinting exist. However, certain injuries and patient-specific co-morbidities 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. 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 Neurological 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:
  • This requires 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 Peripheral 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.^[2]

• Excessive use of splints can lead to chronic pain, stiff joints or weak muscles ^[7]
• Skin irritation ^[8]
• Discomfort ^[9]

Splint use offers many advantages over casting.

• Splints are faster and easier to apply.
• They may be static (i.e., prevent motion) or dynamic (i.e., functional; assist with controlled motion).
• Splints are non-circumferential, allowing for natural swelling that occurs during the initial inflammatory phase of the injury.
• A splint may be removed more easily than a cast, allowing for regular inspection of the injury site. ^[10]

Disadvantages of Splinting[edit | edit source]

Disadvantages of Splinting include;

• Poor Patient Compliance
• Excessive Motion at the Injury Site
• Limitations in their usage, as in unstable or potentially unstable fractures^[10]

Complications of Splinting[edit | edit source]

Compartment Syndrome

• Compartment Syndrome
• Ischemia
• Heat Injury
• Pressure Sores and Skin Breakdown
• Edema
• Infection
• Dermatitis
• Joint Stiffness
• Altered Range of Motion
• Decreased Strength
• Altered Sensation
• Neurological injury^[10]

Considerations for Effective Splinting[edit | edit source]

• Creases provide for landmarks in splint fabrication
• Bony prominences may cause pressure
• Ensure three points of pressure
• Custom made splints to fit the contours of the body rather than ready-made splints
• Patient education for better compliance

1. ↑ VanBlarcom CW, editor. The glossary of prosthodontic terms. Mosby; 1999.
2. ↑ ^2.02.12.2 Althoff AD, Reeves RA. Splinting. StatPearls [Internet]. 2020 May 24.
3. ↑ ^3.03.13.2 Boyd AS, Benjamin HJ, Asplund CA. Splints and casts: indications and methods. American family physician. 2009 Sep 1;80(5):491-9.
4. ↑ Singh KA, Shah H, Joseph B. Comparison of plaster-of-Paris casts and Woodcast splints for immobilization of the limb during serial manipulation and casting for idiopathic clubfoot in infants: a prospective randomized trial. The Bone & Joint Journal. 2020 Oct 3;102(10):1399-404.
5. ↑ Rezaei B, Mahdavinejad R. Massage therapy and Splint in males with Carpal Tunnel syndrome. Journal of Advanced Pharmacy Education & Research| Jan-Mar. 2020;10(S1).
6. ↑ Giang TA, Ong AW, Krishnamurthy K, Fong KN. Rehabilitation interventions for poststroke hand oedema: a systematic review. Hong Kong Journal of Occupational Therapy. 2016 Jun 1;27:7-17.
7. ↑ Gravlee JR, Van Durme DJ. Braces and splints for musculoskeletal conditions. American family physician. 2007 Feb 1;75(3):342-8.
8. ↑ Johnston JJ, Spelman L. Pressure-induced localised granuloma annulare following use of an elbow splint. Prosthetics and orthotics international. 2017 Jun;41(3):311-3.
9. ↑ So H, Chung VC, Cheng JC, Yip RM. Local steroid injection versus wrist splinting for carpal tunnel syndrome: a randomized clinical trial. International Journal of Rheumatic Diseases. 2018 Jan;21(1):102-7.
10. ↑ ^10.010.110.2 Boyd AS, Benjamin HJ, Asplund CA. Principles of casting and splinting. American family physician. 2009 Jan 1;79(1):16-22.

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

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Jaw fracture is not a common medical diagnosis, but its onset is always accompanied by treatment in a dental clinic. First of all, splinting of the jaw is required, which ensures its immobilization, without which it is not possible to heal the fracture. Sometimes the jaw splinting procedure is also required for dislocation or other bite correction situations.

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:

1. In case of fractures with displacement of the facial bones and injuries not associated with displacement.
2. For transverse, zigzag, oblique, longitudinal fractures.
3. For closed and open injuries of the jaw bones.
4. For a simple fracture in the maxillofacial region.
5. 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 it takes much more effort 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:

1. According to the lower level, that is, with breaking off part of the maxillary sinus and nasal septum.
2. On the average level – may accompany the separation of the jaw from the bones of the skull and nose.
3. 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:

1. 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.
2. When properly tensioned, the elastic bands allow feeding through a straw, a tighter fit often results in tube feeding.
3. 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 jaws for fractures in Kaluga

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Maxillofacial Surgery

Splinting of jaws for fractures

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Fracture of the jaw, a fairly common injury, given the fast pace of life and non-compliance with the simplest safety rules. A fracture occurs in the event of a blow or fall. A fracture of the jaw can be incomplete, that is, without displacement, and complete, that is, with displacement. In any case, emergency medical care and appropriate treatment are needed.

After a visual examination and sanitation of the oral cavity, the doctor sends the patient to the X-ray room to determine the location of the fracture, as well as its complexity. After that, a special splint is applied to the patient’s teeth, which fixes the jaw in a fixed position.

After examining the images, the doctor chooses one or another splinting method. If the upper jaw is broken, sometimes it is used to tighten it with the cheekbone bone using metal (titanium alloy) screws to fix it securely. The lower jaw requires the application of special strong elastic bands to entire parts of the bone tissue, if at least one of them breaks, the procedure is started anew.

There are 3 types of designs that are selected depending on the complexity of the fracture. For example, with a fracture of the lower jaw, a one-sided or two-sided design can be used. This design is imposed for a period of 6 to 10 weeks, depending on the patient’s regenerative abilities, a special liquid diet is prescribed, as well as a course of antibiotics and drugs to cleanse the oral cavity.

In any case, a fracture is an emergency and requires immediate medical attention. The quality of the material when installing the tire is also not unimportant, since if the rubber bands break, not only during installation, but also during the restoration process, re-installation will be necessary. In case of such an injury and a suspected fracture, you need to come to our Pain Clinic, probably to one of the best maxillofacial surgeons in the city of Kaluga, where he will provide all the necessary medical care. You can inform us about your arrival by calling us at the number indicated on the website.

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Olga

I want to say a huge thank you to the maxillofacial surgeon Denis Leonidovich Garanichev for the successful operation of my daughter on July 26, 2022 to remove dystopic 48, 38 teeth, for your sensitivity and attention, for your caring attitude, for high professionalism and golden hands ! I wish you continued success, health and all the best!

08/04/2022

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Ruslan

Denis Leonidovich was advised as an experienced surgeon. I live in Obninsk. Last year, two upper wisdom teeth were removed at the Like Smile clinic. To remove the lower teeth, they asked to take a 3D image. After familiarization, the surgeon refused to perform the operation, since both teeth touched the jaw nerve. It was only this year that I decided to have the surgery. I immediately turned to Denis Leonidovich. What to say about the operation itself and its consequences? I didn’t expect this, to be honest. 2 teeth were removed at once (the doctor advised, I did not argue with him). After freezing, I immediately began to touch my jaw and, oh, happiness! All sensitivity remains. Nerves are not hurt! The swelling was gone on the 3rd day! This is great! Denis Leonidovich – talent! May God grant him health and many salvations!

06/19/2022

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Good afternoon, Ruslan! Thank you for your feedback! Denis Leonidovich is a truly talented doctor. We are extremely proud to have him on our team! We wish you health and summer mood! Sincerely, the administration of the Clinic of Pain

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Maria

I am writing in the fresh footsteps) With great gratitude for the work done. A few weeks ago, it was decided to remove the wisdom teeth to install braces. The question arose about choosing a specialist, as there was a great desire to complete what had been started as soon as possible. And what happiness it was to get to Denis
Leonidovich. From the first introductory reception to my exit from the operating room – everything was at the highest level. Anesthesiologist Rakov Vladimir Igorevich, the team of nurses is something. They explained everything, told) They supported me all the time, they were interested in how I felt! There are no words. If it weren’t for the headache after anesthesia, I would almost have been in a sanatorium !!! Once again, a big human THANK YOU

06/04/2022

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Olga

I have been afraid of dentists since childhood. I treat my teeth only with an injection. One of the teeth started and had to be removed already. All my attempts have been unsuccessful. The fear was so strong that in the doctor’s office I was in a fainting state. I canceled the appointment several times out of fear. I was looking for some way for myself to remove a tooth in order to alleviate my suffering. I stumbled upon the Pain Clinic on the Internet and read about a miracle method – removal under sedation. I signed up for Garanichev Denis Leonidovich. On the appointed day, from the very morning, my legs were wadded with fear, my hands were shaking. After a conversation with Denis Leonidovich and Soldatova Irina Viktorovna, the fear began to gradually disappear, and when the procedure began, there was no trace of it at all. Everything went very quickly and absolutely painless. Many thanks to Denis Leonidovich and the whole team that assisted in my operation to remove a tooth on August 17, 2021!!!! Attentive, sensitive staff. Very good attitude towards patients. What was my surprise when the anesthesia went off at home, that nothing hurts me. No feeling of “aching gums” at the site of removal. A little swelling and all. Removal under sedation is the best thing they could think of for cowards like me! Once again, thank you so much for all your hard work!! Health and prosperity!

08/18/2021

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Larisa Ivanovna

Responsive, friendly, professional doctor. He knows and does his job very well. Very high quality and neatly performs all actions. The tooth extraction went almost unnoticed. Thank you for your kind attitude towards your patients and qualified knowledge, professional actions of your doctor

06/30/2021

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I really liked the attitude of the doctor to the patient, very polite, cultured, accurate. It does not hurt, gives good advice on how to take care of yourself later and what to process. Thank you.

12/17/2020

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Evgenia

Removed 2 wisdom teeth at once from Denis Olegovich Garanichev under sedation, because. As I got older, I became terrified of dentists. I live in Tula, but on the recommendation of a friend, I decided to remove teeth from Denis Olegovich (in Tula they refused to do it without a hospital, and even more so with sedation). No negative impressions, sedation is super 🙂 The whole operation is about an hour, there are no consequences from a calming cocktail. Further, everything overgrown without complications. I am very glad that there is such a doctor and such a clinic! Thank you so much!

03/09/2020

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Natalia Petrovna

I am afraid of dentists, I am very afraid. I suffered when the left lower wisdom tooth fell ill for almost a month, with varying success. Two friends stood before my eyes, who over the past year have removed complex lower teeth. Two or three times we went to the surgeon in dentistry to “twitch” pieces of teeth and roots. It’s thrash! I know for sure that no one treats wisdom teeth.