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.

Splints | Uses | Versus Arthritis

• 
  
  What are hand and wrist splints?
  
• 
  
  Resting splints
  
• 
  
  Working splints
  
• 
  
  Caring for your hands
  
• 
  
  How can I get a splint?
  

Get help

What are hand and wrist splints?

Hand and wrist splints are designed to protect and support painful, swollen or weak joints and their surrounding structures by making sure your hand and wrist are positioned correctly. Splints can be used for joints affected by arthritis or for other conditions, such as carpal tunnel syndrome.

There are two main types of splint:

• splints used while resting the joints of the hand and wrist
• splints used to support the hand and wrist while working.

Whichever type of splint you use, it’s best not to wear it all the time as this can increase stiffness in your joints.

Resting splints

A resting splint supports your hand and wrist in the best position while you’re resting. It can help reduce swelling and pain.

Resting splints are usually made from a moulded thermoplastic and are fitted with Velcro fastening straps and are usually made specially made for you by a physiotherapist, occupational therapist or orthotist.

Resting splints are best used:

• if you have pain overnight that disturbs your sleep
• occasionally during the day if your hands are especially painful
• during flare-ups of your arthritis.

Some people find that compression (Isotoner) gloves are also helpful in reducing pain and swelling and are easier to wear. 

How do I put it on?

1. Undo the straps.
2. Place your hand into the splint so that it’s in contact with the palm of your hand and there’s no space between your wrist and the splint.
3. If there’s a thumb section make sure that your thumb is also in contact with the material.
4. Do up the straps – not too tight – starting with the strap nearest your elbow.

You may find it helpful to leave the strap over the fingers done up so that you can slide your hand in or out. This means there’s one less strap to undo.

Caring for your resting splint

Clean your resting splint by wiping it with a damp cloth. You may use warm, soapy water or a mild detergent. Use a towel to dry it and don’t store it on a sunny window sill or near a radiator.

Working splints

Working splints provide flexible support for your wrist and hand joints while you’re doing tasks that you might otherwise find painful.

They can help increase your grip strength, reduce pain and make jobs easier to manage.

Working splints are best used when:

• your wrist or thumb is swollen
• you’re having more discomfort than usual
• the joints in your hand feel weak. 

Working splints are usually made of an elastic or light synthetic rubber-type fabric (e.g. neoprene) with Velcro straps. They’re available commercially or from physiotherapy or occupational therapy departments.

If you want to wear any type of working splint while driving, contact your insurance company first for advice about whether your cover will be affected.

There are different types of working splints, described below:

Wrist working splint

This is a wrap-around splint that has a metal bar inserted in a pocket on the palm side of your wrist. This helps to stabilise your wrist joint in a comfortable and efficient position.

How do I put it on?

1. Undo the straps.
2. Place your hand into the splint so that the supporting metal bar is fitting closely into your palm.
3. Roughly line up the edges.
4. Do up the straps – not too tight – this time starting with the strap nearest your wrist, as this is the narrowest part (if you start with the strap nearest your elbow it tends to push the splint down and restrict movement at your fingers. This isn’t the case for resting splints, which you fasten from your elbow first).

Wrist wrap working splint

This is a wrap-around splint that gives light support to your wrist.

How do I put it on?

1. Place the loop over your thumb.
2. Take the long section of the support round the back of your wrist and wrap around, pulling slightly.
3. Do up the strap.

Thumb spica working splint

This is a wrap-around splint that goes around your thumb and wrist. Some have an extra support for the thumb joints. This helps to stabilise the thumb.

How do I put it on?

1. Undo the straps.
2. Place the reinforced strip on top of your thumb joints.
3. Do up the straps – not too tight.

Caring for your working splint

It’s a good idea to wear cotton or rubber gloves over your splint, for example when gardening or cleaning, to help prevent it from getting dirty or wet.

If the splint contains a metal bar you should remove it (if possible) before the splint is washed. Check the position of the bar and be careful to replace it in the same position after washing the splint.

Working splints can be hand-washed in warm soapy water and then air-dried. Some splints can be washed in a washing machine, but you should check the label. It’s a good idea to place the splint in a pillowcase first to prevent the Velcro attaching to other washing.

Caring for your hands

It’s best not to wear your splint all the time, otherwise your joints may become stiff. And you shouldn’t wear a working splint overnight unless you’ve been advised to by your therapist or nurse.

When you take the splint off, make sure that you do some gentle wrist, finger and thumb exercises to help stop your joints from stiffening up.

Stop wearing your splint if it:

• rubs or causes pain
• doesn’t fit any more or is worn out
• leaves red marks or makes your fingers tingle.

If your skin is sore when you wear your splint then contact your rheumatology department or the therapist that issued the splint. It may be that you’re allergic to the material of the splint, or that it’s rubbing and causing too much pressure on your skin.

How can I get a splint?

Some types of splints are available from pharmacies, sports shops and online retailers.

However, before you buy one, it’s a good idea to get advice from a healthcare professional (such as an occupational therapist, physiotherapist or hand therapist). Any member of the healthcare team, including your doctor or rheumatology nurse can refer you to these services.  

Your therapist may be able to provide a splint or arrange for an orthotist to make one designed for your specific needs.

You shouldn’t borrow or use other people’s splints, or let them use yours, as they may not be suitable. 

Splinting | it’s… What is Splinting?

I
Splinting

immobilization (immobilization) of damaged parts of the body with the help of special devices and devices – splints. All currently used tires can be divided into the following groups: by purpose – transport and medical; according to the principle of action – fixation and distraction; according to the manufacturing conditions – standard (standard), non-standard, improvised; splinting of individual segments of the limbs and trunk – splints for the upper and lower limbs, spine and pelvis, head and neck, chest and ribs. Tires used for transport immobilization are called transport, for medical treatment. Fixation splints provide immobilization of damaged areas only by external fixation of nearby joints. Distraction tires provide immobilization due to fixation and traction (distraction). In this case, not only immobilization is carried out, but also the reposition of bone fragments in a stretched position. Tires produced by the industry are called standard or service. These tires are supplied to equip medical institutions, ambulances. Standard tires include ladder, plastic, plywood, Dieterichs tires, pneumatic and vacuum tires. Tires designed and used in individual medical institutions, but not produced by the industry and not included in the set of standard tires, are called non-standard. Tires made from various improvised means are called improvised, or primitive. The material for improvised tires can be wooden slats, bars, sticks, thick or multi-layered cardboard, bundles of brushwood, etc.

Splinting is indicated for fractures of bones, damage to joints, injury to large vessels and nerves, extensive damage to soft tissues, burns, acute inflammatory processes in the extremities. The principles of splinting are to immobilize the damaged segment of the limb with the obligatory switching off of movements in 2-3 joints adjacent to the area of ​​damage, and to give the limb an average physiological position. Physiological for the upper limb is the position of bringing the shoulder to the body and bending the forearm at an angle of 90°. Physiological for the lower limb is the position of a slight flexion of the hip (5-7 °) in the hip joint and lower leg in the knee joint. Sh. of the spine and pelvis is carried out by fixing the trunk and limbs to a hard surface (stretcher, shield, etc.). If the pelvic bones are damaged, a roller is placed in the popliteal region of the victim, which helps to relax the muscles and prevents secondary displacement of bone fragments. Sh. with injuries of the lower leg and neck is carried out by immobilizing the cervical spine, with injuries of the chest and ribs – by fixing special plastic plates to the chest. Tires are fixed to damaged limbs or torso, without removing clothes, with special fasteners or bandaging.

Sh. occupies a special place in the treatment of injuries of peripheral nerves, while the limbs are given a special position: extension of the hand and fingers – with damage to the radial nerve , flexion of the main and extension of the middle and nail phalanges of the fingers of the hand – with damage to the ulnar nerve, flexion of the fingers and opposition of the first finger of the hand – with damage to the median nerve, abduction of the shoulder from the body shcha – with damage to the axillary nerve, hip flexion – with damage to the femoral nerve, the average physiological position of the lower limb – with damage to the sciatic nerve.

One of the most common complications during splinting are bedsores or compression of soft tissues, nerves and blood vessels in places of bony prominences. Prevention of these complications consists in the preliminary protection of bone protrusions with cotton-gauze pads.

Of the standard transport tires ( fig. 1 ), ladder, plastic, pneumatic and vacuum tires are the most important. Stair bus (modified Kramer bus) is a structure in the form of closed rectangles made of metal wire. The tire is easy to model, has high plasticity, and is easily disinfected. Transport plastic tires – plastic strips reinforced with aluminum wire. According to their characteristics, these tires are close to ladder ones.

Medical pneumatic splint consists of two layers of polymer film, equipped with a zipper and an air valve. The injection of air between the sheets of the polymer film creates a good immobilization of the injured limb. There are various types of pneumatic splints for the upper and lower extremities.

Medical vacuum splint consists of two layers of rubber-fabric shell, inside which are small plastic granules. When pumping out air from the cavity of the rubber-fabric shell with the help of a special pump, the tire acquires the necessary rigidity and provides good immobilization.

Among medical splints, splints designed for skeletal traction ( fig. 2 ) for fractures of the femur and lower leg, an abduction splint for the upper limb, designed for skeletal traction for fractures of the bones of the upper limb, are widely used: a splint for traction for fractures of the bones of the foot, splints made of polivik, manufactured individually; abduction splint for the treatment of congenital hip dislocation; head holder made of foamed polyethylene, designed to immobilize the head and neck; plastic splint for the treatment of finger injuries and a number of others.

Fig. 2a). Tires for skeletal traction of the lower limb: splint with removable hammock.

Fig. 1. Tires for transport immobilization of the lower limb.

Fig. 2b). Tires for skeletal traction of the lower limb: folding splint.

II
Splinting

immobilization with splint(s).

1. Small medical encyclopedia. — M.: Medical Encyclopedia. 1991-96 2. First aid. – M .: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. — M.: Soviet Encyclopedia. – 1982-1984

Rush splinting

Operation technique. fracture
peiio-nated under X-ray control.
Like closed splinting
medullary canal insertion site
exposed, then with the help of an awl
a passage is created in the medullary canal.
Wires with a diameter of 2.5-3 mm one after the other

Fig.
8-47.
Splinting by
eng/i.
Application
fibula splints

Fig.
8-48. Application
two oppositely bent tires
Rush
with supracondylar fracture of the femur
bones

are inserted into the medullary canal, passing
yes.sh-she beyond the fracture plane. Located
next to each other the wires fill
bottlenecks in the medullary canal (Fig. 8-46).

The ends of the wire are bent at the bone and
then the wound closes.

Rush 9 splinting0075

Nailing according to Rush is a special form of splinting
medullary cavity. Through the place
fracture in the medullary cavity
flexible metal inserts
rods with a thickness of 2.5 -6.0 mm. If they are in the respective
position elastically wedged into
bone, then, leaning at three points, well
fix it (fig. 8-47).

Technique
operations.
On the extension table,
closed reduction of the fracture. Reposition
bones are controlled by
amplifying screen. In the relevant
place the bone is exposed by a small
incision, and the medullary canal
opened with a bone awl. In a straight line
the medullary canal is introduced curved,
and into a curved canal
– straight
conductor
Rush
in order for it to be wedged
fixation effect increased. Before
the introduction of the rods attached
corresponding form.

Interference
carried out by a closed method. If
closed method fails to achieve
repositioning of fragments, it follows from
small incision at the site of the fracture
achieve reposition and insertion of the end
rod into the distal part of the medullary
channel. Usually two, curved oppositely
to each other tires provide sufficient
commit (fig.
8-48).
The used metal tires have
hooked ends that are driven in
to the cortical layer, after which the wound
closes. External fixation is
required.

Fracture treatment
neck of the femur became almost
specialty in traumatology.
Splinting for this form of fracture
is good, common and
successful treatment.

Splinting technology
with a fracture of the femoral neck.
Lower limb on extension table
through shoes or through temporary plaster
the bandage is attached to the screw
rod. The fracture is closed
with an intensifying screen
multiple planes checked
the correct position of the fragments. Then
the femur is exposed laterally
near the big trochanter. Into the bone from the spot
intended for the introduction of the tire, is inserted
wire. Kirschner
thick in
2 mm,
and aiming –

Fig.
8-49.
splinting of the femoral neck,
1. Closed
reposition and position control
aiming wire under the amplifying
shield

Fig.
8-50.
splinting of the femoral neck,
II. fracture
fixed with a three-lamellar splint.
Accurate adaptation of fragments and position
tires: a)
front view, b)
side view

Fig.
8-51.
splinting of the femoral neck,
III. Bone
fragments are wedged

in the middle of the femoral head
bones (Fig. 8-49). Guide wire
checked by x-ray
multiple planes.

Wire length
is a guideline for selection.
corresponding triangular tire,
which is driven into the bone over the wire.
At

Fig.
8-52. Outcrop
for open osteosynthesis of a fracture
femoral neck (schematically)

Fig.
8-53.
Osteosynthesis of a transcondylar fracture
flat tire

x-ray
the picture shows whether the tire is on
right place. Then sighting
wire removed (fig.
8-50). Tire
provides an opportunity to insert
Bone fragments into each other (Fig.
8-51), what
enhances internal fixation. Some
surgeons in the treatment of fractures in the area
hip joint do not use
extension table, and expose the fracture
with the patient in the supine position. However
in such cases it is necessary to refuse
from all the advantages of closed splinting
(fig. 8-52).

If necessary
fix a non-medial fracture
neck of the femur, and a fracture in
trochanter area, then after injecting
splint in the neck of the femur is attached
also a plate, which is like a diaphysis
femur, and at its neck
fixed with screws (fig.
8-53).
Injected into the wound before suturing
suction drain. External fixation
not required.

Osteosynthesis with curved plates proposed by the Section for the Study of Osteosynthesis (AO)

For treatment
fractures located near
hip joint, a number of authors
an implant prepared
from one piece. Study Section
issues of osteosynthesis (AO) has developed
curved plate, sharp U-shaped
the blade of which is driven into the neck
femur or spongy layer
condyle of the femur. At the same time, more
thick part of the lamina
the angle covering the screws lies on
cortical layer of the femur. Corner
between the two parts of the plate is constant.
Records are produced with various
tilt angle (fig.
8-54).

Fig.
8-54.
Fixation plates (a,
b, c) for
treatment of fractures or for subtrochanteric
osteotomies, d)
over-slit plate

Fig.
8-55. Application
curved plate AO: a,
b) device
to prepare the insertion site
plates with aiming device

Fig.
8-56.
pretension bent
plates for internal fixation
varus osteotomy. a)
Tool position for preparation
places of the plate and places of punching
bone chisel, b)
compression of bone surfaces with plates

Curved plate
used for osteosynthesis
proximal and distal segments
femur. Application of such
plates created for surgery
hip joint possibility
development of many new methods of conducting
operations.

Technique
operations.
Before surgery with X-ray
shots with a goniometer on a sketched
the sketch sets the angle, which
must have this plate. Operation
usually produced on an extension
table under the control of amplification
screen, but using this method
possible without the use of extensionion
table and screen.

Into bone
part of the plate is driven in
special tools. After
choosing an appropriate place
driving in with a drill is formed
hole in the cortex. on sighting
the machine is set to the angle
corresponding to the selected plate.
The corresponding part of the sighting
the device is applied along the longitudinal
axis to the diaphysis of the femur. Then
driven in under x-ray control
chisel that fits exactly into the guide
tool rail (fig.
8-55). On
on the basis of his position, one can obtain
representation of the desired angle of the selected
plates.