Splinting & Casting Flashcards
General Fracture Management
– Maintain anatomic fracture alignment throughout treatment.
– Stable fractures are generally re-evaluated within one to two weeks following cast application to
assess cast fit & condition, & to perform radiography to monitor healing & fracture alignment.
* Hand & forearm fractures are often re-evaluated within the first week
– Displaced fractures require closed reduction, followed by post-reduction radiography to confirm bone
alignment.
– Both displaced & unstable fractures should be monitored vigilantly to ensure maintained
positioning.
If an open wound is present, what should you do?
apply a sterile dressing, and check
with orthopedist for all open wounds
Immobilize the joints _____ the suspected fracture site
above & below
Typically position the joint to a _____ position when splinting or casting
neutral
As a general rule, casts are rarely used for the initial treatment. In an
acute setting, like an ER/Urgent Care, always use _____
a splint
Prefabricated splints pros and cons
– Benefits: quick, easy, works in some
situations, easily removable
– Cons: One size fits most, lack the ability to
customize to the patients needs
– Typically used emergently &/or when needed
only for a short period of time
Custom Splints pros and cons
– Plaster splints are seldom used anymore
– Fiberglass splints have the advantage of
being lighter, more sanitary, & are typically
more durable than plaster casting
Ulnar Gutter Splint indications and positioning
– Indications
* 4th metacarpal fracture
* 5th metacarpal fracture
– Positioning
* MCP joints at 70 to 90 degrees of flexion
* PIP & DIP joints at 5 to 10 degrees of flexion
Ulnar Gutter Splint – Follow-Up
- One to two weeks
- Refer for angulated, displaced, rotated, oblique, or
intra-articular fracture or failed closed reduction
Ulnar Gutter Cast indications and positioning
– Indications
* 4th metacarpal fracture
* 5th metacarpal fracture
– Positioning
* MCP joints at 70 to 90 degrees of flexion
* PIP & DIP joints at 5 to 10 degrees of flexion
Ulnar Gutter Cast follow up
One to two weeks
Volar Splint indications and positioning
– Indications
* Wrist sprain/strain
* Carpal Tunnel
* Lacerations
* Night Splint
– Positioning
* Wrist is neutral or slightly extended
* MCP joints are free
Volar Splint follow up
- 1-2 weeks
- Refer for angulated, displaced, rotated, oblique, or
intra-articular fracture or failed closed reduction
Thumb Spica Splint indications and positioning
– Indications
* Scaphoid fracture maybe?
* Thumb dislocation
* Thumb fracture
– Positioning
* “Hold a soda can”
Thumb Spica Splint follow up
- One to two weeks
- Refer for angulated, displaced, intra-articular,
incompletely reduced, or unstable fracture - Refer displaced fracture of the scaphoid
Thumb Spica Cast indications and positioning
– Indications
* Non-displaced scaphoid fracture
(middle/proximal 1/3)
* Stable ligamentous injuries to the thumb
* Nonangulated, nondisplaced, extra-articular
fractures of the base of the first metacarpal
* De Quervain tenosynovitis
* 1
st carpometacarpal joint arthritis.
– Positioning
* “Hold a soda can”
Thumb Spica Cast follow up
One to two weeks
Sugar Tong Splint indications and positioning
– Indications
* Nondisplaced or minimally displaced fractures of the distal wrist, such as
– Colles & Smith fractures or greenstick, buckle, & physeal fractures in children
– carpal bone fractures other than scaphoid or trapezium.
– Positioning
* Neutral wrist or slightly extended
* MCP joints are free
Sugar Tong Splint follow up
- One to two weeks
- Refer for angulated, displaced, intra-articular,
incompletely reduced, or unstable fracture
Short-Arm Cast indications and positioning
– Indications
* Nondisplaced or minimally displaced fractures of the distal wrist, such as
– Colles & Smith fractures or greenstick, buckle, & physeal fractures in children
– carpal bone fractures other than scaphoid or trapezium.
– Positioning
* Neutral wrist or slightly extended
* MCP joints are free
Short-Arm Cast follow up
1-2 weeks
Sugar Tong (Coaptation) Splint indications
- Humeral fractures
- Double Sugar Tong Splint
may be used in
combination with each
other
– Greater immobilization
against
pronation/supination
Posterior Long-Arm Splint indications and positioning
– Indications
* Supracondylar fracture
* Elbow sprain/strain
– Positioning
* Elbow at 90 degrees flexion
* Neutral wrist
Long-Arm Cast indications and positioning
– Indications
* Supracondylar fracture
* Elbow sprain/strain
* Could be combined with as a long
arm thumb spica
– Positioning
* Elbow at 90 degrees flexion
* Neutral wrist
Posterior Short-Leg Splint indications and positioning
– Indications
* Tibia/Fibula fracture
* Ankle fracture
* Metatarsal fracture
– Positioning
* Neutral ankle
Short-Leg Cast indications and positioning
– Indications
* Tibia/Fibula fracture
* Ankle fracture
* Metatarsal fracture
– Positioning
* Neutral ankle
Short-Leg Cast with Toe Plate Extension indications and positioning
– Indications
* Distal metatarsal & phalangeal fractures
* Great toe fractures
– Positioning
* Neutral ankle
Posterior Long-Leg Splint indications and positioning
– Indications
* Knee ligament injuries
* Knee joint dislocation
* Tibia & fibula fractures
* Femoral shaft fracture
– Positioning
* Knee flexion at 25-30 degrees
* Neutral ankle
Medial-Lateral Long-Leg Splint indications and positioning
– Indications
* Knee ligament injuries
* Tibia & Fibula fractures
– Positioning
* Knee flexion at 25-30 degrees
* Neutral ankle
Long-Leg Cast indications and positioning
– Indications
* Knee ligament injuries
* Tibia & Fibula fractures
– Positioning
* Knee flexion at 25-30 degrees
* Neutral ankle
* If ankle immobilization is necessary (tibial
shaft injuries) the cast should extend to
include the metatarsals
Compartment syndrome and casting
– Most feared, 2nd to a tight cast or the original injury with changes in swelling
– Poor application technique
– Teach patients what to do if there fingers are numb, fingers can move, and/or the cast is too tight
Complications of casting/splinting
- Compartment syndrome
- Soft tissue burns (plaster splints/casts)
- Nerve compression injuries
- Pressure sores
- Contractures
