Splinting Notes

Question 1

Traction

Answer 1

Traction for femur 15 lbs force, no more than 10% body weight.

Question 2

Tension

Answer 2

Tension 7 to 8 lbs

Question 3

Long bone fractures with obvious deformity

Answer 3

Use gentle longitudinal tension to align the upper arm or lower leg.
Use gentle in-line traction to align mid-femur fractures.
Alignment is important whenever the extremity is in a state of vascular or neurologic compromise.
If patient exhibits signs and symptoms of significant shock quickly attempt to align the injured limb(s) as close to the anatomical position as possible.

Question 4

Shoulder, Clavicle, and Scapula Fracture/Injury

Answer 4

Sling and swathe, not over injury
Figure 8 may be used for proximal and middle thirds of clavicle, not over fracture – sling and swathe – not for A/C joint.

Question 5

Posterior Sternoclavicular Dislocation

Answer 5

Without severe vascular compromise or breathing difficulty, use sling and swathe.
For vascular or respiratory threat use two or one person reduction then figure 8 and sling and swathe.

Question 6

Shoulder Dislocation

Answer 6

Stabilize in position found.

Question 7

Humerus Fracture

Answer 7

Gentle longitudinal tension. Patient should be in supine position for tension.
Grasp Humerus just above the elbow.
Rigid splint along humeral shaft.
Splint in position found if tension creates too much pain.
Sam splint – bent to hold elbow at 90º and continue down forearm.
Sling and swathe.

Question 8

Elbow Injury

Answer 8

Splint is position found.
Sam splint along posterior from axilla to hand.
Rigid splints on both sides.
If distal CMS is worsened by applying splint or a sling and swathe, loosen and then reapply them with less pressure or extend the elbow slightly. If CMS is still compromised, do not try to readjust again.
Splint straight elbow to the side of the body.
If during your assessment of a deformed elbow injury you become sure that the limb distal to the injury has a CMS deficit, it may be appropriate to gently attempt axial alignment to improve blood supply or neurologic function to the distal arm by restoring normal anatomical appearance to the elbow.
Do not attempt axial alignment unless final definitive care is more than 2 hours away.
Sling and swathe.

Question 9

Forearm Fracture

Answer 9

When the forearm is severely deformed (especially when there is CMS compromise), gently realign the arm if the patient will allow it; if not, splint the arm in the position found.

For Sam splint use a sugar tong shape from where the fingers attach to the palm along the palm side of the forearm around the elbow and along the dorsum of the forearm back to where the fingers attach to the back of the hand.
Alternatively use a long splint that starts at the axilla and proceeds posterior along the arm down to the palm crease along the arm.
Sling and swathe.

Question 10

Wrist Injuries

Answer 10

Splint in position of function or if patient complains, in position of comfort.
Splint on palm side of arm.
Alternatively use sugar tong.
Sling and swathe.

Question 11

Hand and Finger Injury

Answer 11

Metacarpal splint like a wrist and if possible in position of function.
For thumb, immobilize the thumb and wrist as a unit.
For skier’s thumb, splint the entire thumb with a tongue blade. Secure thumb to index finger with a roller bandage.
Splint other fingers with a tongue blade.
Sling and swathe as required.

Question 12

Pelvis Fracture (see ch 24)

Answer 12

Use Sheet or SAM pelvic splint.
Place a blanket roll under knees. Blanket between knees if necessary.
Transport on a backboard with full spinal immobilization due to MOI.
May use a scoop/Combi stretcher to move patient to a backboard

Question 13

Hip Dislocations

Answer 13

Stabilize affected leg in position of comfort and gently lift patient to backboard.
Often requires full spinal immobilization.
May use a scoop/Combi or BEAN lift.

Question 14

Proximal Third Femur Fracture

Answer 14

Also known as a fractured hip.
Most common treatment on a backboard with area under the knees padded.
A double poled femur splint may be used with 7-10 lbs of tension.
Transport on a backboard.

Question 15

Mid-Shaft Femur Fracture

Answer 15

Immobilize with a traction splint unless multisystem trauma and rapidly deteriorating. If multi-system trauma then cravat legs together and immobilize on a backboard for rapid transport.
Consider placing loosely rolled blankets between knees if patient permits.
Place a blanket roll under the uninjured knee after splinting.
Transport on a backboard

Question 16

Distal Femur Fracture

Answer 16

Quick or rigid splint in position that is comfortable to the patient.
If compromised CMS and more than 2 hours transport time then a single attempt to re-align leg keeping knee slightly bent.

Question 17

Femur fracture with impaired CMS

Answer 17

Cold pale foot.
Absent dorsalis pedis and posterior tibialis pulses.
Numbness of the foot or loss of motor function in the lower leg.
Grasp the postier aspect of the top of the calf, just below the knee.
Keeping the knee slightly bent, apply gentle traction to align the postier angulation of the femur distal to the fracture. Attempt this only once.
If PMS returns, splint in position.
In unsuccessful, splint in position of comfort.

Question 18

Knee Injuries

Answer 18

Splint in position found if patient will not let you move knee. Use a quick splint or long boards.
Patella dislocation, splint and transport even if it spontaneously reduces. Apply cold.
Splint a dislocated knee with a distal pulse in position found. If no distal pulse and gross deformity may perform one attempt to axially align knee joint. Splint and transport even if it spontaneously reduces.

Question 19

Tibia Fibula Injuries

Answer 19

Realign if patient will allow otherwise splint in position found.
Use Quick Splint or rigid splints. For two splints, place rigid a splint on medial and lateral sides from above the knee to below the ankle and secure with cravats. For a single splint place splint under the leg and secure with an ankle hitch and Kling.
As a last resort a Hare or other double pole traction splint with tension (7 to 8 lbs.) Not appropriate for ankles.

Question 20

Femur/Tibia Fracture in Same Leg

Answer 20

May cause a floating knee.
Use a Quick split.
May use a Hare or other double pole traction splint with tension (7 to 8 lbs.) only.

Question 21

Ankle Injuries

Answer 21

If distal CMS is compromised or if the bone appears ready to come through the skin, one attempt to reduce the ankle may be tried. Apply gentle but firm tension by pulling on the heel (and the top of the foot) and put the ankle into normal anatomical position. Don’t let go until ankle is immobilized.
Use blanket, pillow, Quick, cardboard, or SAM splint. Only a rigid splint will hold tension.
Ankle hitch may be used, particularly for self-evacuation.

Question 22

Foot and Toe Injuries

Answer 22

Splint with a blanket, pillow or well-padded rigid splint.