Splinting

A wise old ER doctor once told me that nobody sees what the bones look like underneath, but everyone sees what the splint looks like. If it is not done well or looks sloppy, it is safe to assume the rest of your care was sloppy too.

I don’t have a ‘how to splint’ video of my own, but I’ve spent some time finding some from YouTube that I think have some merit. There is something from each of them that you can learn. I know that I did. Take a look.

Volar Wrist Splints

Ulnar Gutter

I’m not crazy about how she includes all of the fingers in the splint, but I do like the fact that she uses rolled gauze (brand name Kerlix for example) to wrap her splints rather than an elastic bandage (Ace wrap). I don’t know if it would hold up for weeks on end, but it sure is sleek and easy to wrap around awkward corners.
04:12 how to apply stockinette for the ulnar gutter (though I usually skip what he calls “step 1”)
07:55 the hand surgeon describes how to keep the fingers straight while the splint hardens

A few thoughts about splinting:

  1. At our hospital we have two padding products: Webril (cotton) and Sof-Rol (rayon).
    • I like the Sof-Rol against the skin because its a little fluffier, lays a little smoother, and does not bunch up and wrinkle as much as the webril does.
    • I like webril to cover the plaster because it is easier to tear off pieces – remember, outside the cast material you are just wrapping it to maintain some shape. There is no mandate for it to be one continuous piece of padding. I tear it liberally to get what I want around elbows and ankles. Webril tears easier, that’s why I like it of this purpose.
  2. My rule of thumb is 8 layers of plaster for an upper extremity, 12 layers on lower extremity
  3. Plaster is easier to mold and sets up a little quicker than fiber glass. Sometimes that is very important – like if you ketamine is wearing off.
  4. Fiberglass comes prepadded, so you don’t have to pad under it – you can, but you don’t have to
    • Padded requires you to concentrically wrap around broken bones. This inevitably makes a fulcrum at the fracture when someone is supporting from above and below as you are wrapping. That hurts in an awake patient. That step can be avoided by using fiberglass products.
  5. If I’m sending someone home with a splint, I use stockinette. If I’m admitting them for surgery (i.e. I know the splint will only be on until in the morning), I don’t bother. And I probably am going to use fiberglass in that case.
  6. If I’m sedating someone to reduce a fracture, I make sure to have all of my splint material measured and cut before I sedate them – and I usually use plaster on those cases. I don’t want to waste my sedation minutes measuring splint material and getting water in the bucket. All that needs to be done before you sedate the patient.
  7. When making a sugar tong, rather than trying to make the whole thing out of one long piece of plaster, I like to make it from two pieces and have them overlap at the elbow. That lets me have each piece positioned perfectly on the palm and on the dorsum of the hand, with the overlap happening at the elbow. It ends of neater and I never have the problem of it coming out too short nor having to fold it back.
  8. Try not to immobilize joints unless absolutely necessary.
    • Don’t immobilize fingers when splinting a wrist.
    • Don’t use walking boots (which immobilize ankles) for toe or fifth metatarsal fractures.