Common Types of Emergency Splints

Ovid: Manual of Orthopaedics

Editors: Swiontkowski, Marc F.; Stovitz, Steven D.
Title: Manual of Orthopaedics, 6th Edition
> Table of Contents > 6 – Common Types of Emergency Splints

Common Types of Emergency Splints
I. Emergency Splinting of The Spine
  • Patients with spinal injuries should be splinted with a backboard before they are moved, as shown in Fig. 6-1.
    Immobilize patients with suspected cervical spine injuries by placing
    sandbags, rolled towels, or rolled blankets on each side of the head.
    Then put a cravat through or around the backboard and over the
    forehead. In this way, the patient’s head, neck, and backboard can be moved as one unit.
    Commercial foam as well as plastic neck collars are available in
    different sizes and are carried by emergency medical technician (EMT)
    units. One can also make an adequate neck collar by placing foam or
    felt of the appropriate width, thickness, and length inside a tubular
    stockinet and then fastening the stockinet about the patient’s neck.
    This method is particularly useful for immobilizing the neck of injured
    children where correct sizing is critical so as to immobilize the neck
    without extension or flexion. The only emergency indication for moving
    the neck of an individual with a suspected injured cervical spine is to
    improve an inadequate airway by aligning the neck with the torso and
    opening the airway with a jaw thrust.
  • Be aware of possible neurogenic shock, which is treated by elevating the lower end of the backboard to improve venous return in the reverse Trendelenburg position.
  • If complete evaluation identifies a cervical spine fracture, then the patient is usually placed in traction
    or hard collar immobilization. The direction of traction depends on the
    injury. If there is no dislocation, then a neutral or slightly extended
    position is preferred (see Chap. 9).
II. Upper Extremity Splinting
  • Remember to remove rings from an involved hand!
    Swelling can make them impossible to remove without cutting them off
    and they obscure x-rays. Petroleum jelly can be useful for ring removal.
  • Figure-of-8 splint
    • The principal use is for clavicular fractures (see Chap. 13).
    • Application.
      The factory-made figure-of-8 clavicular strap is recommended because it
      is a webbed fabric and does not stretch. If a properly fitting
      factory-made strap is not available for children younger than 10 years
      old, make a figure-of-8 strap with a tubular stockinet filled with felt
      or cotton padding, as shown in Fig. 6-2.
      These should be used only if they make the patient more comfortable. A
      sling is generally more effective in this regard. Generally, the
      figure-of-8 splint does not improve fracture reduction.
    • Precautions
      • Prevent skin maceration with a powdered pad in the axilla.
      • In the adult, restrict the use of the sling and encourage glenohumeral motion after 2 weeks to prevent shoulder stiffness.
      • Do not tighten the figure-of-8 strap to the point that the axillary artery or brachial plexus is compressed.
  • Velpeau and sling-and-swathe bandages
    • These bandages are used for shoulder dislocations, proximal humerus fractures, and humeral fractures.
    • One application of Velpeau bandage using bias-cut stockinet is seen in Fig. 6-3. The common application of the typical sling-and-swathe bandage is shown in Fig. 6-4.


      Either type of bandage can be covered with a light layer of fiberglass or plaster to prevent unraveling of the material.

      Figure 6-1. A backboard may be used in an emergency to transport a patient with a spinal injury.
    • Precautions
      • Prevent skin maceration with a powdered pad in the axilla and between the arm and chest.
      • Prevent wrist and finger stiffness with active exercise.
        Figure 6-2.
        Typical figure-of-8 splint made for a child younger than 10 years old
        with a fractured clavicle. In adults, use a factory-made splint when
        Figure 6-3. Method for applying Velpeau bandage.
    • P.95

    • A number of commercial shoulder immobilizers
      are available. Although they provide less secure immobilization than
      the Velpeau and sling-and-swathe bandages, these ready-made items have
      proved satisfactory. Commercial straps for acromioclavicular (AC)
      separations are also available; they have straps which go over the
      distal one third of the clavicle and lift up on the elbow in order to
      reduce the AC separation.
  • Use air splints
    in emergency situations for the distal extremity. The air splint is
    closed over the extremity by its zipper and inflated by flowing air
    into the mouth tube. High pressure from mechanical pumps can produce
    circulatory embarrassment and should not be used. Skin maceration
    occurs if air splints are used for any extended period. Cardboard or
    magazines can be used with tape of any sort to achieve temporary
III. Lower Extremity Splinting
  • Thomas splint
    • Use for femoral shaft fractures and, occasionally, knee injuries.
      The following description is for the emergency situation. The Thomas
      splint may also be used as fixed skeletal traction, as described in Chap. 9, VII.F.3.
      Figure 6-4. Slng-and-swathe bandage, covered by a single layer of plaster to help prevent unraveling of the material.
    • P.96

    • The ideal Thomas splint application
      uses a full ring splint that measures 2 in. greater than the
      circumference of the proximal thigh. If a full ring splint is not
      available, use a half ring splint with a strap placed anteriorly. The
      ring engages the ischial tuberosity for countertraction, and traction
      is applied to the end of the splint with an ankle hitch, as shown in Fig. 6-5.
      A Spanish windlass is made by taping several tongue blades together.
      These twist the material used to secure the ankle hitch to the end of
      the splint, producing a traction force. The half ring splint still
      engages the ischial tuberosity, and the strap buckles down across the
      anterior thigh. Towels or a tubular stockinet placed on the Thomas
      splint with safety pins support the leg, as shown in Fig. 6-6.
    • Hare splints and Roller splints
      are also commercially available. They differ from the Thomas splint
      only by the foot attachments and leg supports. They are in widespread
      use by emergency medical technicians.
    • Most precautions relate to complications of fixed skeletal traction and are discussed in Chap. 9, VII.
      Do not leave the temporary splint on for more than 2 hours, whenever
      possible, because the ankle hitch places significant pressure on the
      skin and may produce necrosis.
  • Jones compression splint
    • Use in acute knee trauma (patellar, knee, and some tibial fractures) and acute ankle injuries.
    • Apply by wrapping the injured leg from
      the toes to the groin in rolled cotton. Next, add a single layer of
      elastic bandage. Apply 5- × 30-inch plaster splints posteriorly,
      medially, and laterally to keep the ankle in a neutral position. Medial
      and lateral splints support the knee in the desired degree of flexion.
      Do not overlap the splints, or a circumferential plaster will be
      created about the extremity. The splints are then overwrapped with
      bias-cut stockinet in a herringbone fashion.
    • Precautions
      • Do not apply wraps too tightly.
      • Do not make upper wraps tighter than lower wraps or venous return will be impeded, causing swelling and circulatory problems.
    • Although they provide less satisfactory compression, commercial knee immobilizers are acceptable in most cases.
  • Short-leg or modified Jones compression splint
    • Use in acute ankle and foot trauma such as ankle sprains, calcaneal fractures, and other foot injuries.
      Figure 6-5.
      A Collins hitch is a means of applying traction from the ankle to the
      end of the Thomas splint, but it is used only in emergency situations.
      Figure 6-6. A Thomas splint may be used at the scene of the accident for a fracture of the femur.
    • P.97


    • The splint is applied in a fashion similar to that described for the Jones splint except that it does not extend above the tibial tubercle.
    • Precautions are the same as those for the Jones compression splint.
  • Commercial leg and ankle braces
    • Short leg walkers
      constructed of a rigid foot piece and double uprights and secured with
      Velcro fasteners are available for conditions not requiring more rigid
      cast immobilization.
    • Lace-up canvas ankle supports with removable aluminum stays are also often convenient and useful for ankle sprains and instability.
    • Air splints
      with inflatable medial and lateral supports have recently proven
      extremely useful as supports for ankle sprains and stable fractures
      that are well along in the healing process.
      Figure 6-7. A: A pillow splint may be applied to a leg with a distal injury as a temporary measure. B: Board splints may be used for lower-extremity fractures in emergency situations.
  • P.99

  • Other emergency splints
    • Make-do splints
      may be used as a temporary measure. One may apply a pillow splint,
      rigid cardboard, magazine, or a wooden splint to the upper or lower
      extremity. A pillow splint for the ankle is shown in Fig. 6-7A.
    • Precautions
      • Avoid circulatory embarrassment
        by applying splint straps or wraps in such a way as to prevent pressure
        on the skin over a bony prominence or a tourniquet effect to the
      • Splint
        • For closed fractures,
          restore gross limb angulation into better alignment before the splint
          is applied by using gentle traction first in the direction of the
          angulation and then in the long axis of the limb.
        • Restore alignment in the same manner if there is tenting of the skin over the injury.
        • For open fractures, gross limb alignment should be restored, the wound inspected and dressed with sterile technique, and a splint applied.
      • Cover exposed bone with a saline- or betadine-moistened sterile dressing as first aid treatment.

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