A fracture is break in the continuity of the bone. Fracture splints are the methods and materials to immobilize the fracture for transport when fracture or break in the bone can result from any injury.
Fracture occurs when a force acts on bone and bone can not effectively resist the force and gives way. The fracture can result from a substantial injury or may occur after a trivial injury depending upon bone strength.
It can vary from a simple crack or hairline fracture to a grossly displaced in which the broken fragments of bones have been pulled away from each other by muscular forces.
There are 206 bones in the human body. When a bone is broken, or fractured, it affects not only blood production and function, but there can be complications associated with the muscles, tendons, nerves and blood vessels that are attached, or are close, to the bone.
Why Should Fractured Bone Be Splinted?
Why splint a fracture, you might ask. As we noted before, the fracture may be displaced or undisplaced. Both the conditions are painful.
If the fracture site is not splinted more soft tissues could be damaged which could significantly prolong healing.
A splint helps the injured limb by
– Providing rest to the injured area
– Preventing further displacement of the bone fragments
– Protect underlying vessels and nerves from the fracture fragments which can be injured due to movements of fracture fragments in an unsplinted limb.
How Does Splint Help the Fracture?
Bone is covered by a membranous layer called periosteum. Bone per se does not feel the pain. Pain receptors are present in periosteum only.
The pain that a person feels after fracture is felt by soft tissues around the bone and periosteum.
Whenever the fragments of fractured bone move, the person feels severe pain. Therefore it is essential to immobilize the fractured fragments, so that minimal instances of pain occur.
Splint immobilizes the injured part and reduces pain.
Also, when there is a movement of fractured fragments there is a danger of injury to accompanying blood vessels & nerves that traverse the limb. If fracture is immobilized, these structures stay protected.
Injured bone bleeds and this results in swelling at the fractured site due to accumulation of blood. If limb is allowed to remain unsplinted, there is higher risk of bleeding and potential complication which can occur with such continued bleeding.
In nutshell, a splint reduces pain & minimizes the chance of associated complications. Anything can be used to splint a fractured bone- roll of newspaper cardboard, umbrella, stick are few examples.
Whenever splinting is done, it is necessary to immobilize one joint above and one joint below the fracture for maximum immobilization.
For example, if there is a fracture in leg bone (i.e. tibia), both ankle joints and knee joints need to be included in splinting.
This principle is followed in most of splinting methods with few exceptions.
How To Splint A Fractured Bone?
The fractured area should be splinted with whatever material available around the place of injury. It can be some wooden strip, roll of newspaper or roll of small wooden sticks or umbrella.
If there is an active bleeding from the wound, the wound should be covered and bandaged tightly, with a sterile clothing if anything else is not available.
The limb should be splinted in most comfortable position or in a position that could be attained.
The patient should be rushed to nearest medical center after the splintage and immobilization.
How to Use Fracture Splints – Practical Tips
The injured patient should first be checked for any serious life threatening injury that needs to be managed first. Call for help if not done, If quick evacuation is needed, splinting may be skipped to save time.
For splinting the limb, preferably expose the part by cutting the clothes. Open fractures need to be dressed before splinting.
If possible, a padding using something like jacket or other clothing can be done for comfort of the patient.
After splint has been applied, pulses and sensation should be checked below the splint repeatedly to know if the splinting or bandaging is causing a constriction.
Following general guidelines should be remembered
- If likelihood seems possible, treat the injury as a fracture until imaging can be done
- Even after splinting, the patient should reach the definitive medical care as early as possible
- Patient is not to be moved before splintage of the affected part.
- Airway, breathing and circulation take precedence over the splintage
- Do not attempt to locate a fracture by grating the ends of the bone together.
- Do not attempt to set a broken bone unless a physician will not be available for many days.
- Attempt to normalize the deformity but avoid excessive force. Instead, splint the limb in most plausible position.
- Dress the wound and control bleeding in an open fracture.
Splinting the Upper Limb Injuries
Clavicle, shoulder, and upper arm injuries extending down to the elbow can be supported in clothe sling or simple sling made of bandage.
Flex the injured arm at elbow and place the forearm across the chest. The palm of the hand should be turned in, with the thumb pointed up and the hand raised about 4 inches above the level of the elbow. Support the forearm in this position by means of a wide sling.
For better immobilization, the arm sling is wrapped to the person’s body with a large bandage encircling the person’s chest.
Alternatively, a figure-eight bandage may also be used.
Upper Arm Fracture
Place a pad or folded towel in the armpit, bandage the arm securely to the body, and support the forearm in a narrow sling.
Mid Arm Fracture
Use one well-padded splint on the outside of the arm. extending from the shoulder to the elbow. Fasten the splinted arm firmly to the body and support the forearm in a narrow sling.
Other method is to fasten two wide splints about the arm and then support the forearm in a narrow sling. Do not extend too far up into the armpit to avoid the risk of compression of the neurovascular structures.
Lower Arm Fracture
If the fracture is at or near the elbow, the arm may be either bent or straight. No matter in what position you find the arm, do not attempt to straighten it or move it in any way. Splint the arm as carefully as possible in the position in which you find it.
Forearm and Wrist
Injury to the forearm and wrist requires a straight supportive splint that secures and aligns both sides of the injury. It can be done with firm newspaper roll or open hardback book. A sugar tong splint is another choice.
Forearm has got two bones – radius and ulna. Deformity is more pronounced when both bones break. When only one is fractured, other one acts as splint and the arm retains a more or less natural appearance.
Apply two well-padded splints to the forearm, one on the top and one on the bottom from the elbow to the wrist and secure them in place by bandages.
After the splint is applied, put the forearm across the chest with the palm turned towards chest and the thumb pointing upward. Support the forearm in this with sling with the hand raised about 4 inches above the level of the elbow.
Multiple hand injuries can be splinted by ball and bandage where the patient holds a ball and hand is wrapped with bandage.
An injured finger can be buddy-taped to the adjacent, unaffected fingers, or it can be splinted with small pieces of wood or cardboard.
Splinting for Lower Limb Injuries
Pelvis and Hip Injuries
These injuries need complete immobilization of the person.
They are associated with massive bleeding and can be life threatening themselves or associated with life threatening injuries.
The splints for these injuries should extend to the lower back and down past the knee of the affected side of the extremity and include ankle for absolute immobilization.
These patients should be moved on stretchers only. There are many ready made splinting devices available for these injuries, most common being Thomas splint but these may not always be available and splints.
After carefully straightening the limb, apply two splints, one on the outside of the injured leg and one on the inside.
The outside splint should reach from the armpit to the foot and the inside from the crotch to the foot.
The splints could be bandaged all over the length of the splints. Alternatively, fasten the splints at least at following 5 points
- Around the ankle
- Over the knee
- Just below the hip
- Around the pelvis
- Just below the armpit
As an additional measure, the legs can then be tied together to support.
Special Note: In case nothing is available, the injured limb can be secured to the uninjured limb to provide splinting. This method can be used to splint leg injuries as well.
Knee injuries require splints that extend to the hip and down to the ankle. These splints are applied to the back of the leg and buttock.
Leg injuries can be splinted by a posterior splint extending from thigh to base of toes or a sugar tong splint from knee to ankle.
Carefully straighten the injured leg and apply well padded splints, one on each side of the leg and one underneath.
Alternatively, a pillow and two side splints can be used.
Place the pillow beside the injured leg, then carefully lift the leg and place it in the middle of the pillow. Bring the edges of the pillow around to the front of the leg and pin them together.
Now place one splint on each side of the leg over the pillow, and fasten them in place.
Ankle injuries and foot injuries can be wrapped alone using a figure-of-eight pattern. The foot should be kept at a right angle in the splint to immobilize the ankle. Posterior splint or mediolateral supports can be used.
The primary concern is to avoid a loose piece of rib from puncturing a lung. The patient is put to rest, padded on the chest, and gently wrapped.
Caution After Splintage
Circulation must be checked after a splint or sling has been applied. If the limb swells this will make the bandages tighter and this may cause circulation problems.
Indications that a bandage may be too tight include:
- Absent pulse below the bandage
- Pallor or cyanosis[bluishness]distal to the the bandage
- Cold limb distal to splint
- Tingling or loss of feeling in fingers or toes
Different Types of Slings
Slings are used to upport an injured upper limb or to supplement treatment for another injury such as fractured ribs. There are many different slings, triangular bandages being most commonly preferred.
There are three types of sling
- the arm sling for injuries to the forearm,
- the elevated sling for injuries to the shoulder,
- the ‘collar-and-cuff’ or clove hitch for injuries to the upper arm and as supplementary support to fractured ribs.
- The injured forearm is kept approximately parallel to the ground with the wrist slightly higher than the elbow
- An opened triangular bandage is kept between the body and the arm, with its apex towards the elbow
- Extend the upper point of the bandage over the shoulder on the uninjured side
- Bring the lower point up over the arm, across the shoulder on the injured side to join the upper point and tie firmly with a reef knot
- Fold the excess bandage over the elbow and secure with a safety pin
- Keep the elbow beside the body and the hand extended towards the uninjured shoulder
- Place an opened triangular bandage over the forearm and hand, with the apex towards the elbow
- Extend the upper point of the bandage over the uninjured shoulder
- Tuck the lower part of the bandage under the injured arm, bring it under the elbow and around the back and extend the lower point up to meet the upper point at the shoulder
- Tie firmly with a reef knot
- Secure the elbow as in above method
- Allow the elbow to hang naturally at the side and place the hand extended towards the shoulder on the uninjured side
- Form a clove hitch by forming two loops – one towards you, one away from you
- Put the loops together by sliding your hands under the
- Secure the wrist
- Tie the bandage firmly by extending the bandage behind the neck and tie firmly
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