A fracture is a 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 an 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?
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
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 a fracture is immobilized, these structures stay protected.
Injured bone bleeds and this results in swelling at the fracture site due to the accumulation of blood. If a limb is allowed to remain unsplinted, there is a 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- a roll of newspaper cardboard, umbrella, stick are a 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, a 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.
Practical Tips for Immediate Fracture Care
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 a jacket or other clothing can be done for the 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.
Upper Limb Injuries
Clavicle, shoulder, and upper arm injuries extending down to the elbow can be supported in clothing sling or a simple sling made of the bandage.
Flex the injured arm at the 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.
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.
Another 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. The deformity is more pronounced when both bones break. When only one is fractured, other one acts as a 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 the chest and the thumb pointing upward. Support the forearm in this with the sling with the hand raised about 4 inches above the level of the elbow.
An injured finger can be buddy-taped to the adjacent, unaffected fingers, or it can be splinted with small pieces of wood or cardboard.
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.
Femur Fracture Care
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.
Special spilnts for femur fracture are also available.
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.
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 bandage
- Cold limb distal to splint
- Tingling or loss of feeling in fingers or toes
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