Different types of splints are used for management of various musculoskeletal conditions. Splints are noncircumferential immobilizers. That means they do not cover the limb they splint circumferentially, unlike cast.
Because of being non-circumferential, they can accommodate the swelling that might arise after the injury. In this sense, they are more forgiving and safer than casts.
Splints are commonly used for injuries of limb, for acute fractures or sprains both, either as definitive treatment or definitive treatment.
The purpose of splinting acutely is to immobilize and protect the injured extremity, aid in healing, and lessen pain. Different types of splints are used at different sites.
Though they are not circumferential, splints can still cause many complications and patient needs to be monitored after application. Moreover, the complications of immobilization like joint stiffness, muscle atrophy, or more severe complications, such as complex regional pain syndrome may occur with splinting also.
Splinting begins by placing the injured extremity in its position of function. It is important to maintain good anatomic fracture alignment.
Different Types of Splints
- Volar short arm splint
- Dorsal short arm splint
- Single sugar-tong
- Long arm posterior
- Double sugar-tong
- Long arm
- Posterior knee splint
- Long leg splint
- Long leg splint
- Short leg shaft and distal)
- Posterior ankle splint
- High-top walking boot
Common Types of Splints for Hand/Finger
Ulnar gutter splint begins at the proximal forearm and extends to just beyond the distal interphalangeal joint. It is used for undisplaced, stable fractures of the head, neck, and shaft of the fourth or fifth metacarpal with mild angulation and no rotational deformities.
[More on metacarpal fractures]
[More on phalangeal fractures]
For the splint, the wrist is slightly extended with the metacarpophalangeal joints in 70 to 90 degrees of flexion, and the proximal interphalangeal and distal interphalangeal joints in 5 to 10 degrees of flexion.
Radial Gutter Splint
The radial gutter splint is used for
- Unndisplaced fractures of the head, neck, and shaft of the second or third metacarpal without angulation or rotation
- Nondisplaced shaft fractures and serious injuries of the second or third, proximal or middle phalanx; initial immobilization of displaced distal radius fractures.
The splint is put along the radial aspect of the forearm and extends from just beyond the distal interphalangeal joint of the index finger, leaving the thumb free. Proximally, the extent is up to just short of elbow joint.
Thumb Spica Splint
Thumb spica splint is used for
- Suspected injuries to the scaphoid
- Stable ligamentous injuries to the thumb
- Initial treatment of nonangulated, nondisplaced, extra-articular fractures of the base of the first metacarpal
- de Quervain tenosynovitis
- First carpometacarpal joint arthritis.
The forearm is in the neutral position with the wrist extended to 25 degrees and the thumb in a position of function. Imagine holding a glass or a cold drink can. This is the functional position of the thumb.
Buddy Taping or Dynamic Splinting
The injured finger is taped to the adjacent finger for protection and to allow movement
Dorsal Extension Block Splint
This splint is used in
- Middle phalangeal volar avulsions with potential for dorsal subluxation
- Reduced, stable proximal interphalangeal joint dorsal dislocations.
U Shaped Aluminum Splint
Used most commonly in distal phalangeal fractures. The aluminum splint wraps from the dorsal fingertip around to the volar fingertip and immobilizes only the distal interphalangeal joint in extension.
Mallet Finger Splint
The splint is kept for 6-8 weeks.
Night splinting for an additional two to three weeks is recommended.
Volar/Dorsal Forearm Splints
These splints are used in
- Soft tissue injuries of the hand and wrist
- Temporary immobilization of carpal bone dislocations or fractures (excluding scaphoid and trapezium).
The wrist is slightly extended.
Sugar Tong Splints
Single Sugar Tong Splint
It is used in the acute management of distal radial and ulnar fractures.
The splint extends from the proximal palmar crease, along with the volar forearm, around the elbow to the dorsum of the MCP joints
The forearm is neutral and the wrist is slightly extended.
Double Sugar-Tong Splint
Double sugar tong splint is used in the management of elbow and forearm injuries.
First, a single sugar tong splint is applied as described above.
A second sugar-tong splint is then applied, extending from the deltoid insertion distally around the 90-degree flexed elbow, and proximally to 3 inches short of the axilla.
Long Arm Posterior Splint
This splint is used in
- Acute and definitive management of elbow, proximal and mid-shaft forearm, and wrist injuries
- Acute management of distal radial/ulnar fractures in children.
The splint extends from the axilla over the posterior surface of the 90-degree flexed elbow, and along the ulna to the proximal palmar crease.
Different Slings for Upper Limb Injuries
Slings are used to support 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
Different Types of Splints for Lower Limb
Posterior Ankle Splint
It is used in
- Acute severe ankle sprain
- Undisplaced, isolated malleolar fractures
- Acute foot fractures
- Soft tissue injuries.
The splint extends from the plantar surface of the great toe or metatarsal heads along the posterior lower leg and ends 2 inches distal to the fibular head. It should always end below the fibular head as that would not put common peroneal nerve at risk.
This splint is commonly used in acute ankle injuries, isolated undisplaced malleolar fractures.
The splint extends from the lateral mid-calf around the heel and ends at the medial mid-calf The position of the function is with the ankle flexed to 90 degrees. This is the neutral position for the ankle.
A bulky Jones splint is a variation on the stirrup splint used acutely for more severe ankle injuries. The lower extremity is wrapped with cotton batting and reinforced with a stirrup splint.
Toe Plate Extensions
Posterior Knee Splint
This splint is used in soft tissue injury and fractures around the knee
The splint should start just below the gluteal crease and end just proximal to the malleoli. It is also called cylinder splint.
The knee is positioned in slight flexion.
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