Caveats for Proper Emergency Department Splinting
1. Smooth and mold the splint without squeezing. Use the palms, not the fingers to mold the splint to fit the contour of the body part.
2. Simply roll elastic bandages over an extremity without undue tension.
3. Post-check includes function, arterial pulse, capillary refills, temperature of skin, and sensation (FACTS).
4. Tape over metal clips used to fasten the elastic bandages to keep in place and avoid ingestion by child.
Padding
1. The stockinete should extend at least 10~15 cm beyond the area to be splinted at both ends of the extremities. It can be folded back over the ends of the splint to create smooth, padded rims
2. Wrinkling over flexion creases should also be avoided by slitting and overlapping the stockinette at bony prominences.
3. Padding should be at least 2~3 layers thick and each turn should overlap the previous turn by 25~50% of its width. If significant swelling is anticipated, 3 or 4 layers of padding should be added. It should also extend 2.5~5 cm beyond the ends of the splint so that it, too, can be folded back over areas of bony prominence.
4. Care should be taken to avoid wrinkling, because significant skin pressure might occur.
5. Rare complication of circumferential padding is ischemic injury due to unanticipated swelling. This can be prevented by cutting throught the padding along the side of the extremitiy opposite to the plaster splint.
6. Areas that Require Additional Padding
a. Upper extremities: Olecranon, Radial styloid, Ulnar styloid
b. Lower extremities: Upper portion of inner thigh, Patella, Fibular head, Achilles tendon, Medial & lateral malleoli
Plaster Preparation
1. For an average-sized adult, upper extermities should be splinted with 8 sheets of plaster, whereas lower extremities injuries generally requires 12~15 sheets.
Splint Application
1. Molding the wet splint to conform to the body's anatomy is probably the most important, yet the most frequently overlooked step to ensure adequate immobilization.
2. A single layer of padding or roll gauze can be wrapped around the wet plaster loosely before application of the elastic bandage, to prevent incorporation of elastic bandage into the drying plaster. Only one layer of padding should be use to prevent high drying temperature.
3. Most patients feel better immediately after the splint has been applied. Never release a patient who complains of increased pain after splinting
Patient instructions
1. Cold packs should be applied for at least 30 mins at a time, which is in contrast to the popular recommendation of "ice 20 minutes on, 20 minutes off" which does nothing more than cool the skin.
2. Cold packs should not be applied for more than the first 24~48 hours because cold can interfere with long term healing.