Splinting Techniques

Splinting Techniques

The athletic trainer must be aware of splinting principles and techniques and the specific splints best used for immobilizing orthopedic injuries. From a practical standpoint it is economically difficult to possess every possible splinting device. It is best to acquire splinting supplies adequate for the majority of orthopedic injuries commonly encountered in sports. It should also be stressed that athletic trainers appropriately select emergency medical equipment that satisfactorily meets the inherent risks specific to sports. In the case of a traumatic emergency, athletic trainers should be reassured EMS would have access to additional splinting equipment for more extensive injuries. A well-composed emergency action plan should address these specific situations. Once an injured extremity that is suspected of fracture has been properly evaluated, it should be splinted prior to transport from the field. This is especially true if the injured athlete is transported via cart or stretcher. Proper immobilization of the injury tends to diminish irritation and pain and consequently limits edema or effusion. Furthermore, immobilization of skeletal fractures reduces the danger of magnified fragment displacement. Accurate procedures for splinting an orthopedic injury must continually begin with an extensive visual inspection of the extremity. Lacerations, abrasions, and avulsions should be suitably cleansed and dressed with sterile supplies prior to application of a splint. It is also vital that an extremity be assessed for the sudden onset of acute compartment syndrome and neurovascular compromise before and after splinting.

Five basic classes of splints are used in orthopedic sports medicine and emergency medical care. These include rigid, soft, formable, vacuum, and traction splints. Rigidsplints, which are constructed of stiff and sturdy materials, are most appropriately used for protecting and immobilizing misaligned skeletal fractures or gross joint instability. Soft splints use air pressure or bulky padding for immobilization and protection purposes of skeletal fractures and pathological joint instability. Varied forms of soft devices include pillow and air splints. A pillow splint is a comfortable piece of equipment commonly used with foot and ankle complex injuries that applies mild and steady pressure on the affected anatomy. A pillow splint is wrapped around the foot and ankle complex and then secured with either tape or

triangular bandages. Air splints are structured in a similar way to a fashioned cylinder and permit contouring specific to the injured anatomy. These particular devices rely on air pressure, which shapes and reinforces the splint to compress and immobilize an injured area. Air splints provide the advantage of supplemental compression that may be beneficial in limiting excessive hemorrhages. However, air splints must be regularly monitored and appropriately adjusted for alterations in temperature and atmospheric pressure that may cause changes in the rigidity of the splint once it has been applied.

Moreover, caution should be advised when using a lower extremity air splint. These specific air splints typically cover the foot, which makes evaluating distal pulses and sensory perception problematic. Air splints are not to be used with humeral or femoral fractures because of their inability to adequately limit proximal joint excursion. A formable splint is somewhat of a fusion device consisting of a semi-rigid shell and soft inner lining. The semirigid shell of formable splints is typically constructed of a pliable metal that permits manual contouring. This allows the splint to conform to the angulation of the injured anatomy for immobilization. The formable splint’s soft inner lining is usually composed of foam and serves to support the injured area. Vacuum splints are constructed of fabric or vinyl material containing micro-Styrofoam beads that are fixed and secured to the injured area by straps. A pump is used to draw air from the material to compress the Styrofoam beads together, thereby stiffening the splint. This allows the splint to conform to the affected anatomy, thereby increasing its versatility and adaptability for immobilizing an injured extremity.

Traction splints are often used to treat long-bone fractures, especially of the lower extremity. These splints exert a steady longitudinal pull on the axis of the affected anatomy to limit spasm of surrounding musculature. This potentially results in decreasing pain to facilitate realignment of fractured fragments. However, traction splints are used cautiously with upper extremity long-bone fractures because of the potential for susceptible pathology of respective neurovascular structures. Traction splints are costly and require specialized instruction typically found in emergency medical technician curricula. As such, traction splints and their use should be left to EMS personnel. Regardless of the specific splint selected, it is crucial to immobilize joints both proximal and distal to a fracture site to effectively manage the traumatic orthopedic injury. Splints should be adequately padded to protect the skin and soft tissues prior to their application. This may be accomplished by the use of elastic stockinette or cotton Webril to

envelop the injured extremity. Elastic wraps are typically used in splint application. Caution must be taken to avoid applying elastic wraps so tightly that circulation is hindered. In the case of skeletal fractures where edema or effusion is present, an extremity may substantially expand in girth. The

fact that splints are not rigid cylinders is beneficial in that they may accommodate for such increases in anatomical area. This factor also assists with inhibiting detrimental circumferential pressures. Furthermore, elastic wraps that are properly applied will secure the splint to an injured

extremity and allow expansion of anatomical area because of swelling. The athletic trainer must consistently reassess neurovascular integrity prior to and following application of a splint.Vascular integrity of an injured extremity may also be evaluated via capillary refill time. Extended capillary refill

time is indicative of potential vascular compromise.

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