Pediatric emergency medicine trisk 1116
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FIGURE 130.49 Splinting of musculoskeletal injuries. A. Long arm posterior splint. B.
Below knee posterior splint. C. Ankle stirrup (sugar tong) splint. D. Long leg posterior
splint. E. Ulnar gutter splint. F. Radial gutter splint. G. Forearm sugar tong splint. H. Thumb
spica splint. I. Dorsal extension finger splint.
Procedure
This splint may be used alone or in combination with a posterior splint. It
provides lateral and medial support to the ankle, preventing inversion and
eversion. This splint extends in a U-shaped fashion from the fibular head around
the ankle to just below the knee ( Fig. 130.49C ). The width of the material
should be approximately one-half of the circumference of the narrowest portion
of the lower leg. Application occurs more easily with the patient in the prone
position with the foot dorsiflexed to 90 degrees at the ankle and the knee flexed to
90 degrees. Consider padding the malleoli with felt or additional cotton padding
to decrease the incidence of pressure ulcers. Prepare and apply the splint
materials as described in the “General Splinting” section. When using the
posterior and stirrup splints together, place the posterior splint first with the
stirrup over top of the posterior splint.
Discharge the patient with crutches, if developmentally appropriate, and
discourage weight bearing.
Long Leg Posterior Splint
Indications
Immobilization of knee injuries and fractures of the midshaft and proximal tibia
and fibula.
Procedure
The injuries immobilized by this splint often require early orthopedic
consultation. When used, the splint extends from just behind the toes to the area
below the gluteal fold ( Fig. 130.49D ). The splint material must be sufficiently
wide to support the proximal thigh and the knee. The final position will maintain
the ankle at 90 degrees of dorsiflexion and the knee in slight flexion. The help of
an assistant or two is necessary to support and elevate the leg during the
procedure. Patients often require significant analgesic medications for this
splinting. Prepare and apply the splint materials as described in the “General
Splinting” section. Discharge the patient with crutches and discourage weight
bearing.
Ulnar Gutter Splint
Indications
1. Boxer’s fracture (up to 20 degrees angulation without rotation)
2. Uncomplicated fourth and fifth phalangeal fractures
Procedure
This splint is U-shaped, incorporates the fourth and fifth phalanges, and extends
along the ulnar aspect of the forearm ( Fig. 130.49E ). The splint extends from
the distal fingers to the proximal forearm. The proper splinting position maintains
slight dorsiflexion of the wrist, 60 to 90 degrees of flexion at the
metacarpophalangeal joint, and 20 degrees of flexion at the interphalangeal joints.
To determine the appropriate length of splint material, measure from the
patient’s fingertip to 2 to 3 cm distal to the volar crease at the elbow. The plaster
material should be wide enough to enclose the fourth and fifth phalanges and
overlie both the volar and dorsal surfaces of the fourth and fifth metacarpals.
Place the patient’s elbow in a neutral position so no pronation or supination of the
forearm is possible. Prepare and apply the splint materials as described in the
“General Splinting” section. Remember to place padding between the digits. For
metacarpal fractures, it is desirable to approach 90 degrees of flexion at the
metacarpophalangeal joints. This position tightens the collateral ligaments and
helps maintain reduction.
Radial Gutter Splint
Indications
1. Second and third metacarpal fractures
2. Second and third phalangeal fractures
Procedure
This splint is U-shaped and lies along the radial side of the arm. It extends from
the tips of the second and third phalanges to the proximal forearm a few inches
distal to the flexural crease at the elbow. The width of the material will cover the
second and third metacarpals on the volar and dorsal surfaces. The final position
maintains the forearm in neutral position with the wrist in slight dorsiflexion, the
metacarpophalangeal joints at 60 to 90 degrees of flexion, and slight flexion of
the interphalangeal joints.
Prepare and apply the materials as described in the “General Splinting” section.
Make a hole in the splinting material to allow for the thumb ( Fig. 130.49F ).
Accomplish this by locating the position of the thumb on the splint material,
folding the material in half, and cutting a semicircle of material from the folded
edge. If fiberglass is used, this cut edge is sharp so the padding must be stretched
well or additional padding placed around the thumb to keep fiberglass from direct
contact with the skin. Remember also to place padding between the fingers.
A sling is not necessary but can be dispensed for comfort.
Sugar Tong Splint—Forearm
Indications
Distal radius and wrist fractures in which pronation and supination are minimized
and the elbow is immobilized.
Procedure
As shown in Figure 130.49G , the splint extends along the volar surface from the
flexural crease of the palm, around the elbow, and dorsally to the metacarpal
heads. The fingers and thumb remain free. As shown in the figure, the arm should
