1. SPLINTS
Guided by : Dr. Nitin Sir
Done By : Dr. Rupeshkumar Hatwar

2. What is a splint?
• A splint is a rigid support with padding made from
metal, plaster or plastic. It is used to support, protect,
or immobilize an injured or inflamed part of the body.
The splint is secured in place with an elastic bandage
or an ACE wrap .The purpose of the splint is to preve
nt movement of the injured extremity which helps pre
vent further injury, and to minimize pain

3. • Indications for Splinting
•
•
•
•
•
•
•
Fractures
Sprains
Joint infections
Tenosynovitis
Acute arthritis / gout
Lacerations over joints
Puncture wounds and animal bites of the hands
or feet

4. • To reduce/prevent contracture
• To increase grip strength
• To stabilize and rest joint in ligamentous
injury
• To correct deformity
• To support and immobilize joints and limbs
postoperatively until healing has occured

5. • Contraindications of
Splinting syndrome
 Compartment
 Need for open reduction
 Skin at high risk for infection

6. • Splinting Material
• Plaster of Paris
– Made from gypsum - calcium sulfate
dehydrate
– Exothermic reaction when wet - recrystallizes
(can burn patient)
– Average setting time – 3-9 min
– Average drying time – 24-72 hours

7. – Factors decreasing setting time :Hot water, Salt, Borax, Resins
– Factors increasing setting time :Cold water, sugar
– Upper extremities :– use 8-10 layers
– Lower extremities :-12-15 layers up
to 20 if big person (increased risk of
burn!)

8. • Advantage
• Disadvantage
• Easier to mold
• Less expensive
• More difficult to apply
• Gets soggy when getting
wet

9. • Splinting Material
• Ready Made Splinting Material
(1) Plaster (OCL)
• 10 -20 sheets of plaster with padding and cloth cover
(2) Fiberglass (Orthoglass)
•
•
•
•
Cure rapidly (20 minutes)
Less messy
Stronger, lighter, wicks moisture better
Less moldable
Disadvantage
• More expensive
• More difficult to mold

10. (3) Prefabricated splints
• Plastic shells lined with air cells, foam or gel
components
• Same advantages and disadvantages as fiberg
lass splints

11. (4)Air splints
• Provide less support than plaster and fibergla
ss Splints
• Used for ankle sprains rather than fractures o
r Dislocations
• Used to prevent eversion/inversion while perm
itting free flexion and extension of ankle
• Provides clear vie
w of injury during
x-ray

12. (4) Vacuum splints
- Styrofoam chips contained
inside an airtight cloth, pliable
sleeve
- Molds to shape of injury using
a handheld pump to draw out the
air from within the sleeve

13. • Pre / Post - Splint Checks
•
•
•
•
•
F – Function
A – Arterial Pulse
C – Capillary Refill
T – Temperature (Skin)
S - Sensation

14. • Choose your splints
Upper Extremity
• Shoulder And Arm
- Figure of eight
- Sling and Swathe
- Aeroplane splint
• Elbow/Forearm
– Long Arm Posterior
– Double Sugar - Tong
• Forearm/Wrist
– Volar Forearm / Cockup
– Sugar - Tong
• Hand/Fingers
–
–
–
–
–
Ulnar Gutter
Radial Gutter
Thumb Spica
Finger Splints
Knuckle-bender splint

15. Lower Extremity
• Hip and Thigh
- Von Rosen’s Splint
- Thomas Splint
- Bohler-Braun Splint
Spine
-
Cervical Collar
Four-post Collar
SOMI (Sternal Occipital
Mandibular Immobilizer)
• Knee
- Knee Immobilizer / Bledsoe
- Bulky Jones
- Posterior Knee Splint
• Ankle
- Posterior Ankle
- Stirrup
• Foot
- Denis-Brown splint
- Buddy taping
- Scoliosis
- Milwaukee Brace
- Boston Brace
- Taylor’s Brace

16. • Traction
1. Manual Traction
2. Skin Traction
3. Skeletal Traction

17. Upper
Extremity

18. • Shoulder and Arm
(1) Figure of eight
• Indications:
– Clavicle fractures
• Most figure of eight splints are
prefabricated and Application is
simple.
• Read the product information insert
before applying the splint about the
correct application process.
• Apply with patient standing and
hands on iliac crest.
Shoulders should be abducted

19. Figure of eight

20. (2) Sling and Swathe
• Indication:
– Shoulder and humeral injuries
• Slings supports weight of shoulder
• Swathe holds arm against chest to
prevent shoulder rotation
• Apply the sling and swath with the
patient standing.
• Place the injured arm in the sling
with the elbow at 90 degrees of flexion.
• Next place the strap that is attached to
the sling over the patient head so that
the weight of the arm is supported

21. Sling and Swathe
• Apply the swath.
– This can be anything from
an ACE wrap to a prefabricated
swath. This is designed to hold
the patients affected arm that
is in the sling against the body.
• The swath should wrap around
the front and back of the sling
keeping the affected extremity
against the mid-abdomen

22. (3) Aeroplane Splint
Indication- Brachial plexus injury

23. • Elbow/Forearm
(1) Long Arm Posterior
• Indications:
- Forearm and elbow injuries
- Olecranon and radial head fractures
- Distal humeral fracture
• Not recommended for unstable fractures
• Applied from palmer crease, wrapping around
lateral metacarpals, extending up to posterior arm
with elbow flexed at 90 degrees
NOTE - Doesn’t completely eliminate supination / pronation –either
add an anterior splint or use a double sugar-tong if complex o
r unstable distal forearm fx.

24. Long Arm Posterior

25. (2) Double Sugar - Tong
• Indications :- Elbow and forearm fx
- prox/mid/distal radius and
ulnar fx.
Better for most distal forear
m and elbow fx because li
mits flex/extension and pro
nation / supination.

26. (2) Double Sugar - Tong

27. • Forearm/Wrist
(1) Volar Forearm / Cockup
• Indications:
- Distal forearm and wrist fractures
-
Soft tissue hand / wrist injuries - sprain
, carpal tunnel night splints, etc
- 2nd -5th metacarpal fx.
- Radial Nerve palsy
• Applied from volar
palmer crease to 2/3
forearm
• Allows elbow and
finger ROM
NOTE - Not used for distal radius or ulnar fx - can still supinate
and pronate.

28. Volar Forearm / Cockup

29. (2) Forearm Sugar - Tong
• Indications –
Wrist and distal forearm fractures
•
Extends from MCP joints on dorsum of hand,
tracks along the forearm, wraps around back
of elbow to volar surface of the arm and exte
nds down to mid-palmer crease
•
Immobilises wrist, forearm, and elbow

30. Forearm Sugar - Tong

31. • Hand/Fingers
(1) Ulnar Gutter Splint
(2) Radial Gutter Splint
• Indications:
•Indications
– Phalangeal and metacarpal
- Fractures, phalangeal and
fractures
metacarpal and soft tissue
• Most common use-Boxer
injuries of the index and
fractures
middle fingers.
• 5th MCP fracture Soft tissue
injury to little and ring finger.

32. • Ulnar Gutter Splint
• Extends from DIP joint to the proximal 2/3 of
the forearm
• Should immobilize the ring and little finger
• MCP should be in 70 degrees of flexion, PIP
should be in 30 degrees of flexion and DIP in
no more than 10 degrees of
flexion

33. • Ulnar Gutter Splint

34. • Ulnar Gutter Splint

35. Radial Gutter Splint

36. (3) Thumb Spica
Indications:
– Scaphoid fractures , thumb
phalanx fractures or dislocations
• Most Common use:
1) Gamekeepers thumb or skiers
thumb
2) Dequiervans tenosynovitis
• Extends from DIP joint of thumb,
incorporates the thumb and extends
up 2/3 of the proximal lateral forearm

37. Thumb Spica

38. (4) Finger Splints
Sprains - dynamic splinting
(buddy strapping).
Dorsal/Volar finger splints - phalangeal
fx, though gutter splints probably better
for proximal fxs.

39. Finger Splints
(a) Stack Splint
Use – management of mallet finger

40. (b) Aluminium Splint
Uses - phalangeal fx,
-mallet finger

41. (c) Oval-8 Finger splint

42. Oval-8 Finger splint

43. Finger splints

44. (d) Tripoint Splint
Uses – Boutonniere deformity , Swan neck deform
ity

45. Tripoint Splint

46. (5) Knuckle-bender Splint
Indication- Ulnar Nerve Palsy

47. Lower
Extremity

48. (1) Von Rosen’s Splint
Indication – Congenital dislocation of the Hip
• ‘H’ shaped malleable splint
• Hip should be properly reduced before it
is splinted
• Object is to held hip somewhat flexed an
d abducted
• Extreme positions are avoided and Joint
should allowed some movement in the
splint

49. •
(2) Hip Spica Cas
Uses- Fracture shaft of femur in children and in
t
y
oung adults once the fracture becomes ‘sticky’
• encircles one or both arms or legs and the chest o
r trunk.
• It generally is strengthened with a reinforcement ba
r.

50. Hip Spica Cast
• When applied to a lower extremity , the c
ast is trimmed in the anal and genital ar
eas to allow elimination of urine and sto
ol.

51. Hip Spica Cast

53. (3) Thomas Splint
• Devised by H.O. Thomas initially for T B of
the knee.
• Indication - Now commonly used for immo
bilisation of hip and thigh injuries
• It has a ring and two bars joined distally.
• The ring is at an angle of 120 degree to the i
nside bar
• The ring size is found by addition of 2 inche
s to the thigh circumference at the highest p
oint of the groin
• The length is the measurement from the hig
hest point on the medial side of the groin u
p to the heel plus 6 inches.

54. Thomas Splint
- used as traction splint

55. (4) Bohler-Braun Splint
• Indication ;- Fracture femur – anywhere
• More convenient than Thomas splint since it has n
o ring. As the ring of Thomas splints is a common ca
use of discomfort, especially in old people.
• No in-built system of counter-traction , hence it Is n
ot suitable for transportation.

56. • Knee
(1) Knee Splint
• Indications:
- knee injuries
- proximal Tib/fib fractures
• Place knee in full extension
• The plaster is placed from the
posterior buttocks to 3 inches
above level of bilateral malleoli

57. Knee Splint

58. • Ankle
(1) Posterior Ankle Splint
• Indications
- Distal tibia/fibula fx.
- Reduced dislocations
- Severe sprains
- Tarsal / metatarsal fx
• Use at least 12-15 layers of plaster.
• Placed from metatarsal heads on plantar
surface foot, extends up back of leg to level
of fibular neck
NOTE - Adding a coaptation splint (stirrup) to
the posterior splint eliminates inversion /
eversion - especially useful for unstable fx and
sprains.

59. (2) Stirrup Splint
• Indications
- Similar to posterior splint.
- Unstable ankle fx
• Less inversion /eversion and
actually less plantar flexion
compared to posterior
splint.
• Great for ankle sprains.
• 12-15 layers of 4-6 inch
plaster.

60. Stirrup Splint
• The splint should be
long enough to
involve the leg from
below the medial side
of knee, wrap around
the under surface of
the heel, and back up
to the lateral side of
the same knee.

61. Stirrup Splint

62. • Foot
(1) Denis-Brown splint
Indication – Congenital Talipes Equino Varus (C.T.E.V.)
• Used after successful correction
of deformity ,to prevent relapse.
• used throughout the day before
child starts walking.
• Once child starts walking ,a DB s
plints is used at night and CTEV
shoes during the day.

63. Denis-Brown splint

64. (2) Buddy strapping
• Indications:
– Phalangeal fractures
of the toes
• Small piece of
wadding placed
between toes to
prevent maceration
• Fractured toe secured
to adjacent toe with
tape

65. Buddy strapping
• Use a small piece of
wadding and place
between the injured
toe and an adjacent
toe to prevent
maceration
• The fractured toe is
secured to the
adjacent toe with a
piece of tape

66. • Spine

67. (1) Cervical Collar
• Flexible foam/Rigid/Adjustable
collar
• Encircles the neck to support the
skull against the thorax inferiorly
• Motion control and keeping warm
at cervical level
• Soft tissue injury, minor sprains
for first few days after injury
• Post operative immobilisation
Note :- They are not useful for very unstable injury pattern

68. Cervical Collar
• Soft Cervical Collar
• Commonly used for
mild soft tissue strain
s and sprains

69. Cervical Collar
• Semi-Rigid Cervical Colla
r
• Can provide access to t
he trachea
• Moderate Control of RO
M
• Adjustable

70. (2) Four-post Collar
Indication – Neck immobilisation in cervical spine injury
• More stable than cervical collar
• Applying pressure to mandible , occiput , sternum and up
per thoracic spine
• They can be uncomfortable

71. (3) SOMI (Sternal Occipital
Mandibular Immobilizer)
Uses – cervical spine injur
• Rigidy
Frame Design
• Commonly used in stable fractures
and Moderate to Severe soft tissue
damage
• Limits Flexion and Extension
• Extends Inferior into the Thoracic
Region for greater control of all
cervical levels

72. (4) Milwaukee Brace
Indication- Scoliosis
• Named after the city of Milwaukee where it was designed.
• It fits snugly over the pelvis below; chin and head pads prom
ote active postural correction and thoracic pad presses on t
he ribs at the apex of the curves

73. (4) Boston Brace
Indication-Scoliosis
• Used for low curves
• Worn 23 Hours / Day
• Made of semi-rigid plastic and foam

75. (5) Lyon Brace
Indication-Scoliosis

76. (6) SpineCore Brace
Indication-Scoliosis

77. Scoliosis Braces

78. (7)Taylor’s Brace
Indication – Dorso-lumbar Immobilisation
• Anterior Compression
Fractures of the vertebral
body
• Semi rigid design
• Commonly used for
osteoporosis, trauma,
Degenerative spine disease

79. • Traction

80. • Traction
Traction is a pulling effect exerted on a part
of the skeletal system.
It is a treatment measure for musculoskeletal
trauma and disorders. Traction is used to acco
mplish the following:
•
•
•
•
Reduce muscle spasms
Realign bones
Relieve pain
Prevent deformities

81. Types of Traction

82. 1. Manual Traction
Manual traction means pulling on the body
using a person's hands and muscular strengt
h.
It most often is used briefly to realign
a broken bone .
It also is used to replace a dislocated bone int
o its original position within a joint.

83. Manual Traction

84. 2. Skin Traction
Skin traction means a pulling effect o
n the skeletal system by applying devi
ces, such as a pelvic belt and a cervical
halter, to the skin.
Commonly applied forms of skin tractio
n are –
•
•
•
•
Buck's traction
Russell's traction
Bryant’s (gallows) traction
Dunlop traction

85. Skin Traction
• Limited force can be applied - generally
not to exceed 5 lbs
• More commonly used in pediatric
patients
• Can cause soft tissue problems especially
in elderly or rheumatoid patients
• Not as powerful when used during
operative procedure for both length or
rotational control

86. Skin Traction
A)Pelvic Traction
(B) Cervical halter

87. (1) Pelvic Traction
• Uses –Relief of pain of Sciatica and other
backaches
• Traction is applied to a pelvic
harness with weights over the e
nd of bed
• An alternative in Sciatica
is the 90-90 traction

88. (2) Cervical halter
Uses - short term cervical
traction
-minor neck injuries with
out obvious trauma
e.g.
Whiplash injury,
neck muscle spasm ,
conservative treatment of
cervical disk lesion
Note – Contraindicated in mandibular fracture

89. (3) Buck's traction
• Uses femoral fractures,
lower backache
Acetabular and hi
p fractures
Conventional skin traction

90. Buck's traction
• Provide temporary comfort in hip fracture
s
• Maximal weight - 10 pounds
• Watch closely for skin problems, especially
in elderly or rheumatoid patients

91. (4) Russell's traction
Uses - Trochanteric fractures

92. (5) Gallows traction
Uses- fracture shaft of femur in children below 2 year
s
Imp –check the state of the
circulation in the limb
frequently , because of
danger of vascular compli
cations

93. • Bryant’s Traction
• Useful for treatment femora
l shaft fx in infant or smal
l child
• Combines gallows traction
and Buck’s traction
• Raise mattress for counte
r traction
• Rarely, if ever used currentl
y

94. (6) Dunlop traction
Use- mainly used in the maintenance of reductio
n in supracondylar fractures of humerus in child
ren.
• Forearm skin traction with
weight on upper arm
• Elbow flexed 45 degrees
• Allows swollen elbow to settl
e
• Contraindicated in open fra
ctures and skin defects

95. Dunlop traction

96. (7) Femoral Traction Older
Child in Balkan Frame
Indications
• Child
> 12 kg
• Femoral fractures
• Skin must be intact

97. Balkan Frame

98. 3. Skeletal Traction
Skeletal traction means pull exerted directly on the
skeletal system by attaching wires, pins, or tongs
into or through a bone. Skeletal traction is applied c
ontinuously for an extended period.

99. Skeletal Traction
• More powerful than skin traction
• May pull up to 20% of body weight for the
lower extremity
• Requires local anesthesia for pin insertion
if patient is awake
• Preferred method of temporizing long
bone, pelvic, and acetabular fractures until
operative treatment can be performed

100. (1) HALO TRACTION
• Rigid Frame Design
• Commonly used in unstable
fractures
• Limits All motion
• Extends Inferior into the
Thoracic Region for greater
control of all cervical levels
• Screws Directly into the skull
Disadvantages
- Pin problems
- Respiratory compromise

101. HALO TRACTION BRACE

102. (2) Gardner Wells Tongs
• Used for C-spine reduction /
traction
• Pins are placed one finger breadth
above pinna, slightly posterior to
external auditory meatus
• Apply traction beginning at 5 lbs.
and increasing in 5 lb. increments
with serial radiographs and
clinical exam

103. (3) Olecranon Traction
Uses - supracondylar and comminuted fractures of lower
end of the humerus and unstable fracture of shaft of humer
us
• Rarely used today
• Small to medium sized pin
placed from medial to lateral in
proximal olecranon - enter bone
1.5 cm from tip of olecranon
and walk pin up and down to
confirm midsubstance location.
• Support forearm and wrist with
skin traction - elbow at 90
degrees

104. (4)Distal Femoral Traction
• Uses- Method of choice for acetabular and
proximal femur fractures
• If there is a knee ligament injury usually use
distal femur instead of proximal tibial
traction
• Place pin from medial to lateral at the adductor
tubercle - slightly proximal to epicondyle

105. (5) 90-90 Traction




Useful for subtrochanteric and proximal 3rd
femur fx
Especially in young children
Matches flexion of proximal fragment
Can cause flexion contracture in adult

106. (6) Acetabular Tractio
n
Uses- to maintain reduction in central fractur
e dislocation of acetabulum

108. How do I take care of the splint?
• Do not get the splint wet. Use plastic bags to
cover the splint while bathing.
• Do not walk on the splint.
• Do not stick anything down the splint Such as
a coat hanger to scratch or itch. This may lead
to injury and infection.

109. What danger signs should to look for?
• Numbness, tingling, increased pain,
change in coloration of fingers or toes, or
swelling in fingers or toes.
• If these symptoms occur, you should call
your doctor immediately

110. Complications
• Burns
- Thermal injury as plaster dries
- Hot water, Increased number of
layers, extra fast-drying , poor
padding all increase risk
- If significant pain - remove splint
to cool
• Ischemia
- Reduced risk compared to casting
but still a possibility
- Do not apply Webril and ace wra
ps tightly
- Instruct to ice and elevate extremi
ty
- Close follow up if high risk for
swelling, ischemia.
- When in doubt, cut it off and look
Remember - pulses lost late.
• Pressure sores
Smooth Webril and plaster well
• Infection
- Clean, debride and dress all
wounds before splint application
- Recheck if significant wound or
increasing pain