SPLINTS+TRA

Guided by : Dr. PRAKASH D.R

 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
prevent movement of the injured extremity which
helps prevent further injury, and to minimize pain
 • Indications for Splinting

• Fractures
• Sprains
• Joint infections
• Tenosynovitis
• Acute arthritis / gout
• Lacerations over joints
• Puncture wounds and animal bites of the hands
or feet
• 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
• Contraindications of Splinting
 Compartment syndrome
 Need for open reduction
 Skin at high risk for infection
 • 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
– 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!)
• Advantage • Disadvantage

• Easier to mold • More difficult to apply

• Less expensive • Gets soggy when getting
wet
 • 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
(3) Prefabricated splints
• Plastic shells lined with air cells, foam or gel
components
• Same advantages and disadvantages as
fiberglass splints
(4)Air splints
• Provide less support than plaster and fiberglass
Splints
• Used for ankle sprains rather than fractures or
Dislocations
• Used to prevent eversion/inversion while
permitting free flexion and extension of ankle

• Provides clear view

of injury during x-
ray
(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
• Pre / Post - Splint Checks

• F – Function
• A – Arterial Pulse
• C – Capillary Refill
• T – Temperature (Skin)
• S - Sensation
 • Choose your splints
Upper Extremity
• Shoulder And Arm • Hand/Fingers
- Figure of eight – Ulnar Gutter
- Sling and Swathe – Radial Gutter
- Aeroplane splint – Thumb Spica
• Elbow/Forearm – Finger Splints
– Long Arm Posterior – Knuckle-bender splint
– Double Sugar - Tong
• Forearm/Wrist
– Volar Forearm / Cockup
– Sugar - Tong
Lower Extremity Spine
• Hip and Thigh
- Cervical Collar
- Von Rosen’s Splint - Four-post Collar
- Thomas Splint - SOMI (Sternal Occipital
- Bohler-Braun Splint Mandibular Immobilizer)
• Knee
- Knee Immobilizer / Bledsoe - Scoliosis
- Bulky Jones - Milwaukee Brace
- Posterior Knee Splint - Boston Brace
- Taylor’s Brace
• Ankle
- Posterior Ankle
- Stirrup
• Foot
- Denis-Brown splint
- Buddy taping
• Traction
1. Manual Traction
2. Skin Traction
3. Skeletal Traction
Upper
Extremity
 • 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
Figure of eight
 (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
 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
 (3) Aeroplane Splint

Indication- Brachial plexus injury

 • 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 or
unstable distal forearm fx.
Long Arm Posterior
(2) Double Sugar - Tong
• Indications :-
- Elbow and forearm fx
- prox/mid/distal radius and
ulnar fx.

Better for most distal

forearm and elbow fx
because limits
flex/extension and
pronation / supination.
(2) Double Sugar - Tong
 • 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.
Volar Forearm / Cockup
 (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
extends down to mid-palmer crease

• Immobilises wrist, forearm, and elbow

Forearm Sugar - Tong
 • 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.
 • 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
• Ulnar Gutter Splint
• Ulnar Gutter Splint
Radial Gutter Splint
(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
Thumb Spica
(4) Finger Splints

Sprains - dynamic splinting

(buddy strapping).

Dorsal/Volar finger splints - phalangeal

fx, though gutter splints probably better
for proximal fxs.
 Finger Splints
(a) Stack Splint
Use – management of mallet finger
 (b) Aluminium Splint

Uses - phalangeal fx,

-mallet finger
(c) Oval-8 Finger splint
Oval-8 Finger splint
Finger splints
 (d) Tripoint Splint
Uses – Boutonniere deformity , Swan neck deformity
Tripoint Splint
 (5) Knuckle-bender Splint
Indication- Ulnar Nerve Palsy
Lower
Extremity
 (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 and

abducted

• Extreme positions are avoided and Joint

should allowed some movement in the
splint
 (2) Hip Spica Cast
• Uses- Fracture shaft of femur in children and in
young adults once the fracture becomes ‘sticky’
• encircles one or both arms or legs and the chest
or trunk.
• It generally is strengthened with a reinforcement
bar.
 Hip Spica Cast
• When applied to a lower extremity , the
cast is trimmed in the anal and genital
areas to allow elimination of urine and
stool.
Hip Spica Cast
(3) Thomas Splint
• Devised by H.O. Thomas initially for T B of
the knee.

• Indication - Now commonly used for

immobilisation 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

inside bar

• The ring size is found by addition of 2

inches to the thigh circumference at the
highest point of the groin

• The length is the measurement from the

highest point on the medial side of the
groin up to the heel plus 6 inches.
Thomas Splint
- used as traction splint
 (4) Bohler-Braun Splint
• Indication ;- Fracture femur – anywhere
• More convenient than Thomas splint since it has no
ring. As the ring of Thomas splints is a common cause
of discomfort, especially in old people.
• No in-built system of counter-traction , hence it Is not
suitable for transportation.
 • 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
Knee Splint
 • 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.
 (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.
 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.
Stirrup Splint
 • 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

splints is used at night and CTEV
shoes during the day.
Denis-Brown splint
 (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
 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
• Spine
 (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
Cervical Collar

• Soft Cervical Collar

• Commonly used for

mild soft tissue strains
and sprains
Cervical Collar

• Semi-Rigid Cervical Collar

• Can provide access to
the trachea
• Moderate Control of ROM
• Adjustable
 (2) Four-post Collar
Indication – Neck immobilisation in cervical spine injury

• More stable than cervical collar

• Applying pressure to mandible , occiput , sternum and upper
thoracic spine
• They can be uncomfortable
 (3) SOMI (Sternal Occipital
Mandibular Immobilizer)
Uses – cervical spine injury
• Rigid 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
 (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 promote
active postural correction and thoracic pad presses on the ribs
at the apex of the curves
 (4) Boston Brace
Indication-Scoliosis
• Used for low curves
• Worn 23 Hours / Day

• Made of semi-rigid plastic and foam

(5) Lyon Brace
Indication-Scoliosis
(6) SpineCore Brace
Indication-Scoliosis
Scoliosis Braces
 (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
• Traction
 • 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 accomplish the following:

• Reduce muscle spasms

• Realign bones
• Relieve pain
• Prevent deformities
Types of Traction
 1. Manual Traction

Manual traction means pulling on the body

using a person's hands and muscular strength .
It most often is used briefly to realign a
broken bone .
It also is used to replace a dislocated bone into
its original position within a joint.
Manual Traction
 2. Skin Traction
Skin traction means a pulling effect on
the skeletal system by applying devices,
such as a pelvic belt and a cervical halter,
to the skin.
Commonly applied forms of skin traction
are –

• Buck's traction
• Russell's traction
• Bryant’s (gallows) traction
• Dunlop traction
 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
 Skin Traction

A)Pelvic Traction (B) Cervical halter.

 (1) Pelvic Traction
• Uses –Relief of pain of Sciatica and other
backaches
• Traction is applied to a pelvic
harness with weights over the
end of bed

• An alternative in Sciatica
is the 90-90 traction
 (2) Cervical halter
Uses - short term cervical
traction
-minor neck injuries
without obvious trauma
e.g.
Whiplash injury,
neck muscle spasm ,
conservative treatment of
cervical disk lesion

Note – Contraindicated in mandibular fracture

 (3) Buck's traction
• Uses -
femoral fractures,
lower backache
Acetabular and hip
fractures

Conventional skin traction

 Buck's traction
• Provide temporary comfort in hip fractures
• Maximal weight - 10 pounds
• Watch closely for skin problems, especially
in elderly or rheumatoid patients
(4) Russell's traction
Uses - Trochanteric fractures
 (5) Gallows traction

Uses- fracture shaft of femur in children below 2 years

Imp –check the state of the

circulation in the limb
frequently , because of
danger of vascular
complications
 • Bryant’s Traction

• Useful for treatment femoral

shaft fx in infant or small
child
• Combines gallows traction
and Buck’s traction
• Raise mattress for counter
traction
• Rarely, if ever used currently
 (6) Dunlop traction
Use- mainly used in the maintenance of reduction
in supracondylar fractures of humerus in
children.
• Forearm skin traction with
weight on upper arm

• Elbow flexed 45 degrees

• Allows swollen elbow to settle

• Contraindicated in open
fractures and skin defects
Dunlop traction
 (7) Femoral Traction Older
Child in Balkan Frame

Indications
• Child> 12 kg
• Femoral fractures
• Skin must be intact
Balkan Frame
 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
continuously for an extended period.
 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
(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
HALO TRACTION BRACE
(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
 (3) Olecranon Traction
Uses - supracondylar and comminuted fractures of lower
end of the humerus and unstable fracture of shaft of humerus

• 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
 (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
 (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
 (6) Acetabular Traction
Uses- to maintain reduction in central fracture
dislocation of acetabulum
 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.
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
 Complications
• Burns • Pressure sores
- Thermal injury as plaster dries Smooth Webril and plaster well
- Hot water, Increased number of
layers, extra fast-drying , poor • Infection
padding all increase risk - Clean, debride and dress all
- If significant pain - remove splint wounds before splint application
to cool - Recheck if significant wound or
increasing pain
• Ischemia
- Reduced risk compared to casting
but still a possibility
- Do not apply Webril and ace
wraps tightly
- Instruct to ice and elevate
extremity
- Close follow up if high risk for
swelling, ischemia.
- When in doubt, cut it off and look
Remember - pulses lost late.
TH
AN
KY
De OU
ar ,