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Splinting basics

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Introduction

Selected extremity splinting techniques

Misty Wright, PA-C

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Topics of Discussion

Upper extremity Lower extremity Finger splinting

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Upper extremity splinting Volar splints used mostly for

sprains of the wrist, tendonitis, or any inflammatory process at the the wrist level.

A Volar splint is placed volarly on the forearm from the palmar crease to the proximal 1/3 forearm, allowing movement of the thumb, and the metacarpal phalangeal joints.

04/18/23 5Volar splint

04/18/23 6Velcro splint

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More UE Splints

A thumb spica splint is a volar splint with the thumb immobilized in neutral, and used for thumb injuries, and suspected scaphoid fractures.

04/18/23 8Thumb Spica

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One More UE Splint

The Coaptation splint extends from the axilla medially, and runs laterally around the elbow to the acromioclavicular joint. It is used to immobilize mid to distal humerus fractures.

Sarmiento Fracture cuff- midshaft humerus fractures, circumferential support

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04/18/23 11Coaptation splint

04/18/23 12Sarmiento fracture brace

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The Best Upper Extremity Splint The Sugar tong or stirrup splint for

the forearm and wrist goes from the palmer crease, around elbow, and ends at the dorsal MP joints. It prevents pronation/supination of the forearm, and is used for distal radius and forearm fractures.

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Another Upper Extremity Splint The posterior splint is used for

elbow injuries and fractures, and goes from the proximal 1/3 of the humerus, posteriorly, and can stop at the wrist, or extend to the MP joints, as needed.

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04/18/23 18Posterior Splint

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Lower Extremity Splints

Short leg splints are used for foot and ankle injuries.

The posterior splint is used for foot and soft tissue injuries, or to prevent equinous contracture.

The three way, trauma, stirrup, or lower extremity sugar tong splint is for ankle joint injuries.

04/18/23 20Air Splint

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04/18/23 23Components of 3-way

04/18/23 24Cam Walker Boot

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Lower Extremity Splints

Any Bony injury above the ankle level should be immobilized with a long leg splint, or knee immobilizer.

Hip Reductions can go in knee immobilizers, or an abduction brace, to prevent re-dislocation.

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04/18/23 28Long leg cast

04/18/23 29 Abduction Pillow

04/18/23 30 Knee Immobilizer

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Finger Splints

Use stack splints, or malleable metal splints to splint digits in position of comfort or reduction. Splint Mallet, or avulsion fractures in extension, and do not allow the patient to remove.

04/18/23 32 Mallet finger

04/18/23 33Mallet splint

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Splinting pitfalls

Do not apply splints too tight. Use Bias wrap for upper extremity splints, and do not stretch elastic when applying ace wrap.

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Too Much splinting Is not good Over splinting can lead to stiff

joints, and should be avoided. Adults older than 40 at risk for

frozen shoulder/elbow syndromes. Geriatric patients must be closely

monitored for skin breakdown.

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Questions

Check your splints Bill for any special applications,

molding, and splint checks.

- AHCCCS no longer pays for any prefab splints, just FYI.

Common fracture patterns

Is it broken or fractured?

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04/18/23 39A word about peds fracture patterns

04/18/23 40Salter harris fracture- Type 2

Thurston Holland fragment

04/18/23 41Supracondylar fracture- Type 1

04/18/23 42Supracondylar fracture- Type 2

04/18/23 43Supracondylar fracture- Type 3

Common Upper Extremity Fractures

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04/18/23 45Monteggia fracture

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Galeazzi fracture

04/18/23 47Scaphoid fracture

04/18/23 48Scapholunate widening

Terry thomas sign

04/18/23 49Perlinuate dislocation

04/18/23 50Perilunate dislocation

04/18/23 51Flexor Tenosynovitis

Kanavel Signs of Flexor Tenosynovitis

- Pain passive extension - fusiform swelling (sausage like) - flexed posture - flexor sheath tenderness

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Lower Extremity Fracture Patterns

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Lizfranc Fracture

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“just” an ankle sprain?04/18/23 55

Maisonneuve Fracture04/18/23 56

Pilon Fracture04/18/23 57

Tibial Plateau Fracture

Very commonly causes lateral lower extremity Compartment Syndrome

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Commonly present with Tibia Plateau Fractures

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Proximal Femur Fractures

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The End

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