page 2 ruffin splintinng and casting

o To cover only one surface- the volar or dorsal surface of a limb or the ulnar or radial half of the hand or forearm

o Straps are added to create the three points of pressure necessary to secure the splint

o Effective for supporting joints surrounded by weak or flaccid muscles (ex. CVA, PNI)

§ SINGLE SURFACE SPLINTS

To cover only one surface- the volar or dorsal surface of a limb or the ulnar or radial half of the hand or forearm

§ SINGLE SURFACE SPLINTS

Straps are added to create the three points of pressure necessary to secure the splint

§ SINGLE SURFACE SPLINTS

Effective for supporting joints surrounded by weak or flaccid muscles (ex. CVA, PNI)

§ SINGLE SURFACE SPLINTS

o Wrap around a part, covering all surfaces with equal amounts of pressure

o Effective for immobilizing painful joints or for protecting soft tissue

CIRCUMFERENTIAL SPLINTS

Wrap around a part, covering all surfaces with equal amounts of pressure

CIRCUMFERENTIAL SPLINTS

Effective for immobilizing painful joints or for protecting soft tissue

CIRCUMFERENTIAL SPLINTS

Common Splinting Techniques

• “Bulky” Jones • Sugar-tong • Coaptation • Ulnar gutter • Volar / Dorsal hand • Thumb spica • Posterior slab (ankle) +/- U splint • Posterior slab (thigh

o Splint extends around the distal humerus to provide rotational contro

o Padding should be at least 3 - 4 layers thick with several extra layers at the elbow

SUGAR TONG SPLINT

o Medially splint ends in the axilla and must be well padded to avoid skin breakdown

o Lateral aspect of splint extends over the deltoid

HUMERAL SHAFT FRACTURE COAPTATION SPLINT

o Goal of semi-rigid immobilization while avoiding pressure/ skin complications

o Often a poor choice in the treatment of acute fractures due to swelling and soft tissue complications

o Good cast technique necessary to achieve predictable results

CASTING

Splint extends around the distal humerus to provide rotational contro

SUGAR TONG SPLINT

Padding should be at least 3 - 4 layers thick with several extra layers at the elbow

SUGAR TONG SPLINT

Medially splint ends in the axilla and must be well padded to avoid skin breakdown

HUMERAL SHAFT FRACTURE COAPTATION SPLINT

Lateral aspect of splint extends over the deltoid

HUMERAL SHAFT FRACTURE COAPTATION SPLINT

Goal of semi-rigid immobilization while avoiding pressure/ skin complications

CASTING

Often a poor choice in the treatment of acute fractures due to swelling and soft tissue complications

CASTING

Good cast technique necessary to achieve predictable results

CASTING

- may require two different diameters to avoid overtight or loose material

- Caution not to lift leg by _____ – stretching the _____ too tight around the heel may case high skin pressure

- To avoid wrinkles in the _____ , cut along the concave surface and overlap to produce a smooth contour

§ Stockinette

Roll distal to proximal - 50 % overlap - 2 layers minimum - Extra padding at fibular head, malleoli, patella, and olecranon

§ Cast padding -

is the most common complication of cast treatment as the swelling decreases and the padding compresses while the patient regains mobility

§ Loss of reduction

– may occur as early as 2 hours § Tight cast resulting to compartment syndrome

§ Pressure necrosis

§ Pressure necrosis – may occur as early as 2 hours § Tight cast resulting to what syndrome?

§ Pressure necrosis – may occur as early as 2 hours § Tight cast resulting to compartment syndrome

avoid plaster > 10 ply, water >24°C

Thermal Injury –

increased in lower extremity fracture

• Ask about prior history and family history

• Birth control pills are a risk factor

• Indications for prophylaxis controversial in patients without risk factors

§ DVT/Pulmonary Edema –

• Leave joints free when possible (ie. Thumb MCP for below elbow cast)

• Place joint in position of function

§ Joint stiffness