Principles of Splinting
- Visualize the injured body part.
- Continually recheck the patient’s neurovascular status.
- Traction is indicated if the pulse is not palpable.
- Gentle traction involves less than 10 lbs of force.
- Cover open wounds with sterile dressings.
- Immobilize the joints above and below the injury.
- Padding prevents further tissue damage.
- Do not reset open or protruding fractures.
- Splint the extremity in the position in which it was found.
- Splint the patient before transport (if he or she is stable).
- Ice and elevate the injury after immobilization.
Rigid splints can be improvised from materials such as cardboard, wood, and wire. Proprietary vacuum splints and air splints are commonly used in the field. Rigid splints are attached to the extremity with a variety of fasteners, including tape, straps, gauze, and Velcro. For all splints, ample padding is essential, especially over bony surfaces and swollen tissue to minimize pressure damage and pain.
A soft splint earns its name from the soft, padded material that is used to secure the injury. Soft splints include sling and swathe splints, pillow splints, and blanket-roll splints. Shoulder, clavicle, upper arm, elbow, forearm, wrist, and even hand injuries are commonly stabilized with a sling and swathe.
Improvised Extremity Splints
Improvised splints can be made from branches, boards, padded pack straps, or rolled-up newspapers or magazines. Slings can also be made from unused clothes. In these cases, one need not pack additional materials. Disadvantages lie in less effectiveness compared with commercial splinting devices.
Upper Extremity Splints
The arm is most comfortable in an abducted position. This can be accomplished with a rolled blanket, a pillow, a jacket, or a SAM splint that has been fashioned into a triangle.
Humeral Shaft Injury
Humeral shaft fracture is often treated with a sling or with a sling and swathe splint alone. For pain control, a splint is often desirable
A dislocated elbow can be reduced in the field with the appropriate analgesia and experience. The dislocated elbow can also be splinted in place and the patient transported for definitive care
A sugar-tong splint is useful for most elbow injuries. These most commonly include supracondylar, olecranon, and radial head fractures
photo: sling and swathe and sugar tong splint
The volar wrist or sugar tong splint is used for most wrist fractures, dislocations, sprains, lacerations, and other wrist injuries.
figure: sugar tong splint
Ulnar gutter splints are used for fourth and fifth metacarpal injuries and for corresponding digit injuries.
figure: ulnar gutter splint
A thumb spica splint is used for suspected scaphoid (navicular) fractures, thumb dislocations and fractures, and ulnar collateral ligament injuries.
figure: thumb spica
Lower Extremity Splints
A knee immobilizer splint is used for knee injuries, patella tendon injuries, dislocations, and other severe ligamentous sprains when immobilization is required
figure: knee immobilizer
Long-leg splints are used for tibial and fibular fractures.
figure: single long leg splint
Ankle and Foot Injuries
Ankle stirrup and figure-8 splints provide for the immobilization of ankle injuries. The ankle stirrup splint can also be used for fractures
figure: ankle stirrup splint
Cassell, O’Connor, Gianotti. Splints and Slings. “Wilderness Medicine, 7th ed” Elsevier, Philadelphia, PA, 2016.
Schimelpfenig, T. “Wilderness Medicine, National Outdoor Leadership School.” Stackpole Books, Mechanicsburg PA. 2000
Tilton, B. “Wilderness First Responder, 2nd ed.” The Globe Pequot Press, Guilford CT, 2004.
Wilderson, J et al. “Medicine for Mountaineering & Other Wilderness Activities” The Mountaineers Books, Seattle WA, 2001.