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Splint: Types, Indications, Contraidications and Complications

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A splint is a rigid or flexible device that maintains in position a displaced or movable part, also used to keep in place and protect an injured part to support healing and to prevent further damage.

Purpose of Splinting

Thomas's splint, commonly used for the immobilization of hip and thigh injuries
  • Immobilization
  • Support to promote healing
  • Positioning or supporting during function
  • Pain relief
  • Substitute for weak muscles
  • Correction and prevention of contracture & deformity
  • Restoring or maintaining of range of motion
  • Edema control


Different Types of Splints

Splints are classified based on the movement permissible as
  • Static
  • Dynamic
  • Serial static
  • Static progressive

Indications of Splinting

Swollen sprained ankle, an indication for splinting

Splints are placed to immobilize musculoskeletal injuries, support healing, and to prevent further damage. The indications for splinting are broad, but commonly include:

Temporary stabilization of acute fractures, sprains, or strains before further evaluation or definitive operative management
  • Immobilization of a suspected occult fracture (such as a scaphoid fracture)
  • Severe soft tissue injuries requiring immobilization and protection from further injury
  • Definitive management of specific stable fracture patterns
  • Peripheral neuropathy requiring extremity protection
  • Partial immobilization for minor soft tissue injuries
  • Treatment of joint instability, including dislocation

Contraindications of Splinting

No specific contraindications to splinting exist. However, certain injuries and patient-specific comorbidities require special attention:

Injuries that violate the skin or open wounds: Antibiotic administration should be considered for these patients depending on the severity of the lesion.

These patients also require additional soft tissue care, which may necessitate tissue debridement and skin closure before splint application.

Injuries that result in sensory or neurologic deficits: The complications of splint placement such as compartment syndrome, pressure injuries, or malreduction may go unnoticed if the patient has a concurrent nerve injury.

These patients should undergo evaluation by a surgeon before splint application as neurologic findings may be a sign of a surgical emergency.

Injuries to the vasculature: This require special attention by vascular surgeons, as these may require urgent operative intervention. Furthermore, evaluation of the vasculature is essential both before and after splint application, as the reduction of some fractures may result in acute arterial injury or obstruction if trapped between the fracture fragments.

Patients with peripheral vascular disease or neuropathy: Special care should be taken when applying lower extremity splints in these patients since their baseline sensation may be altered. These patients have difficulty detecting pressure sores, skin irritation, and possible vascular compromise.

Side Effects of Splinting

  • Excessive use of splints can lead to chronic pain, stiff joints or weak muscles
  • Skin irritation
  • Discomfort

Advantages of Splinting

Splint use offers many advantages over casting.

Splints are faster and easier to apply.

They may be static (i.e., prevent motion) or dynamic (i.e., functional; assist with controlled motion).

Because a splint is noncircumferential, it allows for the natural swelling that occurs during the initial inflammatory phase of the injury.

A splint may be removed more easily than a cast, allowing for regular inspection of the injury site.

Disadvantages of Splinting

Disadvantages of splinting include:
  • Lack of patient compliance
  • Excessive motion at the injury site
  • Limitations in their usage, as in unstable or potentially unstable fractures

Complications of Splinting

  • Compartment Syndrome, a complication of splinting
  • Compartment syndrome
  • Ischemia
  • Heat injury
  • Pressure sores and skin breakdown
  • Edema
  • Infection
  • Dermatitis
  • Joint stiffness
  • Decreased ROM, Strength, Sensation
  • Neurologic injury

Considerations for effective splinting

  • Creases provide for landmarks in splint fabrication
  • Bony prominences may cause pressure
  • Ensure three points of pressure
  • Custom made splints to fit the contours of the body rather than ready made splints
  • Patient education for better compliance
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