Splint

Original Editor - Shwe Shwe U Marma Top Contributors - Shwe Shwe U Marma

Definition

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[1] to support healing and to prevent further damage[2].

Image showing arm splint
Arm splint

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[3]
  • Correction and prevention of deformity[4]
  • Restoring or maintaining of range of motion[5]
  • Edema control[6]

Different Types of Splints

Splints for Upper Extrimity[3]

Region Type of splint
Ulnar side of hand Ulnar gutter splint
Radial side of hand Radial gutter splint
Thumb, first metacarpal, and carpal bones Thumb spica splint
Finger injuries
  • Buddy taping
  • Aluminium U-shaped splint
  • Dorsal extension-block splint
  • Mallet finger splint
Image showing mallet finger splint applied
Mallet finger splint
Wrist/hand
  • Volar/dorsal forearm splint
  • Short arm cast
Forearm Single sugar-tong splint
Elbow, proximal forearm, and skeletally immature wrist injuries
  • Long arm posterior splint
  • Long arm cast
  • Double sugar-tong splint

Splints for Lower Extrimity[3]

Region Type of splint
Ankle
  • Posterior ankle splint
  • Stirrup splint
Ankle stirrup splint
Lower leg, ankle and foot Short leg cast
Knee and lower leg Posterior knee splint
Foot Short leg cast with toe plate extension

Indications of Splinting

Image showing swollen sprained left ankle
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[2]

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.[2]

Side Effects of Splinting

  • Excessive use of splints can lead to chronic pain, stiff joints or weak muscles[7]
  • Skin irritation[8]
  • Discomfort[9]

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.[10]

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[10]

Complications of Splinting

Image showing compartment syndrome in arm with blister formation
Compartment Syndrome, a complication of splinting
  • Compartment syndrome
  • Ischemia
  • Heat injury
  • Pressure sores and skin breakdown
  • Infection
  • Dermatitis
  • Joint stiffness
  • Neurologic injury[10]

References

  1. VanBlarcom CW, editor. The glossary of prosthodontic terms. Mosby; 1999.
  2. 2.0 2.1 2.2 Althoff AD, Reeves RA. Splinting. StatPearls [Internet]. 2020 May 24.
  3. 3.0 3.1 3.2 Boyd AS, Benjamin HJ, Asplund CA. Splints and casts: indications and methods. American family physician. 2009 Sep 1;80(5):491-9.
  4. Singh KA, Shah H, Joseph B. Comparison of plaster-of-Paris casts and Woodcast splints for immobilization of the limb during serial manipulation and casting for idiopathic clubfoot in infants: a prospective randomized trial. The Bone & Joint Journal. 2020 Oct 3;102(10):1399-404.
  5. Rezaei B, Mahdavinejad R. Massage therapy and Splint in males with Carpal Tunnel syndrome. Journal of Advanced Pharmacy Education & Research| Jan-Mar. 2020;10(S1).
  6. Giang TA, Ong AW, Krishnamurthy K, Fong KN. Rehabilitation interventions for poststroke hand oedema: a systematic review. Hong Kong Journal of Occupational Therapy. 2016 Jun 1;27:7-17.
  7. Gravlee JR, Van Durme DJ. Braces and splints for musculoskeletal conditions. American family physician. 2007 Feb 1;75(3):342-8.
  8. Johnston JJ, Spelman L. Pressure-induced localised granuloma annulare following use of an elbow splint. Prosthetics and orthotics international. 2017 Jun;41(3):311-3.
  9. So H, Chung VC, Cheng JC, Yip RM. Local steroid injection versus wrist splinting for carpal tunnel syndrome: a randomized clinical trial. International Journal of Rheumatic Diseases. 2018 Jan;21(1):102-7.
  10. 10.0 10.1 10.2 Boyd AS, Benjamin HJ, Asplund CA. Principles of casting and splinting. American family physician. 2009 Jan 1;79(1):16-22.