Splint ppt by rupeshkumar

1. SPLINTS Done By : Dr. Rupeshkumar Hatwar Guided by : Dr. Nitin Sir

2. What is a splint? • A splint is a rigid support with padding made from metal, plaster or plastic. It is used to support , protect, or immobilize an injured or inflamed part of the body. The splint is secured in place with an elastic bandage or an ACE wrap .The purpose of the splint is to prevent movement of the injured extremity which helps prevent further injury, and to minimize pain

3. Fractures Sprains Joint infections Tenosynovitis Acute arthritis / gout Lacerations over joints Puncture wounds and animal bites of the hands or feet Indications for Splinting

4. To reduce/prevent contracture To increase grip strength To stabilize and rest joint in ligamentous injury To correct deformity To support and immobilize joints and limbs postoperatively until healing has occured

5. Contraindications of Splinting Compartment syndrome Need for open reduction Skin at high risk for infection

6. Splinting Material Plaster of Paris Made from gypsum - calcium sulfate dehydrate Exothermic reaction when wet - recrystallizes (can burn patient) Average setting time – 3-9 min Average drying time – 24-72 hours

7. Factors decreasing setting time :- Hot water, Salt, Borax, Resins Factors increasing setting time :- Cold water, sugar Upper extremities :– use 8-10 layers Lower extremities :- 12-15 layers up to 20 if big person (increased risk of burn!)

8. Advantage • Easier to mold • Less expensive Disadvantage More difficult to apply Gets soggy when getting wet

9. Ready Made Splinting Material (1) Plaster (OCL) 10 -20 sheets of plaster with padding and cloth cover (2) Fiberglass ( Orthoglass ) Cure rapidly (20 minutes) Less messy Stronger, lighter, wicks moisture better Less moldable Splinting Material Disadvantage • More expensive • More difficult to mold

10. (3) Prefabricated splints • Plastic shells lined with air cells, foam or gel components • Same advantages and disadvantages as fiberglass splints

11. (4)Air splints • Provide less support than plaster and fiberglass Splints • Used for ankle sprains rather than fractures or Dislocations • Used to prevent eversion/inversion while permitting free flexion and extension of ankle Provides clear view of injury during x-ray

12. (4) Vacuum splints - Styrofoam chips contained inside an airtight cloth, pliable sleeve - Molds to shape of injury using a handheld pump to draw out the air from within the sleeve

13. Pre / Post - Splint Checks F – Function A – Arterial Pulse C – Capillary Refill T – Temperature (Skin) S - Sensation

14. Choose your splints Upper Extremity Shoulder And Arm - Figure of eight - Sling and Swathe - Aeroplane splint Elbow/Forearm Long Arm Posterior Double Sugar - Tong Forearm/Wrist Volar Forearm / Cockup Sugar - Tong Hand/Fingers Ulnar Gutter Radial Gutter Thumb Spica Finger Splints Knuckle-bender splint

15. Lower Extremity Hip and Thigh - Von Rosen’s Splint - Thomas Splint - Bohler-Braun Splint Knee - Knee Immobilizer / Bledsoe - Bulky Jones - Posterior Knee Splint Ankle - Posterior Ankle - Stirrup Foot - Denis-Brown splint - Buddy taping Spine - Cervical Collar Four-post Collar SOMI (Sternal Occipital Mandibular Immobilizer) - Scoliosis - Milwaukee Brace - Boston Brace - Taylor’s Brace

16. Traction 1. Manual Traction 2. Skin Traction 3. Skeletal Traction

17. Upper Extremity

18. • Indications: – Clavicle fractures • Most figure of eight splints are prefabricated and Application is simple . • Read the product information insert before applying the splint about the correct application process. • Apply with patient standing and hands on iliac crest. Shoulders should be abducted (1) Figure of eight Shoulder and Arm

19. Figure of eight

20. (2) Sling and Swathe Indication : – Shoulder and humeral injuries • Slings supports weight of shoulder • Swathe holds arm against chest to prevent shoulder rotation • Apply the sling and swath with the patient standing. • Place the injured arm in the sling with the elbow at 90 degrees of flexion. • Next place the strap that is attached to the sling over the patient head so that the weight of the arm is supported

21. • Apply the swath . – This can be anything from an ACE wrap to a prefabricated swath. This is designed to hold the patients affected arm that is in the sling against the body . • The swath should wrap around the front and back of the sling keeping the affected extremity against the mid-abdomen Sling and Swathe

22. (3) Aeroplane Splint Indication - Brachial plexus injury

23. Elbow/Forearm (1) Long Arm Posterior • Indications: - Forearm and elbow injuries - Olecranon and radial head fractures - Distal humeral fracture • Not recommended for unstable fractures • Applied from palmer crease, wrapping around lateral metacarpals, extending up to posterior arm with elbow flexed at 90 degrees NOTE - Doesn’t completely eliminate supination / pronation –either add an anterior splint or use a double sugar-tong if complex or unstable distal forearm fx.

24. Long Arm Posterior

25. (2) Double Sugar - Tong Indications :- - Elbow and forearm fx - prox /mid/distal radius and ulnar fx . Better for most distal forearm and elbow fx because limits flex/extension and pronation / supination .

26. (2) Double Sugar - Tong

27. Forearm/Wrist (1) Volar Forearm / Cockup • Indications : - Distal forearm and wrist fractures Soft tissue hand / wrist injuries - sprain, carpal tunnel night splints, etc 2nd -5th metacarpal fx . Radial Nerve palsy • Applied from volar palmer crease to 2/3 forearm • Allows elbow and finger ROM NOTE - Not used for distal radius or ulnar fx - can still supinate and pronate.

28. Volar Forearm / Cockup

29. (2) Forearm Sugar - Tong Indications – Wrist and distal forearm fractures Extends from MCP joints on dorsum of hand , tracks along the forearm, wraps around back of elbow to volar surface of the arm and extends down to mid-palmer crease Immobilises wrist, forearm, and elbow

30. Forearm Sugar - Tong

31. Hand/Fingers • Indications: – Phalangeal and metacarpal fractures • Most common use-Boxer fractures • 5th MCP fracture Soft tissue injury to little and ring finger. Indications - Fractures , phalangeal and metacarpal and soft tissue injuries of the index and middle fingers. (2) Radial Gutter Splint (1) Ulnar Gutter Splint

32. • Extends from DIP joint to the proximal 2/3 of the forearm • Should immobilize the ring and little finger • MCP should be in 70 degrees of flexion, PIP should be in 30 degrees of flexion and DIP in no more than 10 degrees of flexion Ulnar Gutter Splint

33. Ulnar Gutter Splint

34. Ulnar Gutter Splint

35. Radial Gutter Splint

36. (3) Thumb Spica Indications: – Scaphoid fractures , thumb p halanx fractures or dislocations • Most Common use: Gamekeepers thumb or skiers thumb 2) Dequiervans tenosynovitis Extends from DIP joint of thumb, incorporates the thumb and extends up 2/3 of the proximal lateral forearm

37. Thumb Spica

38. (4) Finger Splints Sprains - dynamic splinting (buddy strapping ). Dorsal/Volar finger splints - phalangeal fx, though gutter splints probably better for proximal fxs .

39. Finger Splints (a) Stack Splint Use – management of mallet finger

40. (b) Aluminium Splint Uses - phalangeal fx, -mallet finger

41. (c) Oval-8 Finger splint

42. Oval-8 Finger splint

43. Finger splints

44. (d) Tripoint Splint Uses – Boutonniere deformity , Swan neck deformity

45. Tripoint Splint

46. (5) Knuckle-bender Splint Indication - Ulnar Nerve Palsy

47. Lower Extremity

48. (1) Von Rosen’s Splint Indication – Congenital dislocation of the Hip ‘H’ shaped malleable splint Hip should be properly reduced before it is splinted Object is to held hip somewhat flexed and abducted Extreme positions are avoided and Joint should allowed some movement in the splint

49. Uses- Fracture shaft of femur in children and in young adults once the fracture becomes ‘sticky’ encircles one or both arms or legs and the chest or trunk . It generally is strengthened with a reinforcement bar. (2) Hip Spica Cast

50. When applied to a lower extremity , the cast is trimmed in the anal and genital areas to allow elimination of urine and stool. Hip Spica Cast

51. Hip Spica Cast

52. (3) Thomas Splint Devised by H.O. Thomas initially for T B of the knee. Indication - Now commonly used for immobilisation of hip and thigh injuries It has a ring and two bars joined distally. The ring is at an angle of 120 degree to the inside bar The ring size is found by addition of 2 inches to the thigh circumference at the highest point of the groin The length is the measurement from the highest point on the medial side of the groin up to the heel plus 6 inches.

53. Thomas Splint - used as traction splint

54. (4) Bohler-Braun Splint Indication ;- Fracture femur – anywhere More convenient than Thomas splint since it has no ring. As the ring of Thomas splints is a common cause of discomfort, especially in old people. No in-built system of counter-traction , hence it Is not suitable for transportation .

55. Knee (1) Knee Splint Indications: - knee injuries - proximal Tib /fib fractures • Place knee in full extension • The plaster is placed from the posterior buttocks to 3 inches above level of bilateral malleoli

56. Knee Splint

57. (1) Posterior Ankle Splint Indications - Distal tibia/fibula fx. - Reduced dislocations - Severe sprains - Tarsal / metatarsal fx Use at least 12-15 layers of plaster. Placed from metatarsal heads on plantar surface foot , extends up back of leg to level of fibular neck NOTE - Adding a coaptation splint (stirrup) to the posterior splint eliminates inversion / eversion - especially useful for unstable fx and sprains. Ankle

58. (2) Stirrup Splint Indications Similar to posterior splint . Unstable ankle fx Less inversion /eversion and actually less plantar flexion compared to posterior splint . Great for ankle sprains. 12-15 layers of 4-6 inch plaster .

59. The splint should be long enough to involve the leg from below the medial side of knee, wrap around the under surface of the heel, and back up to the lateral side of the same knee. Stirrup Splint

60. Stirrup Splint

61. Foot (1) Denis-Brown splint Indication – Congenital Talipes Equino Varus (C.T.E.V.) Used after successful correction of deformity ,to prevent relapse. used throughout the day before child starts walking. Once child starts walking ,a DB splints is used at night and CTEV shoes during the day.

62. Denis-Brown splint

63. (2) Buddy strapping Indications: – Phalangeal fractures of the toes • Small piece of wadding placed between toes to prevent maceration • Fractured toe secured to adjacent toe with tape

64. • Use a small piece of wadding and place between the injured toe and an adjacent toe to prevent maceration • The fractured toe is secured to the adjacent toe with a piece of tape Buddy strapping

65. Spine

66. (1) Cervical Collar Flexible foam/Rigid/Adjustable collar Encircles the neck to support the skull against the thorax inferiorly Motion control and keeping warm at cervical level Soft tissue injury, minor sprains for first few days after injury Post operative immobilisation Note :- They are not useful for very unstable injury pattern

67. Cervical Collar Soft Cervical Collar Commonly used for mild soft tissue strains and sprains

68. Semi-Rigid Cervical Collar Can provide access to the trachea Moderate Control of ROM Adjustable Cervical Collar

69. (2) Four-post Collar Indication – Neck immobilisation in cervical spine injury More stable than cervical collar Applying pressure to mandible , occiput , sternum and upper thoracic spine They can be uncomfortable

70. Rigid Frame Design Commonly used in stable fractures and Moderate to Severe soft tissue damage Limits Flexion and Extension Extends Inferior into the Thoracic Region for greater control of all cervical levels (3) SOMI (Sternal Occipital Mandibular Immobilizer) Uses – cervical spine injury

71. (4) Milwaukee Brace Indication - Scoliosis Named after the city of Milwaukee where it was designed. It fits snugly over the pelvis below; chin and head pads promote active postural correction and thoracic pad presses on the ribs at the apex of the curves

72. (4) Boston Brace Indication -Scoliosis Used for low curves Worn 23 Hours / Day Made of semi-rigid plastic and foam

73. (5) Lyon Brace Indication -Scoliosis

74. (6) SpineCore Brace Indication -Scoliosis

75. Scoliosis Braces

76. (7)Taylor’s Brace Indication – Dorso-lumbar Immobilisation Anterior Compression Fractures of the vertebral body Semi rigid design Commonly used for osteoporosis, trauma, Degenerative spine disease

77. Traction

78. Traction Traction is a pulling effect exerted on a part of the skeletal system. It is a treatment measure for musculoskeletal trauma and disorders. Traction is used to accomplish the following: Reduce muscle spasms Realign bones Relieve pain Prevent deformities

79. Types of Traction

80. Manual traction means pulling on the body using a person's hands and muscular strength . It most often is used briefly to realign a broken bone . It also is used to replace a dislocated bone into its original position within a joint. 1. Manual Traction

81. Manual Traction

82. 2. Skin Traction Skin traction means a pulling effect on the skeletal system by applying devices , such as a pelvic belt and a cervical halter, to the skin. C ommonly applied forms of skin traction are – Buck's traction Russell's traction Bryant’s (gallows) traction Dunlop traction

83. Limited force can be applied - generally not to exceed 5 lbs More commonly used in pediatric patients Can cause soft tissue problems especially in elderly or rheumatoid patients Not as powerful when used during operative procedure for both length or rotational control Skin Traction

84. Pelvic Traction (B) Cervical halter . Skin Traction

85. (1) Pelvic Traction Uses –Relief of pain of Sciatica and other backaches An alternative in Sciatica is the 90-90 traction Traction is applied to a pelvic harness with weights over the end of bed

86. (2) Cervical halter Uses - short term cervical traction -minor neck injuries without obvious trauma e.g. Whiplash injury, neck muscle spasm , conservative treatment of cervical disk lesion Note – Contraindicated in mandibular fracture

87. (3) Buck's traction Uses - femoral fractures, lower backache Acetabular and hip fractures Conventional skin traction

88. Provide temporary comfort in hip fractures Maximal weight - 10 pounds Watch closely for skin problems, especially in elderly or rheumatoid patients Buck's traction

89. (4) Russell's traction Uses - Trochanteric fractures

90. (5) Gallows traction Uses- fracture shaft of femur in children below 2 years Imp –check the state of the circulation in the limb frequently , because of danger of vascular complications

91. Bryant’s Traction Useful for treatment femoral shaft fx in infant or small child Combines gallows traction and Buck’s traction Raise mattress for counter traction Rarely, if ever used currently

92. (6) Dunlop traction Use - mainly used in the maintenance of reduction in supracondylar fractures of humerus in children . Forearm skin traction with weight on upper arm Elbow flexed 45 degrees Allows swollen elbow to settle Contraindicated in open fractures and skin defects

93. Dunlop traction

94. (7) Femoral Traction Older Child in Balkan Frame Indications • Child > 12 kg • Femoral fractures • Skin must be intact

95. Balkan Frame

96. 3. Skeletal Traction Skeletal traction means pull exerted directly on the skeletal system by attaching wires, pins , or tongs into or through a bone. Skeletal traction is applied continuously for an extended period .

97. More powerful than skin traction May pull up to 20% of body weight for the lower extremity Requires local anesthesia for pin insertion if patient is awake Preferred method of temporizing long bone, pelvic, and acetabular fractures until operative treatment can be performed Skeletal Traction

98. Rigid Frame Design Commonly used in unstable fractures Limits All motion Extends Inferior into the Thoracic Region for greater control of all cervical levels Screws Directly into the skull (1) HALO TRACTION Disadvantages - Pin problems - Respiratory compromise

99. HALO TRACTION BRACE

100. Used for C-spine reduction / traction Pins are placed one finger breadth above pinna, slightly posterior to external auditory meatus Apply traction beginning at 5 lbs. and increasing in 5 lb. increments with serial radiographs and clinical exam (2) Gardner Wells Tongs

101. Rarely used today Small to medium sized pin placed from medial to lateral in proximal olecranon - enter bone 1.5 cm from tip of olecranon and walk pin up and down to confirm midsubstance location. Support forearm and wrist with skin traction - elbow at 90 degrees Uses - supracondylar and comminuted fractures of lower end of the humerus and unstable fracture of shaft of humerus (3) Olecranon Traction

102. (4)Distal Femoral Traction Uses - Method of choice for acetabular and proximal femur fractures If there is a knee ligament injury usually use distal femur instead of proximal tibial traction Place pin from medial to lateral at the adductor tubercle - slightly proximal to epicondyle

103. (5) 90-90 Traction Useful for subtrochanteric and proximal 3 rd femur fx Especially in young children Matches flexion of proximal fragment Can cause flexion contracture in adult

104. (6) Acetabular Traction Uses- to maintain reduction in central fracture dislocation of acetabulum

105. How do I take care of the splint? • Do not get the splint wet. Use plastic bags to cover the splint while bathing. • Do not walk on the splint. • Do not stick anything down the splint Such as a coat hanger to scratch or itch. This may lead to injury and infection.

106. What danger signs should to look for? • Numbness, tingling, increased pain, change in coloration of fingers or toes, or swelling in fingers or toes. • If these symptoms occur, you should call your doctor immediately

107. Complications Burns - Thermal injury as plaster dries - Hot water, Increased number of layers , extra fast-drying , poor padding all increase risk - If significant pain - remove splint to cool Ischemia - Reduced risk compared to casting but still a possibility - Do not apply Webril and ace wraps tightly - Instruct to ice and elevate extremity - Close follow up if high risk for swelling , ischemia. - When in doubt, cut it off and look Remember - pulses lost late. Pressure sores Smooth Webril and plaster well Infection - Clean , debride and dress all wounds before splint application - Recheck if significant wound or increasing pain

108. THANK YOU , Dear