Abstract
This chapter provides a review of casting and splinting in children and adolescents.
Keywords
casting, fracture treatment, splinting
2
What materials are needed for splinting?
- •
Gauze roll or elastic ACE bandage ( Fig. 46.1A )
Fig. 46.1
A, Tape (foreground) and ACE bandage (background)
From Garza D: Taping and bandaging. In: Auerbach PS, Cushing TA, Harris NS (eds): Auerbach’s Wilderness Medicine . Philadelphia, 2016, Elsevier.) B. Webril/cotton soft padding. (From Ramirez MA: Procedures Consult. General Splinting Techniques, 2007, Philadelphia, 2017, Elsevier.
- •
Cotton stocking material (stockinette)
- •
Soft cotton roll (Webril) ( Fig. 46.1B )
- •
Fiberglass roll (Ortho glass) or plaster roll
- •
Measuring tape/scissors/water
3
What are the layers of a splint, from inner to outer layer?
- •
Stockinette (optional)
- •
Soft cotton bandage/undersplint material (e.g., Webril padding), especially at bony prominences ( Fig. 46.2 )
Fig. 46.2
Webril (B) and plaster splint application (A,C,D) for a sugar tong wrist splint.
From Mazzola T: Splinting and casting. In: Seidenberg P, Beutler A (eds): The Sports Medicine Resource Manual . Philadelphia, 2008, Saunders, Fig. 16-3.
- •
Plaster or fiberglass placed to maintain position of immobilization
- •
Outer layer of ACE bandage
10
What is the proper splint to immobilize the wrist for fracture/sprain?
Volar ( Fig. 46.3 ) or dorsal splint with the following:
LENGTH = proximal fingers to proximal forearm
WIDTH = as wide or slightly wider than the surface of the forearm
11
What are the different methods of casting/splinting of the upper extremities?
See Table 46.1 .
| Proximal or middle phalanx: stable and nondisplaced | Buddy taping |
| Distal phalangeal fracture | Aluminum U-shaped splint |
| Carpal bone fractures (excluding scaphoid and trapezium) | Volar/dorsal splint |
| Scaphoid (nondisplaced) | Thumb spica |
| First metacarpal and thumb fracture (nondisplaced) | Thumb spica |
| Second or third metacarpal or corresponding proximal/middle phalangeal shaft fracture (nondisplaced/nonrotated) | Radial gutter |
| Third or fourth metacarpal or corresponding proximal/middle phalangeal shaft fracture (nondisplaced/nonrotated) | Ulnar gutter |
| Acute distal radial/ulnar fractures | Sugar tong, long arm posterior splint |
| Proximal humeral/humeral shaft fractures | Simple sling or coaptation splint for severely displaced fractures |
| Distal humeral, proximal (supracondylar Type I Gartland)/middle forearm, and nonbuckle wrist fractures | Long arm posterior cast |
| Supracondylar (Type II, III Gartland) | Surgical reduction with pin fixation |
| Lateral condylar fracture | Surgical fixation |
| Medial condylar fracture (nondisplaced <3–5 mm) | Long arm posterior splint |
| Clavicle (middle 1/3, distal 1/3, medial 1/3) | Figure-of-eight splint or simple sling (need clavicle-specific x-rays) |
14
What is the proper splint to immobilize the above problems in question 13?
Sugar tong ( Fig. 46.4A )/Posterior ( Fig. 46.4B ) splint with the following:
LENGTH = fibular head to base of toes or fibular head around heel to below the medial knee
WIDTH = half the circumference of the lower leg
15
Is it appropriate to manage an open toe fracture with splinting only?
No. Open toe fractures, in which the germinal matrix of the proximal nail bed is trapped in the fracture site:
- •
Need external repair and antibiotics
- •
If severe, may need Open Reduction Internal Fixation surgery with K-wire repair and intravenous antibiotics
16
What are the different methods of casting/splinting the lower extremities?
See Table 46.2 .
| Hip fracture | Hip spica cast |
| Femur fracture | Spica cast |
| Tibular/fibular fracture | Long leg splint or long leg cast |
| Ankle fracture (nondisplaced) | Short leg posterior splint or short leg cast |
| Fifth metatarsal fracture (Jones fracture) | Bulky Jones dressing and postoperative shoe or non–weight-bearing short leg cast |
| Spiral fracture, fifth metatarsal neck (dancer’s fracture) | Short leg cast |
| Toe fracture (nondisplaced) | Buddy taping |
Key Points
- 1.
Splinting is a potential treatment for nondisplaced, closed fractures or sprains.
- 2.
Contraindications to splinting include open fractures, fractures involving the joint, severe fractures (displaced, angulated, or overlapping fractures), Salter-Harris V fractures, severe plastic fractures (greenstick, bowing), or evidence of compartment syndrome.
- 3.
Splints should be placed with extremities in their normal position of function.
10
What is the proper splint to immobilize the wrist for fracture/sprain?
Volar ( Fig. 46.3 ) or dorsal splint with the following:
LENGTH = proximal fingers to proximal forearm
WIDTH = as wide or slightly wider than the surface of the forearm
11
What are the different methods of casting/splinting of the upper extremities?
See Table 46.1 .
| Proximal or middle phalanx: stable and nondisplaced | Buddy taping |
| Distal phalangeal fracture | Aluminum U-shaped splint |
| Carpal bone fractures (excluding scaphoid and trapezium) | Volar/dorsal splint |
| Scaphoid (nondisplaced) | Thumb spica |
| First metacarpal and thumb fracture (nondisplaced) | Thumb spica |
| Second or third metacarpal or corresponding proximal/middle phalangeal shaft fracture (nondisplaced/nonrotated) | Radial gutter |
| Third or fourth metacarpal or corresponding proximal/middle phalangeal shaft fracture (nondisplaced/nonrotated) | Ulnar gutter |
| Acute distal radial/ulnar fractures | Sugar tong, long arm posterior splint |
| Proximal humeral/humeral shaft fractures | Simple sling or coaptation splint for severely displaced fractures |
| Distal humeral, proximal (supracondylar Type I Gartland)/middle forearm, and nonbuckle wrist fractures | Long arm posterior cast |
| Supracondylar (Type II, III Gartland) | Surgical reduction with pin fixation |
| Lateral condylar fracture | Surgical fixation |
| Medial condylar fracture (nondisplaced <3–5 mm) | Long arm posterior splint |
| Clavicle (middle 1/3, distal 1/3, medial 1/3) | Figure-of-eight splint or simple sling (need clavicle-specific x-rays) |
14
What is the proper splint to immobilize the above problems in question 13?
Sugar tong ( Fig. 46.4A )/Posterior ( Fig. 46.4B ) splint with the following:
LENGTH = fibular head to base of toes or fibular head around heel to below the medial knee
WIDTH = half the circumference of the lower leg
15
Is it appropriate to manage an open toe fracture with splinting only?
No. Open toe fractures, in which the germinal matrix of the proximal nail bed is trapped in the fracture site:
- •
Need external repair and antibiotics
- •
If severe, may need Open Reduction Internal Fixation surgery with K-wire repair and intravenous antibiotics
16
What are the different methods of casting/splinting the lower extremities?
See Table 46.2 .
| Hip fracture | Hip spica cast |
| Femur fracture | Spica cast |
| Tibular/fibular fracture | Long leg splint or long leg cast |
| Ankle fracture (nondisplaced) | Short leg posterior splint or short leg cast |
| Fifth metatarsal fracture (Jones fracture) | Bulky Jones dressing and postoperative shoe or non–weight-bearing short leg cast |
| Spiral fracture, fifth metatarsal neck (dancer’s fracture) | Short leg cast |
| Toe fracture (nondisplaced) | Buddy taping |
Key Points
- 1.
Splinting is a potential treatment for nondisplaced, closed fractures or sprains.
- 2.
Contraindications to splinting include open fractures, fractures involving the joint, severe fractures (displaced, angulated, or overlapping fractures), Salter-Harris V fractures, severe plastic fractures (greenstick, bowing), or evidence of compartment syndrome.
- 3.
Splints should be placed with extremities in their normal position of function.
Bibliography
Bibliography
10
What is the proper splint to immobilize the wrist for fracture/sprain?
Volar ( Fig. 46.3 ) or dorsal splint with the following:
LENGTH = proximal fingers to proximal forearm
WIDTH = as wide or slightly wider than the surface of the forearm
11
What are the different methods of casting/splinting of the upper extremities?
See Table 46.1 .
