Orthopedic Braces, Traction & Splints

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

Indications for splinting

• Fractures
• Sprains, which are injuries to the ligaments around a joint
• Joint infections
• Tenosynovitis, inflammation of the fluid-filled synovium within the tendon sheath
• Acute arthritis or gout
• Lacerations over joints
• Puncture wounds and animal bites of the hands or feet

Other Splint indications

• Reduce or prevent contracture
• Increase grip strength
• Stabilize and rest joint in ligamentous injury
• Correct deformity
• Support and immobilize joints and limbs postoperatively until healing has occurred

Contraindications of splinting

• Compartment syndrome
• Skin at high risk for infection

Splinting Materials

• Plaster of Paris is made from gypsum, which is calcium sulfate dehydrate
• Plaster of Paris undergoes an exothermic reaction when wet and recrystallizes, which can burn a patient
• Plaster of Paris takes an average of 3-9 minutes to set
• Plaster of Paris takes an average of 24-72 hours to dry
• Initial setting time is from mixing gypsum powder with water until half-hardened gypsum
• Final setting time is the time from mixing until the material hardens and can be removed from the mold

Factors decreasing Pop setting time

• Hot water
• Salt
• Borax
• Resins

Factors increasing setting time

• Cold water
• Sugar

Layers for extremities

• Use 8-10 layers for upper extremities
• Use 12-15 layers for lower extremities, up to 20 layers if the person is big which increases the risk of burns

Advantages of Plaster of Paris

• Easier to mold
• Less expensive

Disadvantages of Plaster of Paris

• More difficult to apply
• Gets soggy when wet

Ready Made Splinting Materials

• Plaster OCL consists of 10-20 sheets of plaster with padding and a cloth cover
• Fiberglass or Orthoglass cures rapidly in 20 minutes
• Fiberglass is stronger, lighter, and wicks moisture better
• Fiberglass less messy

Disadvantages to Fiberglass

• Fiberglass is more expensive
• Fiberglass is more difficult to mold

Prefabricated splints

• Prefabricated splints are plastic shells lined with air cells, foam, or gel components
• Prefabricated splints have the same advantages and disadvantages as fiberglass splints

Air splints

• Air splints provide less support than plaster and fiberglass splints
• Air splints are used for ankle sprains rather than fractures or dislocations
• Air splints prevent eversion/inversion while permitting free flexion and extension of the ankle
• Air splints provide a clear view of injury during x-ray

Vacuum splints

• Vacuum splints consist of Styrofoam ships in an airtight cloth, pliable sleeve
• Vacuum splints mold to the shape of injury using a handheld pump to draw out the air from within

Pre and Post-Splint Checks

• F stands for function
• A stands for arterial pulse
• C stands for capillary refill
• T stands for Temperature of the skin
• S stands for sensation

Upper Extremity Splinting

• Types of upper extremity splints to choose

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

Lower Extremity

• Types of lower extremity splints to choose

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

• Types of spine splints to choose

Spine

• Cervical Collar
• Four-post Collar
• SOMI or Sternal Occipital Mandibular Immobilizer

Scoliosis

• Milwaukee Brace
• Boston Brace
• Taylor's Brace

Figure of eight splint

• A figure of eight splint is indicated for clavicle fractures
• Most of the figure of eight splints are prefabricated, making application simple
• Apply when the patient is standing and have their hands on the iliac crest
• Shoulders should be abducted when applying a figure of eight splint

Sling and Swathe splint

• A sling and swathe splint are used for shoulder and humeral injuries
• Slings support the weight of the shoulder
• Swathe holds arm against chest to prevent shoulder rotation
• Apply the sling and swathe with the patient standing
• The injured arm should be placed in the sling with the elbow at 90 degrees of flexion
• The strap attached to the sling should be placed over the patient head so the weight of the arm is supported
• This can be anything from an ACE wrap to a prefabricated swath
• The swath should wrap around the front and back of the sling, keeping the affected extremity against the mid-abdomen

Aeroplane Splint

• An Aeroplane splint is rarely used
• The indication for an Aeroplane splint is a brachial plexus injury

Long Arm splint

• Indications are forearm and elbow injuries, olecranon and radial head fractures, and distal humeral fracture
• NOT recommended for unstable fractures
• Application is from palmer crease, extending up to the posterior arm with the elbow flexed at 90 degrees
• it does not completely eliminate supination/pronation
• Adding an anterior splint or using a double sugar tong is an option, if complex or unstable distal forearm fracture

Double Sugar Tong Splint

• Elbow and forearm fx unstable, prox/mid/distal radius, and ulnar fx
• Better for distal forearm and elbow fx because limits flex/extension and pronation/supination

Volar Forearm

• Indications for distal forearm and wrist fractures, soft tissue hand and wrist injuries, sprain, carpal tunnel night splints etc, 2nd - 5th metacarpal fx, radial nerve palsy
• Note not used for distal radius or ulnar fx and can still pronate.

Forearm Sugar

• Indications for wrist distal radius fractures
• Extends MCP joints on dorsum of hand, tracks along forearm, wraps around back to volar surface forearm and extends down to mid palmer crease
• Immobilising the wrist forearms and elbows

Ulna Gutter

• Indication as phalangeal and metacarpal fractures and used in Boxers fractures
• Extends from DIP joint to proximal 2/3 to forearm
• Should immobilize ring and little finger MCP should be in 70 degrees flexion

Radial Gutter Splint

• Fractures, phalangeal, and metacarpal and soft tissue injuries. Often used in boxer fractures,
• 5th Metacarpophalangeal fracture Soft tissue injuries
• injury to little and ring finger.

Thumb Spica

• Indication as Scaphoid fractures, thumb phalanx fractures and Most Common use as Gamekeepers or skier thumb, Dequiervams tenosynovitis
• Skier is acute partial or complete rupture of the ulnar collateral ligament

Finger Splints

• Uses -phalangeal fx, Dynamic and buddy strapping
• Phalangeal fx, mallet finger and Oval-8 finger Splints
• Used as the following management mallet finger Stack splints or auminium splint
• Boutonniere is treated as the following Tripoint Splint Oval-8 Finger can splints help reduce Boutonniere Deformity

Knuckle Splints

• Indication used from and the Ulna Nerve Palsy

Lower Extremity Splints

• Splint is used as a Pavlik in the DDH
• Can provide support when uses a low extremity. When the cart trimmed in anal and genital areas is is used allow urine of stool.

Rosen Splints

• Is the indication Congenital dislocation of hips
• Has an shape malleable
• Can be used for the up to 16 years at older of and age

Hip Spica Case

Most used as when Fracture shaft if with child and and youngers adults. Strengthens and provides the of reimforcment bar

• Can be used for the hip to trunk to help and support

Thomas Split

• Devised bu H.O and Thomas initially for for T B of the knee Is Now commonly if immobilises for and thigh injuries
• Has if a as the ring with the two as the bar joined bar distally

Bohles Braum Splint

• Is indicated from frature femur – anywhere than Thomas splint to where has that is ring. That As to Thomas.

Knee splint

• Indications from for knees injuries then proximal Tub/Fib fractures Place in full extension in the Popliteal artery.
• Avoid from and the stretching as 3 inches as that Malleilo

Medial

Has and is Similar from of Ankle Sprains with Plaster, Use is great for ankle sprains - and - below Knee

(Denis Brown Splint)

• Indication for Congenital (C.T.E.V.)
• Also used throughout days and the before starts a walking before

(Congenital and Splints)

• Indication used and as the from the toes. - Prevents and Small use of the toe with with tape

Scoillosis

• The Boston Brace where Scoliosis from as 20-40

Cervicle Caloar

• Flexible from the minor sprains

Three Splint

• Immobilises then fracture stable fractures of damage
• All of the Extend Thoracic from of as them cervical of levels

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Questions about different orthopedic braces, traction methods like manual or skin traction, and splints such as the ulnar gutter splint. Topics covering their specific applications, benefits, and limitations for patient care.