Splinting

Related topics — Assessing trauma - primary and secondary survey

Attention

• Check circulation and sensation — after putting on splint check hands/fingers, feet/toes for colour, warmth, sensation, movement, capillary refill, peripheral pulses — Figure 10.1
  
• If any not normal — take off splint
• Padding — use combines, shirts, jumpers, towels, blankets, cushions etc
• Splints — best if made for the job, but you can use any rigid or firm material
• Can use thick folded blankets, sticks, cardboard boxes, rolled up newspapers
• Bandages for splinting — thick, strong triangular bandages used for slings are best, but ordinary bandages will do
• Splint needs to cover and immobilise joints on either side of injury/fracture to prevent movement
• Tie all knots away from injured area
• Check bandages are not too tight or uncomfortable — ask person, check circulation

Splinting collarbone

What you need

• Padding
• 2 triangular or ordinary bandages

What you do

• Offer pain relief
• Person sits in comfortable chair
• Put padding under armpit on side of injury — Figure 10.29
• Tie first bandage around upper arm and chest — Figure 10.30
• Put on elevation sling — Figure 10.31 or collar and cuff sling to take weight of arm
• Check circulation and sensation in hand

Splinting upper arm — break not close to elbow

What you need

• Padding
• 3 triangular or ordinary bandages

What you do

• Offer pain relief
• Person sits on comfortable chair
• Put on a collar and cuff sling — Figure 10.32
• Put padding between arm and chest
• Tie one bandage around arm and chest below break, another above break — Figure 10.33
• Check circulation and sensation in hand

Splinting wrist or forearm

Attention

• Splint needs to go from elbow to fingertips

What you need

• Splint
• 3 triangular bandages

What you do

• Offer pain relief
• Person sits in comfortable chair
• Put forearm and hand on splint, palm downward — Figure 10.34
• Tie 1st bandage around arm and splint, between elbow and the break — Figure 10.35
• Tie 2nd bandage around hand and splint — Figure 10.35
• Use 3rd bandage to make simple sling — Figure 10.36
• Check circulation and sensation in hand

Splinting hand or finger/s

What you need

• Padding
• Splint
• 2 ordinary bandages
• 1 triangular bandage
• Tape or pin for bandage

What you do

• Offer pain relief
• Person sits in comfortable chair
• Put injured hand on padded splint, palm down — Figure 10.37
• Put rolled bandage under palm to support it — Figure 10.37
• Secure the splint to the limb by securing it above the fracture and around the hand, below the fracture — Figure 10.38
• Put on elevation sling or simple sling to raise (elevate) hand/fingers
• Check circulation and sensation in fingers

Splinting single finger/toe

What you need

• 2 clean gauze swabs
• Splint — aluminium foam splint, 2 tongue depressors, sticks
• Paper dressing tape

What you do

• Offer pain relief
• Tape broken finger/toe to next finger/toe — Figure 10.39 OR ones on either side if middle finger/toe (‘buddy splint’). This will act as natural splint
• Put strip of gauze between fingers/toes to protect skin if needed

• OR Put splints on both sides of straightened finger/toe, tape around splint and finger/toe
• Check circulation and sensation in fingers/toes

Pelvic stabilisation

• To reduce a pelvic fracture, provide mechanical stability to pelvis and reduce blood loss
• Early reduction and stabilisation of pelvic fractures can be lifesaving 
• Apply compression around the pelvis by wrapping with a sheet or using a Pelvic Circumferential Compression Device (PCCD) such as the Pelvic Binder or Sam Sling
• Application of PCCDs are quick, safe, and easy. They can assist in stabilising the disrupted pelvic ring, decrease mobility, reduce bleeding and pain
• Application of pelvic binding has negligible adverse effects on patients later found not to have a pelvic fracture

Pelvic Sheeting

Used for rotationally unstable pelvic fractures

What you need

• Bed sheet or towel
• Helpers

What you do

• Offer pain relief
• Log-roll person with helpers. Put folded sheet/towel under their buttocks — between top of hip bones and buttock crease
• Roll person back onto folded sheet/towel, pull through so equal amount on each side — Figure 10.40

• Cross sheet/towel over hip bones, pull firmly in both directions so it tightly fits around and stabilises pelvis — Figure 10.41
• With helpers holding it in position, clamp sheet/towel at 4 points — Figure 10.42

• If no clamps available — use large safety pins or tie sheet to stretcher
• Check circulation and sensation in feet

Pelvic Circumferential Compressive Device (PCCD)

Use this method or pelvic sheeting 

PCCDs are most commonly used in pelvic fractures where there has been separation of the pelvic ring, particularly the symphysis pubis. The PCCDs are easy to apply, provide controlled pressure delivery and do not hinder ongoing resuscitation efforts 

• The most effective application site is the greater trochanters and symphysis pubis regions (lower hips)
• The PCCD should be tightened to 180 Newtons which is equivalent to lifting an eighteen-kilo weight
• PCCDs are not without complications which include pressure areas and skin abrasions from friction on tightening

What you need

• PCCD
• Helpers

What you do

• Ensure the skin is clean and dry and wounds are covered
• Offer pain relief
• Place T-Pod belt orange side down on stretcher, position midline fold in centre of stretcher
• Line up the pelvic binder on the bed then log-roll the person onto the pelvic binder to minimise risk of skin injury 
• The patient should be positioned on the belt, aligning upper edge of belt with person’s iliac crest (upper hips)
• Position the T-POD splint with the midline of the splint at the greater trochanters (lower hips)
• Cut or fold the belt to allow a 15–20cm gap between the ends at the front
• Apply the Velcro pulley system to the front
• Pull the tab to apply tension equally in both directions on the pulley system
• Maintain a 15cm gap between the two ends of the strap and ensure that two fingers can be fitted under the splint when tension applied
• Secure the pull tab
• Check circulation and sensation in feet
• Record the date and time of application on the space provided

Splinting lower leg

What you need

• Padding or pillow
• 5 triangular or ordinary bandages

What you do

• Offer pain relief
• Support fractured area with pillow
• OR Put folded padding between thighs and lower legs
• Tie ankles and feet together using figure of 8 bandage
• Tie 2nd bandage around both thighs
• Tie 3rd bandage around both knees
• Tie 4th bandage around both legs, above broken bone
• Tie 5th bandage around both legs, below broken bone — Figure 10.43
• Check circulation and sensation in feet

Splinting upper leg

What you need

• Padding
• 4 triangular or ordinary bandages

What you do

• Offer pain relief
• Put folded padding between thighs and lower legs
• Tie ankles and feet together using a figure of 8 bandage
• Tie 2nd bandage around both legs, above broken bone
• Tie 3rd bandage around both legs, below broken bone
• Tie 4th bandage around both knees — Figure 10.44
• Check circulation and sensation in feet