Splinting (HB)

Splinting is a skill that is useful to help support musculoskeletal injuries. It works by providing an external structure to help immobilize (or reduce movement to) a joint or a bone. The goal of the splint is not necessarily to “lockdown” the injury—it is to provide a way to support the injury so that the patient does not have to rely on muscle tension to relieve the pain. It should also protect the injury from further harm. Most patients will be able to overcome a splint if they want to power through it—but they aren’t going to do so because it would cause pain and defeat the point of trying to help.

There are a few basic principles of splinting to perform this skill successfully. The splint must be complete, comfortable, and compact (what is called the “three C’s of splinting).

You must also continually reassess your splint (really any interventions you do) to make sure the splint is still working and that you have not introduced any problems to the affected part’s circulation, sensation, or motor function.

Complete

You need to support the Injury correctly. This means if the injury is to a long bone, you must stabilize the JOINT above and below the injured bone. If the injury is to a joint, you must stabilize the BONES above and below the joint. A splint is complete if it meets this condition.

Comfortable

A splint needs to be comfortable. Both now and in the future. You should pad any rigid surfaces (fleece works well here)—tape off any sharp edges. Be mindful of using large poles and where the ends point (a stick or walking stick pointing up at the groin could have disastrous consequences). If you tie any knots, make sure those knots are not lying on the skin—as the patient moves, the knot can rub and cause a hot spot. Make sure whatever knots you tie can be easily untied.

Aluminum splints are great, but they are made of a sheet of aluminum covered with a thin layer of foam. Repeated bending of a splint can cause the metal to breach the foam. And the foam itself should not be considered to be the padding—use more.

Remember that damaged tissue swells. Do not put splinting materials on too tightly. A patient should be able to wiggle their fingers and toes and should have good circulation and sensation whenever you check. If this is degrading, you may need to redo your splint.

Compact

A splint should only use the material it needs to perform its job. You do not want to have any parts that are sticking out and can snag on the ground or branches or whatever. Tuck or trim loose ends (but leave enough so you can readjust the splint if needed). Cut down any rigid materials to be the right length. Use padding to protect between the splint material and the patient’s body—use a strip of a blanket, not the whole blanket.

You can cut down an aluminum splint to make a finger splint rather than use the whole device (just make sure to protect any sharp edges).