MEDICAL PRACTICE

The vacuum splint: an aid in emergency splinting of

fractures
R. M. Letts, m.d., b.sc. (med.), m.sc, f.r.c.s.[c] and D. A. Hobson,

Summary: The vacuum splint has been

shown to be a simple, safe and
effective method of emergency splinting
of fractured extremities. The splint
is simply constructed from clear
vinyl sheeting and contains 2-mm.
expanded polystyrene balls. Evacuation
of air causes the splint to become
rigid, thereby providing stability and
immobilization of the limb. The
splint is radiolucent, containing no
obstructive metal components that
would interfere with the radiographic
appearance of the injured limb. The
ease of application of this splint
makes it especially effective for the
emergency splinting of fractures
in children.
Resume: Attelle en vinyl devant rigide
par Evacuation d'air: methode simple
de reduction temporaire des fractures
Cette attelle s'est revelee comme
une methode d'urgence simple, sure
et efficace de reduction temporaire des
fractures des membres. Cette attelle
se compose d'une feuille de vinyl
transparent contenant des billes dilatees
de polystyrene de 2 mm de diametre.
L'6vacuation de I'air contenu dans cette
enveloppe le rend rigide et, partant,
confere a I'attelle la stabilite qui
permet d'immobiliser le membre
fracture. La substance de vinyl

b.sc.

(mech. eng.), Winnipeg,

Man.

Emergency splinting of fractures in the the children as a comfortable, efficient

Pediatric Emergency Department is in method of fracture splinting, but it
many instances inadequate. The splints has also been very well received by the
currently available for immobilization nursing staff who find this type of splint
leave much to be desired. Many com easy to apply.

mercial splints, although moulded to

fit the anatomically normal extremity,
are unsuitable for application to a limb
that has an abnormal shape owing to
fracture of constituent bones. Such
splints are usually very rigid and one
is faced with the task of fitting the limb
to the splint rather than the splint to
the limb. Many splints in current use
are of metal and hence not completely
radiolucent. This often gives rise to
considerable difficulty in the interpreta
tion of injuries to the growth plate in
children. Air splints have been used in
an attempt to overcome some of these
difficulties.1 However, they too have
their drawbacks. Zippers running the
full length of the splint are often superimposed on the bone in the radiograph.
It is often difficult, in children es
pecially, to slide the splint on and then
close the zipper. If such a device is
left on for more than a few minutes
the skin becomes wet from unevaporated
perspiration, an undesirable feature
should operation be contemplated. Finally, there is always the danger of
compression due to excessive air within
the splint, and the risk of consequent
est radiotransparente, ne comporte
vascular insufficiency.
aucune piece de metal susceptible de
Having faced these frustrations on
du
fausser I'image radiographique
occasions in the treatment of
many
membre fracture. La facilite de pose
in the
children
de cette attelle la rend particulierement of children's EmergencyweDepartments
undertook
hospitals,
precieuse pour la reduction temporaire to devise a splint
obviate
would
that
des fractures chez I'enfant.
all drawbacks of the more conventional
appliances, and yet supply adequate
From the Section of Orthopaedics,
immobilization to the limb.
The Children's Hospital of Winnipeg and
The vacuum splint has now been
the Shriner's Hospital for Crippled Children,
Winnipeg
used in over 50 children with fractures
Reprint requests to: Dr. R. M. Letts,
involving upper and lower extremities.
The Children's Hospital of Winnipeg,
Not only has it been well tolerated by
685 Bannatyne Ave., Winnipeg, Man. R3E OWl
CMA

Technical considerations
As may be seen from Fig. 1, the
splint is simply constructed from clear
vinyl sheeting to form a double-walled
vinyl envelope cut to the desired shape
and heat-sealed along the edges. It is
filled with 2-mm. expanded polystyrene
balls. A valve sealed in the outer wall
of the envelope allows the air to be
evacuated from the splint by either a
vacuum pump or a wall suction. Prior
to such evacuation the splint is suf-

FIG. 1.The vacuum splint

for the forearm and leg.

as

designed

JOURNAL/OCTOBER 6, 1973/VOL. 109 599

ficiently flexible to be readily moulded

extremity with minimal discomto the shape of the limb. Velcro straps
fort to the patient.
secure the splint in place. Evacuation
2. It provides stable and comfortable
causes the splint to become rigid thereby
support to the fracture site with
providing stability and immobilization
minimal compression.
of the limb (Figs. 2A and 2B). At the
3. The inner surface texture of the
same time the surface of the splint besplint allows full air circulation
comes slightly irregular. This allows
and prevents the skin from macthe air to circulate beneath it and
erating because of accumulated
prevents the skin from becoming soggy
perspiration.
and macerated.
4. The splint is light and completely
Since all parts are made of plastic,
radiolucent and therefore the pathere is no metal to obscure the view
tient can be readily transported to
on radiographs. As may be seen in
the x-ray department for radioFig. 3, the splint is completely radiolugraphs of the affected area. Fig. 4
cent.
illustrates the splint in use.
Advantages of the vacuum splint
Additional applications
Although experience with the splint
Such a splint is also useful in the
is limited, the following advantages are emergency treatment of fractures of
evident:
the cervical spine where it will provide
1. It is easily applied to the fractured excellent immobilization of the spine
.

. ...

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while moulded to the contours of the

head, neck and thorax.
The vacuum splint is also adaptable
for the limb immobiiization required
during surgical procedures.' In this case
a pillow configuration of the splint is
most useful since it can be indented
to form a gutter or otherwise moulded
to support the limb or body.
Such splints could well be part of the
emergency equipment of ambulances,
together with a vacuum pump, so that
patients with suspected spinal injuries
could be rigidly immobilized and transported much more efficiently than with
present methods.
References
1. NICOLL EDV: Air splints for the emergency
treatment of fractures. J Bone Joint Surg
[Am] 46: 1761, 1964
2. PoVzY RW: A vacuum splint for use In
orthopaedic operations. J Bone Joint Surg
[Br] 52: 585, 1970

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FIG. 2A-Application of the

vacuum

splint to the forearm.

FIG. 2B-Immobilization of the forearm

vacuum

splint.

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600 CMA JOURNAL/OCTOBER 6, 1973/VOL. 109

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