SPLINTING

TECHNIQUES
By
Madhumitha M,Aruna G,Abi P,
Sakthivelayudham G,Sujidha R,
Srivignesh M
INTRODUCTION AND
TYPES OF SPLINTS
By
Sakthivelayudham G
Bsc.(Hons)Allied Health Sciences
 𝗪𝗵𝗮𝘁 𝗶𝘀 𝗮 𝘀𝗽𝗹𝗶𝗻𝘁??
• A splint is a supportive device that
protects a broken bone or injury
• A splint keeps the injured part of
your body still to help with pain and
promote healing
 𝗪𝗵𝗮𝘁 𝗶𝘀 𝗦𝗣𝗟𝗜𝗡𝗧𝗜𝗡𝗚 ?

• Splinting is often used to stabilize a broken

bone while the injured person is taken to the
hospital for more advanced treatment.
 𝗧𝘆𝗽𝗲𝘀 𝗼𝗳 𝗦𝗣𝗟𝗜𝗡𝗧

• 𝗦𝘁𝗮𝘁𝗶𝗰
• 𝗗𝘆𝗻𝗮𝗺𝗶𝗰
• 𝗦𝗲𝗿𝗶𝗮𝗹 𝘀𝘁𝗮𝘁𝗶𝗰
• 𝗦𝗲𝗿𝗶𝗮𝗹 𝗣𝗿𝗼𝗴𝗿𝗲𝘀𝘀𝗶𝘃𝗲
 STATIC SPLINT

• A static splint has no moving parts.

It can be used for support,
protection, or correction. This type
is often used to support normal hand
arches.
 Features of Static Splint

• Improved range of motion without

pain
• patient can control the force of the
tension
• The patient is able to adjust the
tension force
 Dynamic Splint
• A Dynamic Splint has both a rigid
component (which immobilises) as
well as a dynamic component
which can be used to exercise the
fingers and restore mobility and
muscle tone.
•  
 Features of Dynamic Splint

• Springs can be added or removed

to adjust wrist tension
• Well-padded inner surface for
patient comfort
• Light weight, unbreakable and
washable material
 Serial Static Splint

• A serial static splint helps increase

tissue length by positioning soft
tissues toward the end of their
available range of motion.
Features of Serial Static Splinting
• Remodeling of Static splint
• Hold the joint at a tolerable
degree of ROM
• Promotes tissue remodelling
 Static Progressive Splint
• A static progressive splint applies a
low-load prolonged stretch at the
end of the available movement. It
uses non-elastic components to
place tension on the joint/tissue
with the goal of improving passive
motion.
 Features of Static Progressive Splint

• Provides non elastic constant pull

on stiff joints
• Increases Passive range of motion
• End range position is maximum
 Types of splints
(based on Rigidity)
• RIGID SPLINT
• Board
• Plastic/Metal
• Rolled news paper /Magazine
• Thick Cardboard
• Soft splint
• Pillow
• Folded blanket/Towel
• ANATOMIC SPLINT
• Bandage injured leg or finger to uninjured one
How to apply a
Splint?
By
Srivignesh M
Bsc (Hons) Allied Health Sciences
 Step 1 : Attend to any bleeding.

• Attend to bleeding, if any, before you

attempt to place the splint, You can
stop the bleeding by putting pressure
directly on the wound.
 Step 2: Apply Padding

• Then, apply a bandage, a square of gauze,

or a piece of cloth.
• Don’t try to move the body part that
needs to be splinted. By trying to realign
a misshapen body part or broken bone,
you may accidentally cause more damage.
 Step 3: Place the Splint
•Carefully place the homemade splint so that it
rests on the joint above the injury and the joint
below it.
•For example, if you’re splinting a forearm,
place the rigid support item under the forearm.
Then, tie or tape it to the arm just below the
wrist and above the elbow.
 Precautions to place the splint

• Avoid placing ties directly over the injured area

• Don’t tie the splint tightly that the ties will cut off the
person’s circulation.
Step 4: Watch for signs of decreased blood circulation
or shock
• If the extremities begin to appear pale, swollen, or 
tinged with blue, loosen the ties that are holding the
splint.
• Post-accident swelling can make the splint too tight.
While checking for tightness, also feel for a pulse. If
it’s faint, loosen the ties.
• If the injured person complains that the splint is
causing pain, try loosening the ties a little. Then
check that no ties were placed directly over an
injury.
Step 4 Cont…….
• If these measures don’t help and the person is still feeling
pain from the splint, you should remove it.
• The injured person may be experiencing shock, which
might include them feeling faint or taking only 
short, rapid breaths. In this case, try to lay them down
without affecting the injured body part. If possible, you
should elevate their legs and position their head slightly
below heart level
 Step 5: Seek for Medical help

• After you’ve applied the splint and the

injured body part is no longer able to
move, call your local emergency
services. 
Splinting the hand
By
Srivignesh M
Step 1: Control any bleeding
First, treat any open wounds and
control any bleeding.
 Step2 : Place an object in the palm of the hand

•Then place a wad of cloth in the palm of

the injured person’s hand. A washcloth, a
ball of socks, or a tennis ball can work
well.
•Ask the person to close their fingers loosely
around the object.
 Step 3: Apply padding
• After the person’s fingers are closed around the object,
loosely place padding between their fingers.
• Next, use a large piece of cloth or gauze to wrap the
whole hand from the fingertips to the wrist. The cloth
should go across the hand, from the thumb to the
pinkie.
 Step 4: Secure the padding
• Finally, secure the cloth with tape or ties. Make sure to
leave the fingertips uncovered. This will allow you to
check for signs of poor circulation
Splinting Procedure
By
Sakthivelayudham G
Bsc.(Hons)Allied Health Sciences
 EQUIPMENTS
• 1. Stockinet (optional)
• 2. Plaster or fiberglass splinting/casting material
• 3. Webril (splint padding)
• 4. Warm water (room temperature)
• 5. Elastic wrap, Tape, Sling
 PROCEDURE
• PREPARE
• SELECT
• LENGTH
• WIDTH
• LAYERS
• PADDING
• PADDING
• POSITION
• WET
• APPLY
• FINISH
PREPARE Clean, repair and dress any skin lesions prior to splinting
Consider removing clothing that will not be able to be removed after
Evaluate neurovascular status

SELECT Appropriate splint type

• LENGTH Use unaffected extremity to measure the materials

• In general, the plaster is used to immobilize the joint above and joint
• below the injured area, if this is anatomically possible
• The stockinet should be longer than the splining material so that it can be
• rolled over the ends of the splints.
• Cut dry plaster or fiberglass to fit area to be splinted. Plaster of Paris
• should be slightly longer than needed as it retracts during setting
LAYERS In an average sized adult, upper extremities should be splinted
with 8-10
layers of plaster. Lower extremities generally require 12-14 layers.
• PADDING Roll Webril around stockinet. This should be about 2-3
layers thick & each
• turn should overlap the previous turn’s with by 25-50% of its thickness.
• Alternatively, layers of Webril (approximately ½ the number of layers
as
• the plaster & the same diameter as the plaster) may be used
• One additional layer of Webril is placed on the outside of the plaster
(non-
• skin side) to avoid sticking of the elastic wrap to the plaster.
• Place additional padding (Webril) over boney prominences (such as the
• ankle malleoli) to avoid pressure injuries.
POSITION In general, splints are prepared to immobilize the effective limp in a
position of function. See individual splints to follow. There are exceptions
to this rule. 5th metacarpal neck fractures are position with the 5th MCP at
70-90 degrees. Distal finger extensor tendon avulsion leading to Mallet
deformity are splinted in extension
• WET Wet plaster/fiberglass material (not the padding)
• Plaster of Paris and water create an exothermic reaction. The water
• should be at room temperature (ideally at 24° C) The plaster drying rate is
• directly related to water temperature. The colder the water, the longer the
• drying time. As the water temperature approaches 40° C, the potential for
• serious burns from the splint doubles.
• Squeeze out excess water. Lie the plaster on a flat surface and smooth
• out any lumps or wrinkles
• APPLY The Webril-lined splint is then positioned over
the area to be immobilized
• Perform initial splint shaping at large joints. secured
with an ACE wrap.
• Shape splint contours to final form.
Maintain splint positioning until it has completely
hardened.
• FINISH Re-evaluate and document neurovascular
status
• Provide a sling for comfort (upper extremity) or
crutches (lower extremity)
 Step 5: Seek for
Medical help
Once the hand splint is on, seek medical
attention at an ER as soon as possible
 Splint for Upper
extremities
By
ABI P
Bsc.(Hons) Allied health sciences (2 nd semester)
Region: Ulnar Side of
Hand
Type of splint: Ulnar
Gutter Splint
 Indications

• 4th or 5th metacarpal fractures

• Angulated or unstable proximal and middle 4th
and 5th phalanx fractures
• Fractures with significant angulation and/or
rotation may require reduction prior to
splinting.
• Position
• Wrist in slight extension
• MCP joints in 70-90 degrees flexion
• PIP joints in 5-10 degrees flexion
• DIP joints in 5-10 degrees flexion
• Construction
• Splint from the proximal Forearm to slightly beyond the fourth
and fifth finger DIP joints
• Leave the thumb, index and middle fingers freely
Region:Radial side of
hand
Type of Splint:
Radial Gutter Splint
 Indications

• Distal Radius Fracture

• Non-displaced, non-rotated second or third 
Metacarpal Fractures
• Non-displaced, non-rotated second or third 
Proximal Phalanx Fractures
• Position
• Wrist in slight extension
• MCP joints in 70-90 degrees flexion
• PIP joints in 5-10 degrees flexion
• DIP joints in 5-10 degrees flexion
• Construction
• Cast from the proximal Forearm to the index, middle finger DIP
joints
• Leave the thumb, ring and pinky fingers freely mobile
 Region : Thumb,1st
Metacarpal and Carpal
bones
Type of Splint: Thumb Spica
Splint
 INDICATIONS

• Thumb metacarpal fracture.

• Scaphoid fracture.
• Lunate fracture.
• Thumb ulnar collateral ligament injuries.
• De Quervain's tenosynovitis.
• Position
• Fore arm in neutral position
• Thumb in wineglass position

• Application
• The splint covers the radial aspect of the forearm, from
the proximal one third of the forearm to just distal to
the interphalangeal joint of the thumb, encircling the
thumb
 Region : Fingers

• Type of Splint
• Buddy Taping
• Aluminium U-shaped Splint
• Dorsal Extension-block Splint
• Mallet Finger Splint
Buddy Taping
Alumnium U Shaped Splint
• INDICATIONS
• Distal Phalanx Fracture or Injury

• Construction
• Wrap from Dorsal to Volar Fingertip and
only immobilize DIP
Dorsal Extension Block Splint
 Indications

• Middle phalanx volar avulsion Fracture

 (larger avulsions with risk of dorsal
subluxation)
• PIP joint dorsal dislocations (reduced and
stable)
•Construction
•Splint applied to dorsal surface of affected finger from distal finger
nail to proximal Metacarpals
•Tape the splint to finger over the MCP joint and the proximal phalanx
•PIP should be able to freely flex, but limited in extension by the splint
position
•Position
•Start with the splint angled over the PIP to 45 degrees (maximal PIP
extension is 45 degrees)
•Decrease the angle by 15 degrees per week (45,30,15, and finally 0)
 Mallet Finger Splint
Indications
• open mallet finger injuries
• patients who are incompliant or
unable to adhere to continuous
extension splinting
• cases with a large dorsal fracture
fragment
• palmar subluxation of the distal
phalanx.
Region:Wrist/Hand.
Type of splint
Volar/Dorsal fore arm splint
 Indications

• Soft tissues injury of hand and wrist

• Carpal bone fractures
• 2 - 5 Metacarpal head fractures
nd th
• Position
• Fore arm in neutral position in thumb up
• Wrist slightly extended
• Like holding a can
• Construction
• Start at palm at tge metacarpals
• Down tge Volar fore arm
• End at distal fore arm
 Click icon to add picture

Region: Forearm

Type of splint: Single

sugar tong splint
• Indications
• Distal radius and ulna fractures
• Position
• Elbow at 90degres
• Fore arm neutral with thumb up
• Slightly extended wrist (10-20degrees)
• Construction
• From MC head on the dorsal hand around Elbow to
Volar MCP joints
 Region: Elbow,Proximal forearm

• Type of splints
• Long arm posterior splint
• Double sugar tong splint
• Long arm cast
Long arm posterior
splint

Indications
Injuries to elbow and
proximal fore arm
• Indications
• Injuries to elbow and proximal fore arm
• Position
• Elbow at 90 degrees
• Fore arm neutral position with thumb up
• Slightly extended wrist (10-20 degrees)
• Construction
• Starts at posterior aspect of proximal fore arm
• Down the ulnar aspect of arm
• Ends at MCP joints
Double sugar-tong
splint

Indications

Complex/unstable
forearm and elbow
fractures
• Indications
• Complex/unstable forearm and elbow fractures
• Position
• Elbow at 90 degrees
• Fore arm neutral with thumb up
• Slightly extended wrist
• Construction
• Fore arm splint- From MC heads On the dorsal hand around
elbow to volar MCP joints
• Arm splint- From anterior proximal humerus around elbow
to posterior arm to proximal humerus
Splints for lower
extremities
By
Sujidha R
Bsc.(Hons)Allied health sciences (2nd semester)
 Region:Ankle

• Type of splints
• Posterior ankle splint
• Stirrup splint
Posterior ankle splint

• Indications
• Severe ankle sprains
• Fractures of distal tibia and
fibula
• Reduced ankle dislocation
• Position
• Prone position
• Ankle to 90 degrees
• Construction
• From plantar surface of meta tarsal
heads to the level of fibular head
posteriorly
 Stirrup splint

• Indications
• Severe ankle sprains
• Fractures of distal tibia and
fibula
• Reduced ankle dislocation
• Position
• Prone position
• Snkle 90 degrees
• Construction
• Passes under plantar surface of foot
• Extends up medial and latral sides of leg
• Just below the level of fibular head
Region: Lower leg,Ankle and Foot

Type of Splint:
SHORT LEG CAST
• Indications
• Distal tibia and fibula fractures
• High grade ankle sprains
• Meta tarsal fractures
• Position
• Prone position
• Ankle 90 degrees
• Construction
• extends from the metatarsal joints to the fibular
head and is intended to immobilize the foot and ankle. 
Region : Knee and Lower
leg

Type of Splint:
Posterior Knee Splint
• Indications:
• Patients with leg too large for Knee immobilizer
• Angulative fractures
• Injuries that require uegent operative fixations
• Position
• Slightly flexed Knee
• Construction
• Starts just below buttocks creasecon dorsal aspect of leg
to 5-8cm above malleoli
 Region: Foot

Type of splint
Short Leg Cast with Toe Plate
Extension
• Indications
• Toe injury
• Frqctures of meta tarsus
• Position
• Prone position
• Ankle 90 degrees
• Construction
• extends from the metatarsal joints to the fibular
head and is intended to immobilize the foot and ankle
and covers foot
Splinting for burns
By
Aruna G
Bsc.(Hons) Allied health sciences(2nd Semester)
Finger extension splints for burns
Purpose: to support a finger joint so
that it heals without contracting and
to prevent deformity
Wearing Schedule: varies; a
common schedule would be to wear
it at night while resting and take it
off during the day for exercise and
activity
 Resting hand splint for
burns
Purpose: to support the hand and
wrist joints so that they heal without
contracting and so that a deformity
does not develop.
Wearing Schedule: varies; a common
schedule would be to wear it at night
while sleeping and take it off during
the day for exercise and activity.
Interdigital (between
fingers) inserts for
burns
Inserts for between fingers and thumb
web space
Purpose: to prevent the skin from
shrinking as it heals and to restore
range of motion by stretching the skin
Wearing Schedule: usually full-time
under compression gloves
 Clavicle strap for
burns
A strap for the shoulders
Purpose: to prevent the skin from
shrinking as it heals and restore motion
by stretching the skin
Wearing Schedule: varies; may be part-
time or full-time, often used to help hold
an axillary splint in place
 Airplane or axillary
splint for burns
Splint for the shoulders or axilla
Purpose: to prevent the skin from
shrinking as it heals and to restore
motion of the shoulder by stretching
the skin.
Wearing Schedule: varies; may be
part-time or full-time
 Mouth splints for
burns
Purpose: to keep the skin around the mouth
from shrinking. This could cause a condition
called microstomia which makes it difficult to
open mouth, eat, speak clearly, brush teeth,
complete dental work. There are a variety of
mouth splints available, some of them are
prefabricated and some are custom fabricated.
Wearing Schedule: part time on a schedule 2-4
times/day.
 Ankle foot orthoses
Purpose: to maintain range of
motion in the ankle while a
patient is on bed rest.
Wearing Schedule: usually when
in bed or in the chair. May have
an on and off schedule
throughout the day.
Indications and contra
indications of splint
By
Madhumitha M
Bsc.(Hons)Allied health sciences (2nd semester)
 Indications of Splinting
• Splints are used to immobilize musculoskeletal and nerve injuries, support
healing, and to prevent further damage. The indications for splinting are
broad, but commonly include:
• Temporary stabilization of acute fractures, sprains, strains or nerve injuries
before further evaluation or definitive operative management
• Immobilization of a suspected occult fracture (such as a scaphoid fracture)
• Severe soft tissue injuries requiring immobilization and protection from
further injury
• Definitive management of specific stable
fracture patterns
• Peripheral neuropathy requiring extremity
protection
• Partial immobilization for minor soft tissue
injuries
• Treatment of joint instability, including
dislocation
• Acute Arthritis including acute gout.
• Severe contisions
• Tendon laceration
• Skin lacerations
• Tenosynovitis
• Puncture or wounds
 Contra indications of Splinting

• Injuries that Violate the Skin or Open Wounds:

• Antibiotic administration should be considered for
these patients depending on the severity of the lesion.
These patients also require additional soft tissue care,
which may necessitate tissue debridement and skin
closure before splint application.
• Injuries that Result in Sensory or Neurological Deficits:
• The complications of splint placement such as compartment
syndrome, pressure injuries, or malreduction may go unnoticed if
the patient has a concurrent nerve injury. These patients should
undergo evaluation by a surgeon before splint application as
neurologic findings may be a sign of a surgical emergency.
• Injuries to the Vasculature:
• This requires special attention by vascular surgeons, as these
may require urgent operative intervention. Furthermore,
evaluation of the vasculature is essential both before and
after splint application, as the reduction of some fractures
may result in acute arterial injury or obstruction if trapped
between the fracture fragments.
• Patients with Peripheral Vascular Disease or Peripheral
Neuropathy:Special care should be taken when applying lower
extremity splints in these patients since their baseline sensation
may be altered. These patients have difficulty detecting
pressure sores, skin irritation, and possible vascular
compromise.
 Complications,
Advantages and Dis
advantages
By
Aruna G
Bsc.(Hons)Allied health sciences
 Complications
•Compartment Syndrome
•Ischemia
•Heat Injury
•Pressure Sores and Skin Breakdown
•Edema
•Infection
•Dermatitis
•Joint Stiffness
•Altered Range of Motion
•Decreased Strength
•Altered Sensation
•Neurological injury
 Advantages of Splinting
• Splints are faster and easier to apply.
• They may be static (i.e., prevent motion) or dynamic (i.e., functional;
assist with controlled motion).
• Splints are non-circumferential, allowing for natural swelling that occurs
during the initial inflammatory phase of the injury.
• A splint may be removed more easily than a cast, allowing for regular
inspection of the injury site.
 Disadvantage of Splinting

• Poor Patient Compliance

• Excessive Motion at the Injury Site
• Limitations in their usage, as in unstable or potentially
unstable fractures
Considerations for effective splinting
• Creases provide for landmarks in splint fabrication
• Bony prominences may cause pressure
• Ensure three points of pressure
• Custom made splints to fit the contours of the body rather than ready-
made splints
• Patient education for better compliance