Splint ppt by rupeshkumar


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Splint ppt by rupeshkumar

  1. 1. SPLINTS Guided by : Dr. Nitin Sir Done By : Dr. Rupeshkumar Hatwar
  2. 2. What is a splint? • A splint is a rigid support with padding made from metal, plaster or plastic. It is used to support, protect, or immobilize an injured or inflamed part of the body. The splint is secured in place with an elastic bandage or an ACE wrap .The purpose of the splint is to preve nt movement of the injured extremity which helps pre vent further injury, and to minimize pain
  3. 3. • Indications for Splinting • • • • • • • Fractures Sprains Joint infections Tenosynovitis Acute arthritis / gout Lacerations over joints Puncture wounds and animal bites of the hands or feet
  4. 4. • To reduce/prevent contracture • To increase grip strength • To stabilize and rest joint in ligamentous injury • To correct deformity • To support and immobilize joints and limbs postoperatively until healing has occured
  5. 5. • Contraindications of Splinting syndrome  Compartment  Need for open reduction  Skin at high risk for infection
  6. 6. • Splinting Material • Plaster of Paris – Made from gypsum - calcium sulfate dehydrate – Exothermic reaction when wet - recrystallizes (can burn patient) – Average setting time – 3-9 min – Average drying time – 24-72 hours
  7. 7. – Factors decreasing setting time :Hot water, Salt, Borax, Resins – Factors increasing setting time :Cold water, sugar – Upper extremities :– use 8-10 layers – Lower extremities :-12-15 layers up to 20 if big person (increased risk of burn!)
  8. 8. • Advantage • Disadvantage • Easier to mold • Less expensive • More difficult to apply • Gets soggy when getting wet
  9. 9. • Splinting Material • Ready Made Splinting Material (1) Plaster (OCL) • 10 -20 sheets of plaster with padding and cloth cover (2) Fiberglass (Orthoglass) • • • • Cure rapidly (20 minutes) Less messy Stronger, lighter, wicks moisture better Less moldable Disadvantage • More expensive • More difficult to mold
  10. 10. (3) Prefabricated splints • Plastic shells lined with air cells, foam or gel components • Same advantages and disadvantages as fiberg lass splints
  11. 11. (4)Air splints • Provide less support than plaster and fibergla ss Splints • Used for ankle sprains rather than fractures o r Dislocations • Used to prevent eversion/inversion while perm itting free flexion and extension of ankle • Provides clear vie w of injury during x-ray
  12. 12. (4) Vacuum splints - Styrofoam chips contained inside an airtight cloth, pliable sleeve - Molds to shape of injury using a handheld pump to draw out the air from within the sleeve
  13. 13. • Pre / Post - Splint Checks • • • • • F – Function A – Arterial Pulse C – Capillary Refill T – Temperature (Skin) S - Sensation
  14. 14. • Choose your splints Upper Extremity • 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
  15. 15. Lower Extremity • Hip and Thigh - Von Rosen’s Splint - Thomas Splint - Bohler-Braun Splint Spine - Cervical Collar Four-post Collar SOMI (Sternal Occipital Mandibular Immobilizer) • Knee - Knee Immobilizer / Bledsoe - Bulky Jones - Posterior Knee Splint • Ankle - Posterior Ankle - Stirrup • Foot - Denis-Brown splint - Buddy taping - Scoliosis - Milwaukee Brace - Boston Brace - Taylor’s Brace
  16. 16. • Traction 1. Manual Traction 2. Skin Traction 3. Skeletal Traction
  17. 17. Upper Extremity
  18. 18. • Shoulder and Arm (1) Figure of eight • Indications: – Clavicle fractures • Most figure of eight splints are prefabricated and Application is simple. • Read the product information insert before applying the splint about the correct application process. • Apply with patient standing and hands on iliac crest. Shoulders should be abducted
  19. 19. Figure of eight
  20. 20. (2) Sling and Swathe • Indication: – Shoulder and humeral injuries • Slings supports weight of shoulder • Swathe holds arm against chest to prevent shoulder rotation • Apply the sling and swath with the patient standing. • Place the injured arm in the sling with the elbow at 90 degrees of flexion. • Next place the strap that is attached to the sling over the patient head so that the weight of the arm is supported
  21. 21. Sling and Swathe • Apply the swath. – This can be anything from an ACE wrap to a prefabricated swath. This is designed to hold the patients affected arm that is in the sling against the body. • The swath should wrap around the front and back of the sling keeping the affected extremity against the mid-abdomen
  22. 22. (3) Aeroplane Splint Indication- Brachial plexus injury
  23. 23. • Elbow/Forearm (1) Long Arm Posterior • Indications: - Forearm and elbow injuries - Olecranon and radial head fractures - Distal humeral fracture • Not recommended for unstable fractures • Applied from palmer crease, wrapping around lateral metacarpals, extending up to posterior arm with elbow flexed at 90 degrees NOTE - Doesn’t completely eliminate supination / pronation –either add an anterior splint or use a double sugar-tong if complex o r unstable distal forearm fx.
  24. 24. Long Arm Posterior
  25. 25. (2) Double Sugar - Tong • Indications :- Elbow and forearm fx - prox/mid/distal radius and ulnar fx. Better for most distal forear m and elbow fx because li mits flex/extension and pro nation / supination.
  26. 26. (2) Double Sugar - Tong
  27. 27. • Forearm/Wrist (1) Volar Forearm / Cockup • Indications: - Distal forearm and wrist fractures - Soft tissue hand / wrist injuries - sprain , carpal tunnel night splints, etc - 2nd -5th metacarpal fx. - Radial Nerve palsy • Applied from volar palmer crease to 2/3 forearm • Allows elbow and finger ROM NOTE - Not used for distal radius or ulnar fx - can still supinate and pronate.
  28. 28. Volar Forearm / Cockup
  29. 29. (2) Forearm Sugar - Tong • Indications – Wrist and distal forearm fractures • Extends from MCP joints on dorsum of hand, tracks along the forearm, wraps around back of elbow to volar surface of the arm and exte nds down to mid-palmer crease • Immobilises wrist, forearm, and elbow
  30. 30. Forearm Sugar - Tong
  31. 31. • Hand/Fingers (1) Ulnar Gutter Splint (2) Radial Gutter Splint • Indications: •Indications – Phalangeal and metacarpal - Fractures, phalangeal and fractures metacarpal and soft tissue • Most common use-Boxer injuries of the index and fractures middle fingers. • 5th MCP fracture Soft tissue injury to little and ring finger.
  32. 32. • Ulnar Gutter Splint • Extends from DIP joint to the proximal 2/3 of the forearm • Should immobilize the ring and little finger • MCP should be in 70 degrees of flexion, PIP should be in 30 degrees of flexion and DIP in no more than 10 degrees of flexion
  33. 33. • Ulnar Gutter Splint
  34. 34. • Ulnar Gutter Splint
  35. 35. Radial Gutter Splint
  36. 36. (3) Thumb Spica Indications: – Scaphoid fractures , thumb phalanx fractures or dislocations • Most Common use: 1) Gamekeepers thumb or skiers thumb 2) Dequiervans tenosynovitis • Extends from DIP joint of thumb, incorporates the thumb and extends up 2/3 of the proximal lateral forearm
  37. 37. Thumb Spica
  38. 38. (4) Finger Splints Sprains - dynamic splinting (buddy strapping). Dorsal/Volar finger splints - phalangeal fx, though gutter splints probably better for proximal fxs.
  39. 39. Finger Splints (a) Stack Splint Use – management of mallet finger
  40. 40. (b) Aluminium Splint Uses - phalangeal fx, -mallet finger
  41. 41. (c) Oval-8 Finger splint
  42. 42. Oval-8 Finger splint
  43. 43. Finger splints
  44. 44. (d) Tripoint Splint Uses – Boutonniere deformity , Swan neck deform ity
  45. 45. Tripoint Splint
  46. 46. (5) Knuckle-bender Splint Indication- Ulnar Nerve Palsy
  47. 47. Lower Extremity
  48. 48. (1) Von Rosen’s Splint Indication – Congenital dislocation of the Hip • ‘H’ shaped malleable splint • Hip should be properly reduced before it is splinted • Object is to held hip somewhat flexed an d abducted • Extreme positions are avoided and Joint should allowed some movement in the splint
  49. 49. • (2) Hip Spica Cas Uses- Fracture shaft of femur in children and in t y oung adults once the fracture becomes ‘sticky’ • encircles one or both arms or legs and the chest o r trunk. • It generally is strengthened with a reinforcement ba r.
  50. 50. Hip Spica Cast • When applied to a lower extremity , the c ast is trimmed in the anal and genital ar eas to allow elimination of urine and sto ol.
  51. 51. Hip Spica Cast
  52. 52. (3) Thomas Splint • Devised by H.O. Thomas initially for T B of the knee. • Indication - Now commonly used for immo bilisation of hip and thigh injuries • It has a ring and two bars joined distally. • The ring is at an angle of 120 degree to the i nside bar • The ring size is found by addition of 2 inche s to the thigh circumference at the highest p oint of the groin • The length is the measurement from the hig hest point on the medial side of the groin u p to the heel plus 6 inches.
  53. 53. Thomas Splint - used as traction splint
  54. 54. (4) Bohler-Braun Splint • Indication ;- Fracture femur – anywhere • More convenient than Thomas splint since it has n o ring. As the ring of Thomas splints is a common ca use of discomfort, especially in old people. • No in-built system of counter-traction , hence it Is n ot suitable for transportation.
  55. 55. • Knee (1) Knee Splint • Indications: - knee injuries - proximal Tib/fib fractures • Place knee in full extension • The plaster is placed from the posterior buttocks to 3 inches above level of bilateral malleoli
  56. 56. Knee Splint
  57. 57. • Ankle (1) Posterior Ankle Splint • Indications - Distal tibia/fibula fx. - Reduced dislocations - Severe sprains - Tarsal / metatarsal fx • Use at least 12-15 layers of plaster. • Placed from metatarsal heads on plantar surface foot, extends up back of leg to level of fibular neck NOTE - Adding a coaptation splint (stirrup) to the posterior splint eliminates inversion / eversion - especially useful for unstable fx and sprains.
  58. 58. (2) Stirrup Splint • Indications - Similar to posterior splint. - Unstable ankle fx • Less inversion /eversion and actually less plantar flexion compared to posterior splint. • Great for ankle sprains. • 12-15 layers of 4-6 inch plaster.
  59. 59. Stirrup Splint • The splint should be long enough to involve the leg from below the medial side of knee, wrap around the under surface of the heel, and back up to the lateral side of the same knee.
  60. 60. Stirrup Splint
  61. 61. • Foot (1) Denis-Brown splint Indication – Congenital Talipes Equino Varus (C.T.E.V.) • Used after successful correction of deformity ,to prevent relapse. • used throughout the day before child starts walking. • Once child starts walking ,a DB s plints is used at night and CTEV shoes during the day.
  62. 62. Denis-Brown splint
  63. 63. (2) Buddy strapping • Indications: – Phalangeal fractures of the toes • Small piece of wadding placed between toes to prevent maceration • Fractured toe secured to adjacent toe with tape
  64. 64. Buddy strapping • Use a small piece of wadding and place between the injured toe and an adjacent toe to prevent maceration • The fractured toe is secured to the adjacent toe with a piece of tape
  65. 65. • Spine
  66. 66. (1) Cervical Collar • Flexible foam/Rigid/Adjustable collar • Encircles the neck to support the skull against the thorax inferiorly • Motion control and keeping warm at cervical level • Soft tissue injury, minor sprains for first few days after injury • Post operative immobilisation Note :- They are not useful for very unstable injury pattern
  67. 67. Cervical Collar • Soft Cervical Collar • Commonly used for mild soft tissue strain s and sprains
  68. 68. Cervical Collar • Semi-Rigid Cervical Colla r • Can provide access to t he trachea • Moderate Control of RO M • Adjustable
  69. 69. (2) Four-post Collar Indication – Neck immobilisation in cervical spine injury • More stable than cervical collar • Applying pressure to mandible , occiput , sternum and up per thoracic spine • They can be uncomfortable
  70. 70. (3) SOMI (Sternal Occipital Mandibular Immobilizer) Uses – cervical spine injur • Rigidy Frame Design • Commonly used in stable fractures and Moderate to Severe soft tissue damage • Limits Flexion and Extension • Extends Inferior into the Thoracic Region for greater control of all cervical levels
  71. 71. (4) Milwaukee Brace Indication- Scoliosis • Named after the city of Milwaukee where it was designed. • It fits snugly over the pelvis below; chin and head pads prom ote active postural correction and thoracic pad presses on t he ribs at the apex of the curves
  72. 72. (4) Boston Brace Indication-Scoliosis • Used for low curves • Worn 23 Hours / Day • Made of semi-rigid plastic and foam
  73. 73. (5) Lyon Brace Indication-Scoliosis
  74. 74. (6) SpineCore Brace Indication-Scoliosis
  75. 75. Scoliosis Braces
  76. 76. (7)Taylor’s Brace Indication – Dorso-lumbar Immobilisation • Anterior Compression Fractures of the vertebral body • Semi rigid design • Commonly used for osteoporosis, trauma, Degenerative spine disease
  77. 77. • Traction
  78. 78. • Traction Traction is a pulling effect exerted on a part of the skeletal system. It is a treatment measure for musculoskeletal trauma and disorders. Traction is used to acco mplish the following: • • • • Reduce muscle spasms Realign bones Relieve pain Prevent deformities
  79. 79. Types of Traction
  80. 80. 1. Manual Traction Manual traction means pulling on the body using a person's hands and muscular strengt h. It most often is used briefly to realign a broken bone . It also is used to replace a dislocated bone int o its original position within a joint.
  81. 81. Manual Traction
  82. 82. 2. Skin Traction Skin traction means a pulling effect o n the skeletal system by applying devi ces, such as a pelvic belt and a cervical halter, to the skin. Commonly applied forms of skin tractio n are – • • • • Buck's traction Russell's traction Bryant’s (gallows) traction Dunlop traction
  83. 83. Skin Traction • Limited force can be applied - generally not to exceed 5 lbs • More commonly used in pediatric patients • Can cause soft tissue problems especially in elderly or rheumatoid patients • Not as powerful when used during operative procedure for both length or rotational control
  84. 84. Skin Traction A)Pelvic Traction (B) Cervical halter
  85. 85. (1) Pelvic Traction • Uses –Relief of pain of Sciatica and other backaches • Traction is applied to a pelvic harness with weights over the e nd of bed • An alternative in Sciatica is the 90-90 traction
  86. 86. (2) Cervical halter Uses - short term cervical traction -minor neck injuries with out obvious trauma e.g. Whiplash injury, neck muscle spasm , conservative treatment of cervical disk lesion Note – Contraindicated in mandibular fracture
  87. 87. (3) Buck's traction • Uses femoral fractures, lower backache Acetabular and hi p fractures Conventional skin traction
  88. 88. Buck's traction • Provide temporary comfort in hip fracture s • Maximal weight - 10 pounds • Watch closely for skin problems, especially in elderly or rheumatoid patients
  89. 89. (4) Russell's traction Uses - Trochanteric fractures
  90. 90. (5) Gallows traction Uses- fracture shaft of femur in children below 2 year s Imp –check the state of the circulation in the limb frequently , because of danger of vascular compli cations
  91. 91. • Bryant’s Traction • Useful for treatment femora l shaft fx in infant or smal l child • Combines gallows traction and Buck’s traction • Raise mattress for counte r traction • Rarely, if ever used currentl y
  92. 92. (6) Dunlop traction Use- mainly used in the maintenance of reductio n in supracondylar fractures of humerus in child ren. • Forearm skin traction with weight on upper arm • Elbow flexed 45 degrees • Allows swollen elbow to settl e • Contraindicated in open fra ctures and skin defects
  93. 93. Dunlop traction
  94. 94. (7) Femoral Traction Older Child in Balkan Frame Indications • Child > 12 kg • Femoral fractures • Skin must be intact
  95. 95. Balkan Frame
  96. 96. 3. Skeletal Traction Skeletal traction means pull exerted directly on the skeletal system by attaching wires, pins, or tongs into or through a bone. Skeletal traction is applied c ontinuously for an extended period.
  97. 97. Skeletal Traction • More powerful than skin traction • May pull up to 20% of body weight for the lower extremity • Requires local anesthesia for pin insertion if patient is awake • Preferred method of temporizing long bone, pelvic, and acetabular fractures until operative treatment can be performed
  98. 98. (1) HALO TRACTION • Rigid Frame Design • Commonly used in unstable fractures • Limits All motion • Extends Inferior into the Thoracic Region for greater control of all cervical levels • Screws Directly into the skull Disadvantages - Pin problems - Respiratory compromise
  100. 100. (2) Gardner Wells Tongs • Used for C-spine reduction / traction • Pins are placed one finger breadth above pinna, slightly posterior to external auditory meatus • Apply traction beginning at 5 lbs. and increasing in 5 lb. increments with serial radiographs and clinical exam
  101. 101. (3) Olecranon Traction Uses - supracondylar and comminuted fractures of lower end of the humerus and unstable fracture of shaft of humer us • Rarely used today • Small to medium sized pin placed from medial to lateral in proximal olecranon - enter bone 1.5 cm from tip of olecranon and walk pin up and down to confirm midsubstance location. • Support forearm and wrist with skin traction - elbow at 90 degrees
  102. 102. (4)Distal Femoral Traction • Uses- Method of choice for acetabular and proximal femur fractures • If there is a knee ligament injury usually use distal femur instead of proximal tibial traction • Place pin from medial to lateral at the adductor tubercle - slightly proximal to epicondyle
  103. 103. (5) 90-90 Traction     Useful for subtrochanteric and proximal 3rd femur fx Especially in young children Matches flexion of proximal fragment Can cause flexion contracture in adult
  104. 104. (6) Acetabular Tractio n Uses- to maintain reduction in central fractur e dislocation of acetabulum
  105. 105. How do I take care of the splint? • Do not get the splint wet. Use plastic bags to cover the splint while bathing. • Do not walk on the splint. • Do not stick anything down the splint Such as a coat hanger to scratch or itch. This may lead to injury and infection.
  106. 106. What danger signs should to look for? • Numbness, tingling, increased pain, change in coloration of fingers or toes, or swelling in fingers or toes. • If these symptoms occur, you should call your doctor immediately
  107. 107. Complications • Burns - Thermal injury as plaster dries - Hot water, Increased number of layers, extra fast-drying , poor padding all increase risk - If significant pain - remove splint to cool • Ischemia - Reduced risk compared to casting but still a possibility - Do not apply Webril and ace wra ps tightly - Instruct to ice and elevate extremi ty - Close follow up if high risk for swelling, ischemia. - When in doubt, cut it off and look Remember - pulses lost late. • Pressure sores Smooth Webril and plaster well • Infection - Clean, debride and dress all wounds before splint application - Recheck if significant wound or increasing pain