Choosing the splint type: lower extremities Posterior leg Foot, ankle & distal fibula fx Ankle sprains Stirrup Foot, ankle & distal tibia/fibula fx
Cadillac Splint - Fleisher, 2006 12 Step 2: Gather all of your supplies 13
14 15 Splinting Material Stockinette
16 Cotton Wadding Cast Padding 17 Ace wrap
18 Shears 19 Step 3: Protect the skin 20
Apply stockinette to extremity Extend it past the proximal and distal ends of where the splint will end 21
Cut out any areas that bunch up that could damage the skin 22 Create thumb hole
23 Protect bony prominences 24
Cut splint material to proper size 25 Protect the skin by creating ~1.5 cm border
of cotton by cutting the fiberglass 26 Step 4: Activate the Fiberglass 27
Approximate initial hardening times Ambient Humidity: 15 min Cold Water: 5 min Hot Water: 2 min 28
Hot water will cause the fiberglass to harden very quickly 29 Cold water
30 Keep padding as dry as possible 31 Protect the skin. If cotton
padding is wet, dry it. 32 Some fiberglass material comes with a thick padded side and a thin side. Protect the skin. Always place the thick-side to
the skin-side. 33 Step 5: Apply the Splint 34
Wrap the splint in place not too loose or too tight. Protect the skin. Do not apply pressure with finger tips, use a curved palm. 35
36 Allow time for the fiberglass to cure 37 Step 6: Check splint placement
Make sure patient has normal sensation distal to splint Make sure there is normal capillary refill after splint placement Make sure the splint does not cause any pain 38
Splint Complications Complications Prevention Risk of ischemia Keep splint snug
Compartment Syndrome Possible neurovascular compromise Check distal neurovascular status after placement Skin breakdown
Keep splint dry Use minimal water necessary and dry thoroughly before placement Pain or Ineffective Immobilization 39
Use padding Avoid kinks Check splint after placement If either of these, replace the splint Discharge Instructions
Protect the skin. Keep splint dry If extremities become tingly or blue, re-wrap the bandage Dont allow weight bearing on the splint If splint hurts, or there is increasing pain, TAKE THE SPLINT OFF! Seek medical attention 40
Case 1 12 yo female s/ p bike accident, fell and landed on wrists
41 Case 2 3 yo male fell while running and landed on leg
42 Case 2 43 Case 3 16 yo female with
left wrist injury ~ 6 wks ago. Extremity was splinted w/o reduction; unable to F/U with orthopedics
44 Suggested Reading Fleisher, GR. Textbook of Pediatric Emergency Medicine, 5th ed, 2006 45
Ultimately it leads to love." ~~ Douglas Forbes. One comes into this world with a box of tools and our socialisation, experience and inclination will dictate which tools we will prefer using in response to others.
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