AUTHOR: RAMYA NETHRA
Splints – immobilization and ambulation. Its purpose, types and general instruction
TYPES OF SPLINTS
For emergency purpose, splints may be improvised from any available material that is firm enough to provide support and to prevent movement. Rolled magazines, rolled newspapers, rolled pillows, umbrellas, walking sticks, pieces of light wood etc. are used as splints in an emergency, e.g., tying the hands to the trunk immobilizes the fractures of the upper limbs.
Splints to be worn for long periods and used for corrective, preventive and supportive purpose are made up of inflexible materials such as plaster of Paris, plastic, metal or wood. Adhesive strapping ad elastic bandages etc. are used in conditions that do not demand prolonged immobilization and where protection is the major requirement, e.g., support of the arm where there is dislocation or incomplete fracture of the shoulder girdle.
It is a rectangular wooden splint which is well padded. It is widely used in the hospital situation to support and immobilize the limbs, e.g., during an I.V. infusion.
These splints should be well padded before they are used. To pad a splint, cut calico, lint or old cloth 3 times the width of the splint and 6 inches longer than the splint. Lay a layer of wool over the calico. Then fold the edges of the calico to the centre and overlap them. Turn the top edges down and switch it neatly. Place the splint on the pad. Turn the edges of the pad over the edges of splint and stitch them neatly all round making the corners very neat and fix it with strong cotton thread. We can pad the splint by using the roller bandages also.
It is traction splint used for an immobilization of suspected or diagnosed fractures of the shaft of the femur. It is also used in combination with skeletal or skin traction.
The Thomas splint consists of two long rods of light metal which are joined proximally by a leather covered half or full ring that fits into the groin and distally by a cross bar on which the cord or bandage may be secured. The ring may be turned right or left so that it will fit on either the right or left leg. When it is required for use, one must be selected which is correct for length and ring size and prepared by fastening roller bandage or calico bands across the splint to form a cradle on which the leg can rest. The heel must project over the edge of the lowest strip and a pad is placed under the knee to relax a little. When full ring Thomas splint is used, the ring is placed high in the groin against the ischial tuberosity. When a half ring is used, it is placed under the client and a groin strap is secured over the anterior thigh. The leg is secured to the frame with bandages. Traction is maintained by the use of an ankle hitch, skin traction or by skeletal traction. The splint should be elevated so that the client’s heel is not resting on the bed.
It is a metal frame which rests on the bed and supports the leg with knee partly fixed. There is a pulley at the end for traction purpose. It is used for the fracture of the lower leg and the femur just above the knee.
There are some fractures which are treated by a rigid fixation directly across the fracture line from one fragment to another. This type of fixation is provided by pins, nails and plates. With this type of fixation, there is marked decrease in the period of immobilization and hospitalization.
These are supportive appliances applied around the neck. They are used for immobilize the neck in suspected cervical spine fractures, to relieve muscle spasm of the neck and to support the head in degenerative diseases of the cervical vertebrae and after surgery or trauma.
Plaster of Paris Slabs
There are the least expensive of these materials used to form a rigid, contoured splint and can be accurately molded to provide the best support. However, splints made of plaster are heavy, easily cracked or broken and are difficult to keep clean.
Plaster splints are made up of plaster bandages, usually 6 to 8 thickness of the desired length. It is then drawn through the water and is applied to the area immediately. The layers are rubbed together with the open hand. To keep it in position, it is secured with roller bandages.
Plaster bandages are made up of crinoline or other fabric with plastic powder entrapped into its meshes. These are available in rolls of 5 to 15 cm wide.
1. Splints are applied on the part in its functional position e.g., arm splints are applied on the hands in a position flexed at the elbow.
2. Skin surfaces are separated and padded so that maceration of tissues due to moisture is avoided.
3. The joint above and the joint below the involved area are to be immobilized because the movement in the either joints may cause pain and cause separation of the bone fragments.
4. Bony prominences and hollows are to be padded before the application of the splints.
5. The part distal to the area to be splinted is left exposed whenever possible so that neuro-vascular integrity can be assessed.
6. The pulse should be evaluated both before and after the application of the splints to the area. Before the splints are applied, mark the location of the pulse. Any change in the character of the pulse indicates constriction of the blood vessels and the splint must be removed and re-applied.
7. Bandages and straps used to secure the splints are applied away from the injured area.
8. No complaints or discomforts of the client must be ignored. A properly applied splint is comfortable and relieves pain. If the pain persists or increases and swelling appears, the splint must be removed and reapplied.
9. Splints must always be well padded with cotton wool or rag pieces to prevent compression of the splint on the blood vessels and nerves.
10.The splint must be long and wide to give support to the full length of the part that is to be immobilized.
11. Splints must be light in weight but should be firm enough to give support to the part.
12. Pressure points of the client where splints are applied should be well cared to prevent necrosis of skin and the development of the pressure sores.
13. Clients in splints with limited activity needs frequent change of position unless contra-indicated.
14. Area under the splints requires frequent inspection to detect early signs of pressure sores and circulatory impairment. Massaging the skin under and around the splint helps to increase the blood supply to the area. The skin should be washed well, dried and powdered to prevent pressure sores. If blister appears under the splints, it should be reported immediately and treated with asepsis.
Splints are used temporarily to support or immobilize injured parts of the musculo-skeletal systems. Therefore, they are applied in the management of fractures, sprains, strains, dislocations, lacerations, degenerative disorders or in the clients who are unable to sustain a part in functional position.
Purposes of Splints
1. To maintain immobilization of an injured part, at the same time allowing an easy inspection and treatment of the part.
2. To prevent or to correct a deformity due to muscle contractures and to support a weak muscle.
3. To protect bone or other tissues by preventing the movement of fragments during the healing phase.
4. To apply traction and maintain reduction of bone in case of fractures of long bones.
5. To relieve pain and muscle spasm when there is damage to soft tissues surrounding a bone or joint.
6. To replace the plaster casts when there is fracture of bone, but with no displacement of the fragments.
7. To maintain a body part in its functional position.
8. To prevent complications of a fracture by preventing movement of bone fragments. Movement of the fragments can damage nerves, blood vessels and soft tissues around the fracture. A closed fracture may be converted into an open fracture if immobilization is not applied immediately.