#EMconf: Splinting complications
Splinting Complications and Pearls
● Heat injury and thermal burns → avoid hot water on plaster
● Pressure Sores → secondary to folds and kinks of splint
○ Smooth the splint with the palms of your hands to avoid bumps and pressure points
○ Support bony prominences with extra webril
■ Upper extremity → olecranon, radial styloid, ulna styloid
■ Lower extremity → patella, fibula head, malleoli, upper portion of inner thigh
● Compartment Syndrome
○ Always do a neurovascular exam after reduction/splinting
○ Patient may return with splint ‘too tight': may need to remove cast
● Contact Dermatitis → secondary to the material and can lead to rash and itching
● Fracture blisters → usually from the original trauma but frequently attributed to the splint/ cast because often seen on a second visit
○ Inform ortho if seen in ED as operative management may be delayed until wound healing
● Joint Stiffness → an expected result of immobilization that can be mild to debilitating
○ Leave splints on for only the time period needed to require healing
○ Any immobilization that is over 7 days requires orthopedic follow up
● Discharge instructions should include:
○ Weight bearing status
○ Education on using ambulatory adjuncts
○ Keeping the splint dry
○ Return to ED precautions for neurovascular compromise
○ Specific follow-up instructions
Reference: Stacie E. Byers, and Carl R. Chudnofsky. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA. Elsevier INC., Saunders 2014.