0071643192.pdf

Splints and Casts

INDICATIONS

■ To immobilize fractures/tendon injuries and maintain bony alignment in

order to facilitate the healing process

■ To decrease pain and protect extremity from further injury

CONTRAINDICATIONS

■ Casts should not be placed on swollen or recent injuries that may become

swollen and cause compartment syndrome of that limb.

TECHNIQUE

■ Splints are placed over stocking and cushion and wrapped with elastic

bandage (see Table 19.4).

COMPLICATIONS

■ Dermal damage from splint/cast due to insufficient cushioning

■ Compartment syndrome leading to ischemic limb due to constrictive

cast/bandage

■ Burns from plaster or fiberglass during hardening process

■ Infection, dermatitis, joint stiffness

INTERPRETATION OFRESULTS

■ Always assess and document neurovascular status before and after splinting.

■ Patients who return to the ER with pain at the site of a splint or cast need

to have the splint or cast removed to allow examination of the extremity

An 8-year-old boy falls backward off a swing. He is diagnosed with a supra-

condylar fracture, splinted, and sent home with next-day orthopedic follow-

up. The child returns to the ED the same evening complaining of arm pain.

What limb-threatening diagnosis must be considered?

Compartment syndrome.

Compartment Pressure Measurement

INDICATIONS

■ Evaluation of patients with suspected compartment syndrome based on: Tight

muscle compartment in patients with extremity trauma or bleeding, pain out

of proportion to exam, paresthesias, or otherwise unexplained limb ischemia

■ Limb may be salvageable for up to 10–12 hours, but with very high pres-

sures, the time period may be as little as 4 hours.

CONTRAINDICATIONS

■ Infection overlying site of needle insertion

TECHNIQUE

■ Use sterile technique and local anesthesia.

■ The compartment to be measured should be at the same level as the heart.

PROCEDURES AND SKILLS