Special Operations Forces Medical Handbook

8-32

What Not To Do:
Do not cut too deeply or too early when performing fasciotomy.
Do not close fasciotomy incisions until one week post-op.

Procedure: Splint Application

LTC Winston Warme, MC, USA

When: A casualty has a fractured or dislocated bone that requires stabilization. Apply a splint to relieve
pain and prevent further harm by immobilizing the underlying bone, the joint above the injury and the joint
below the injury.

What You Need: Water (NOT HOT), padding material (rolled cotton or Webril), a knife, scissors or cast
saw, plaster or fiberglass casting material. Alternatives for splints: thin boards, sticks, or adjacent body parts
for fingers/toes/legs or to splint an arm against the body.

What To Do:

1. Before applying a splint, inspect skin carefully to ensure that there are no sores or breaks in the skin
   that should be cleaned and dressed with Telfa before casting. Small puncture wounds might be open
   fractures and should be treated emergently to decrease the incidence of infection. Patients with open
   fractures should receive tetanus prophylaxis and antibiotics if available (e.g., 1gm of Rocephin IM or IV)
   before being evacuated.


2. Immobilize the injury in a position of function (as described below) extending to the joint above and below
   the fracture. Position the patient and encourage them to relax.
   a. Arm: Wrist–in a natural position, 15° extension (as if holding a can). Elbow–at a 90° angle
   b. Leg: Knee–5° to 15° flexion, ankle–90°. There should be no inversion or eversion of the foot.


3. Pad the fracture and joint area with sheet cotton or Webril in acute injuries and postoperative cases to
   provide comfort and lessen the possibility of pressure sores. Wrap the padding smoothly with the turns
   overlapping about 1⁄2 the width of the previous layer. Pad bony prominences with pieces of felt, or use
   several additional layers of Webril, or cotton.


4. Use 5X30 inch splints or rolls torn/cut to size. Dip and squeeze the casting material. Use a splint of
   10 thicknesses (plies) of casting material on the posterior lower leg and continuing onto the plantar
   surface of the foot for ankle injuries. Extend out beyond the toes on the foot. Similarly, use 5-ply casting
   material to make medial and lateral splints for the arm. Extend just to the proximal palmar crease on
   the hand. Rub the plaster/fiberglass smooth as it is applied so that the layers blend. Rub and mold the
   splint with your hands over the contour of the body part until it is firmly set. Continue molding until
   reaching the setting point of the plaster/fiberglass.


5. Make sure the splint is not circumferential so that there is room for some swelling to occur. Elevate
   the extremity above heart level to minimize the swelling and maximize comfort. Encourage the patient
   to wiggle toes and fingers


6. Cover the splint with an ace bandage.


7. Check peripheral neurovascular status to insure that the splint is not too tight.


8. Evacuate the patient to orthopedics for definitive management.

What Not To Do:
Do not forget to reassess neurovascular status later. Remember that inflammation and swelling can continue
and result in loss of neurovascular function 8 to 12 hours later. Inform the patient and arrange for
re-examination.
DO NOT CAST AN ACUTELY INJURED PATIENT. Allow for tissue swelling with a non-circumferential splint.