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  Splinting a fracture is useful to permit healing, relieve pain, and stabilize bony fragments.

  
  
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  In acute injuries, splints are preferable to circumferential casts to limit the potential for iatrogenic compartment syndrome.

  
  
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  The position of immobilization is important to facilitate proper healing and limit secondary joint stiffness.

  
  
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  Always maintain a low threshold for splint application in situations with strong clinical concern but normal radiographs, as some fractures may be occult on initial imaging.

Fracture immobilization is extremely important to ensure proper healing, relieve pain, and stabilize bony fragments. Most acute injuries in the emergency department (ED) are immobilized with the use of splints (instead of casts) to prevent the consequent swelling from inducing a significant increase in tissue pressures. Of note, not all fractures require splinting, and in some situations, prolonged immobilization can lead to contracture formation and the long-term loss of function. In most cases, the extremity is placed in the position of function before immobilization (Table 95-1). The joints immediately distal and proximal to the fracture should be included in the splint to ensure proper stabilization of the injury.

Splints are indicated for the majority of extremity fractures and certain soft tissue injuries such as reduced joint dislocations (Table 95-2). Splint placement is also warranted when there is clinical evidence for a fracture despite equivocal or negative plain radiographs. In some cases, fractures that are not visible on the initial radiographs may become visible on repeat imaging performed several days to weeks later.

Splints

Posterior Leg Splint

This splint extends along the posterior aspect of the leg from the toes to just below the knee (short leg) or to the middle of the thigh (long leg) (Figure 95-1). Fractures at the knee (ie, tibial plateau) require the placement of a long leg splint, whereas fractures of the ankle require only a short leg splint. Apply an additional U-shaped splint (“stirrup”) for particularly unstable ankle fractures (eg, bimalleolar fracture). It should extend from the area just below the knee on the medial aspect of the leg, around the heel, to the same position on the lateral aspect of the leg.

Coaptation Splint

The coaptation splint is the preferred splint for fractures of the humeral shaft. This splint extends from above the shoulder joint down the lateral aspect of the arm, around the elbow, and then up the medial aspect of the arm to the axilla (Figure 95-2A). The weight of the splint applies gentle continuous traction to the fractured humerus to aid proper reduction and healing.