playing in plaster – the basics of splintingc.ymcdn.com/.../206_npo_slides.pdfplaying in plaster...
TRANSCRIPT
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PLAYING IN PLASTER – THE
BASICS OF SPLINTING
Kari M. Komlofske, FNP-C&
John Workinger, FNP-C
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OBJECTIVES
To demonstrate an increased ability in identifying various types of fractures
Understand the various splinting options; choosing the appropriate splint for a given fracture
Evaluate and understand splint application
Discuss multiple medications used in treatment of orthopedic injuries
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WHY SPLINT To stabilize a fracture Assist in making a patient more
comfortable Promote vascularization Prevent wound or tissue compromise Transportation
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Fractures Open or Closed fracture
Open – A fracture that breaks through the skin
This fracture should have immediate referral to orthopedics (may need to go to the operating room) Closed – A fracture that is contained in the
skin Look for vascular compromise and skin
tenting
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Displaced or Non-Displaced? DISPLACED
NON-DISPLACED
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SPLINT TYPES Ulnar Gutter Thumb Spica Sugar Tong Finger Splint Dorsal Forearm Short Leg Splint
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ULNAR GUTTER Ulnar Gutter Splint - is used to support,
stabilize and immobilize dislocations and fractures of the hands, fingers or wrists.
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THUMB SPICA Thumb Spica -- immobilize the thumb
and/or wrist while allowing other digits freedom to move. It provides support for thumb injuries (ligament instability, sprain or muscle strain), gamekeeper's thumb, osteoarthritis, de Quervain's syndrome, scaphoid fracture, thumb sprains.
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SUGAR TONG SUGAR TONG -- splinting fractures of the
radius, ulna, or wrist. It prevents flexion and extension at the wrist, limits flexion and extension at the elbow, and prevents supination and pronation.
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FINGER SPLINT FINGER SPLINT -- can be used to treat a
variety of conditions from mallet finger and arthritis to swan neck deformity.
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DORSAL FOREARM DORSAL FOREARM -- Soft tissue injuries or
fractures of the hand and wristCarpal bone fractures, 2nd – 5th MC head fractures
Splint -Starts in the palm at the MC heads, down the volar aspect of forearm to distal forearm
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Short Leg Splint Severe ankle sprains Fractures of distal fibula and tibia Reduced ankle dislocations
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OTHER FRACTURES: CLAVICLE HUMERUS FEMUR HIP ELBOW
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DISCUSSIONConcerns Swelling Circulation
Alignment Positioning Comfort - Support
PAIN MEDICATION
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Swelling, fracture blisters –cause problems….
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Pharmacological options
Acetaminophen AVOID NSAIDS in acute FRACTURES Muscle relaxants – flexeril, skelaxin Narcotics – Norco, percocet, oxycodone,
dilaudid, morphine Immediate release versus extended release
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Non-pharmacological options
Heat Ice Elevation Massage Acupuncture Chiropractor
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SPLINTING SUPPLIESStockinettePlaster of ParisStrips or rolls (2-, 3-, 4- or 6-inch widths)Prefabricated Splint RollsPlasterFiberglass with polypropylene padding Padding (Webril)Ace WrapBucket/receptacle of warm waterTrauma shears
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PROCEDUREStockinette is applied (optional)Webril is applied The wet plaster is positionedWebril on outside Elastic bandage is appliedThe plaster is molded
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LET’S PLAY WITH PLASTER
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My Daughter Brittany 19 years
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My son Jackson 16 years
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So I have to do this…
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REFERENCES
Sarwark, John, F. (2010). Essentials of Musculoskeletal Care 4. Rosemont, IL: American Academy of OrthopaedicSurgeons.
Stoller, David, W. (2008). Stoller's Atlas of Orthopaedics and Sports Medicine. Baltimore, MD: Lippincott Williams & Wilkins, a Wolters Kluwer business. Bickley, Lynn, S. (2007).
Bates' Guide to Physical Examination and History Taking, 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins