# Splinting Angulated Fractures



## IvanD (Aug 23, 2011)

Hi all,

I have a question regarding splinting of angulated fractures, I was taught as a WFR to apply traction and straighten it out but I know this is probably not the case on the street.

How would one apply a splint to angulated fractures on the tibia/fibula or ulna/radius?

Thanks!


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## Shishkabob (Aug 23, 2011)

Depends on a few things, such as if they have CMS compromise, and if your protocols allow you to try and set it in it's anatomical position.


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## IvanD (Aug 23, 2011)

Right, but say if there was no CSM compromise, limb circulation is fine but its all bent out of shape.

I volunteer on the sidelines for school games and I was curious how I should splint that up before transporting them to the hospital.


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## Shishkabob (Aug 23, 2011)

If there's no compromise, chances are I'm not going to screw with it and will splint it as found.

Just use the correct board, vacuum, air, or even a pillow /towels. I find pillows are great... wrapped tightly they often relieve a bit of pain in my experience.





But I also give the patient a crap load of Fentanyl, so who knows.


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## fast65 (Aug 23, 2011)

If CMS isn't compromised then I would just try to splint it as is. However, in my protocols, if CMS is compromised then I've got one shot at reducing it to get CMS back, if not, then I just splint it in place.


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## Chief Complaint (Aug 23, 2011)

Like Linuss said, i would check your protocols to be sure, but i would also prefer to splint the extremity in the position in which i found it.  Pillow would likely work well here.


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## IvanD (Aug 23, 2011)

Does anyone have any visual aid on how to splint an angulated fracture though? I agree on splinting it as it is but I haven't seen anyone do this before so I'm unsure how to splint it in the position it was found.

Would you secure the sites above and below the point of fracture? 

Sorry if this is a stupid question.


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## ol' poke (Aug 23, 2011)

Had an MVA last spring where the end of driver's tibia was extending above her kneecap.  Her leg was bent nearly 90 degees in a normal position.  We splinted it as found, making sort of a triangle with the splint, attaching one end of the splint to the upper leg, and the other to the lower leg, with a towel roll in back of the knee.  Padded the entire mess with towels and transported. Without pictures, that's about as visual as I can describe.  Our protocols don't allow for (re)setting - we splint as found.  Splinting can be a very creative excercise.


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## phideux (Aug 23, 2011)

If the break is in or near a joint, splint it as it lays. If PMS is present and intact, splint it as it lays. If it is an open fracture, splint it as it lays.  If PMS is compromised, we can manipulate to try and restore PMS. If it is a mid shaft Femur, traction splint.
Like ol'poke said, sometimes you have to get creative.


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