n00b question: Splinting

adamjh3

adamjh3

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Ran a call yesterday, 54 y/o female, chief was leg pain after she was struck by a truck going 5-10 MP/H while in her wheel chair. I'm not going to go too far into the assessment other than the leg, unless necessary.

She complained of pain @ 7/10 in her left leg going from her ankle to just inferior of her knee. There was some bruising approx. 2 cm in diameter on the anterior of her left leg about an inch superior to where the tibia meets the talus navicular. If the area around the bruising was even lightly touched the patient would complain of pain @10/10Distal pulse was intact, as well as sensation, movement was impaired, complained of pain @ 10/10 when she tried to wiggle her toes. The patient's foot was extended (as in the muscles on the posterior of her leg were flexed) as that was the most comfortable position for her.

We splinted her ankle, but looking back, I'm fairly certain we didn't immobilize properly. We used a cardboard splint like thisand curlex. The splint ran from her heel to about half way up her calf. Curlex wrapped from probably midway on the metatarsals to about midway up the tibia.

I know I'm probably doing a pretty piss poor job of explaining the splinting, but does it sound right to you? Something just feels off about it to me, I kept looking at it thinking it didn't look right. I don't deal with Trauma very often, so that's really my weak spot right now.
 
it sounds about like what we would do in the ER if we didnt have ortho coverage and there was no brake. Only diff would be a posterior leg splint with OrthoGlass and an Ace wrap.
 
You're supposed to immobilize the joint above and below the injury. So ideally you should have used s splint that imobilized her entire foot, and extended to mid-way up the thigh (so that her knee couldn't move).
 
Underoath87 said:
You're supposed to immobilize the joint above and below the injury. So ideally you should have used s splint that imobilized her entire foot, and extended to mid-way up the thigh (so that her knee couldn't move).
Click to expand...

In many cases immobilizing above the knee is appropriate for a tib/fib type injury, but I do not think it would be necessary in this situation. The point of splinting is to alleviate pain and prevent further movement. As stated, placing her foot in flexion was the most comfortable position for her, so ideally the splint should do some of that work for.

That said, immobilizing a foot in flexion with the type of splint shown is not going to be easy. It may have been possible to to extend the splint several inches distal to her heel, allowing you to anchor her foot in a flexed position with kerlix. Not sure if this would be possible, however.
 
This sounds more like a joint injury than a tib/fib fx per say. I know the text book says "joint above and below" but I never saw an MD order plaster or a metal splint immobilize the knee for an injury similar to whats described when working in the ED either. Personally if I'm picturing the injury correctly I would have tried a pillow first. A SAM splint would have probably worked well too. We only carry padded boards, so it would have been challenging.
 
IMO when in doubt immobilize it. Its always easy for us in the ER to go shoot an xray and see what is really going on. Out in the world you dont have that option
 
usalsfyre said:
This sounds more like a joint injury than a tib/fib fx per say. I know the text book says "joint above and below" but I never saw an MD order plaster or a metal splint immobilize the knee for an injury similar to whats described when working in the ED either. Personally if I'm picturing the injury correctly I would have tried a pillow first. A SAM splint would have probably worked well too. We only carry padded boards, so it would have been challenging.
Click to expand...

Padded boards are a serious pain IMO. They have their place, but I wish we could have these on the ambulance. We have these at my Sports Medicine gig and they are great for foot/ankle/lower tib/fib injuries prior to x-ray. They take up almost no room, are way stronger than cardboard, and can lock into several different configurations with a tab/hole system.

The top picture with the splint on the arm would , along with some padding, be perfect for an ankle injury, especially since the proximal end can be extended.

000000019825_r_speed-splint.jpg
 
We had even cheaper ones where I worked.

The foam pading will break down if left where it stays hot or in strong sunlight/high UV. I almost prefer padded anatomic splinting (blanket and/or towels, MediRip or duct tape).

Pt position of comfort was an extended ankle, not flexed.

Splint to the joints on proximal and distal, then to adjacent leg for limb immobilization (don't splint to wheelchair); vitals, transport for xray and medical care. No rocket science. They'll see if it is a fx and tx prn.
 
store.emsinnovations.com/p-120-prosplint-adult-splints.aspx

The site did not have individual pictures but these Prosplints with a little padding are EZ mode and I have yet to see one not do the job.

If the image or link doesn't work the best way I can describe the material similar to the foam padding on the floor of McDonalds playlands with heavy duty Velcro straps. Just enough to conform but still retain their shape and material integrity. Look into some of these bad boys if you're in the market.
 
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