Immobilisation

Immobilising the limb, following a bony or soft tissue injury reduces the likelihood of further injury and reduces pain by limiting unnecessary movement.

It is important to splint above and below an injured joint. Padding over bony prominences reduces pressure from an external splint and thus reduces the risk of further tissue damage.

Box Splints

These are made of 3 long padded boards and a foot piece and come in short and long sizes. The limb is placed on the middle part of the splint. The outer boards are then folded around the limb and held in place with velco straps.

Vacuum Splints

These splints are made from strong plastic materials which are filled with polystyrene beads. Removal of the air using a pump will make the splint rigid. Vacuum splints conform to the limb and can therefore accommodate deformities. They are available in a variety of sizes from small to full body splints. Once punctured, the splints will not maintain immobilisation and care must be taken when using around sharp objects.

Traction Splints

Traction splints are commonly used in the pre-hospital and transport setting for the immobilisation of fractures of the shaft of the femur (Wood et al, 2003). Traction splints are used for retaining the correct position of the fractured bone after the fracture has been reduced and manual traction force has been applied. Without traction the splints can be used to support injuries around the knee.

Some concomitant injuries can complicate and/or contraindicate the use of traction splints for femur fracture immobilisation, and are shown in Table 1.

Table 1: Injuries that complicate and contra-indicate the use of traction splints.

Contra-indications to traction splinting
Pelvic injuries
Patella and knee fractures
Ligamentous injuries of the knee
Sciatic nerve damage
Ankle fractures

The choice of splint depends both on its availability and the type of injury. Table 2 summarises the correct choice of splints in lower limb injuries.

Table 2: Choice of splint related to injury pattern (Lee, C. and Porter, K. 2005).

Injury Splintage Options
Fractured neck of femur Padding between legs Figure of 8 bandage around ankles Broad bandage: 2 above, 2 below the knee
Fractured shaft of femur Traction splint
Fracture or fracture / dislocation of knee Long leg box splint Vacuum splint Traction splint without the application of traction
Patella dislocation Pre-reduction: Companion strapping Support on pillow Contoured vacuum splint Post-reduction: Box splint
Tibial shaft fracture Long leg box splint Long vacuum splint Traction splints: partially useful in the presence of ipsi lateral tibial and femoral diaphyseal fractures
Ankle fracture Short leg box splint Short vacuum splint
Foot fractures Short box splint Short vacuum splint