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 external pressure from asplint, reducing the risk of further tissue damage.

Box Splints

These are made of 3 long padded boards and a foot piece, in short and long sizes. The limb is placed on the middle 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 makes 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 near sharp objects.

Traction Splints

Traction splints are commonly used in pre-hospital care for the immobilisation of fractures of the femoral shaft (Wood et al, 2003). Traction splints are used for maintaining the correct position of the fractured bone after the fracture has been reduced.

Some concomitant injuries can complicate and/or contraindicate the use of traction splints for femur fracture immobilisation (Table 1).

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

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

The choice of splint depends on 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