FIGURE 130.49 Splinting of musculoskeletal injuries A Long arm posterior splint B Below knee posterior splint C Ankle stirrup (sugar tong) splint D Long leg posterior splint E Ulnar gutter splint F Radial gutter splint G Forearm sugar tong splint H Thumb spica splint I Dorsal extension finger splint Procedure This splint may be used alone or in combination with a posterior splint It provides lateral and medial support to the ankle, preventing inversion and eversion This splint extends in a U-shaped fashion from the fibular head around the ankle to just below the knee ( Fig 130.49C ) The width of the material should be approximately one-half of the circumference of the narrowest portion of the lower leg Application occurs more easily with the patient in the prone position with the foot dorsiflexed to 90 degrees at the ankle and the knee flexed to 90 degrees Consider padding the malleoli with felt or additional cotton padding to decrease the incidence of pressure ulcers Prepare and apply the splint materials as described in the “General Splinting” section When using the posterior and stirrup splints together, place the posterior splint first with the stirrup over top of the posterior splint Discharge the patient with crutches, if developmentally appropriate, and discourage weight bearing Long Leg Posterior Splint Indications Immobilization of knee injuries and fractures of the midshaft and proximal tibia and fibula Procedure The injuries immobilized by this splint often require early orthopedic consultation When used, the splint extends from just behind the toes to the area below the gluteal fold ( Fig 130.49D ) The splint material must be sufficiently wide to support the proximal thigh and the knee The final position will maintain the ankle at 90 degrees of dorsiflexion and the knee in slight flexion The help of an assistant or two is necessary to support and elevate the leg during the procedure Patients often require significant analgesic medications for this splinting Prepare and apply the splint materials as described in the “General Splinting” section Discharge the patient with crutches and discourage weight bearing Ulnar Gutter Splint Indications Boxer’s fracture (up to 20 degrees angulation without rotation) Uncomplicated fourth and fifth phalangeal fractures Procedure This splint is U-shaped, incorporates the fourth and fifth phalanges, and extends along the ulnar aspect of the forearm ( Fig 130.49E ) The splint extends from the distal fingers to the proximal forearm The proper splinting position maintains slight dorsiflexion of the wrist, 60 to 90 degrees of flexion at the metacarpophalangeal joint, and 20 degrees of flexion at the interphalangeal joints To determine the appropriate length of splint material, measure from the patient’s fingertip to to cm distal to the volar crease at the elbow The plaster material should be wide enough to enclose the fourth and fifth phalanges and overlie both the volar and dorsal surfaces of the fourth and fifth metacarpals Place the patient’s elbow in a neutral position so no pronation or supination of the forearm is possible Prepare and apply the splint materials as described in the “General Splinting” section Remember to place padding between the digits For metacarpal fractures, it is desirable to approach 90 degrees of flexion at the metacarpophalangeal joints This position tightens the collateral ligaments and helps maintain reduction Radial Gutter Splint Indications Second and third metacarpal fractures Second and third phalangeal fractures Procedure This splint is U-shaped and lies along the radial side of the arm It extends from the tips of the second and third phalanges to the proximal forearm a few inches distal to the flexural crease at the elbow The width of the material will cover the second and third metacarpals on the volar and dorsal surfaces The final position maintains the forearm in neutral position with the wrist in slight dorsiflexion, the metacarpophalangeal joints at 60 to 90 degrees of flexion, and slight flexion of the interphalangeal joints Prepare and apply the materials as described in the “General Splinting” section Make a hole in the splinting material to allow for the thumb ( Fig 130.49F ) Accomplish this by locating the position of the thumb on the splint material, folding the material in half, and cutting a semicircle of material from the folded edge If fiberglass is used, this cut edge is sharp so the padding must be stretched well or additional padding placed around the thumb to keep fiberglass from direct contact with the skin Remember also to place padding between the fingers A sling is not necessary but can be dispensed for comfort Sugar Tong Splint—Forearm Indications Distal radius and wrist fractures in which pronation and supination are minimized and the elbow is immobilized Procedure As shown in Figure 130.49G , the splint extends along the volar surface from the flexural crease of the palm, around the elbow, and dorsally to the metacarpal heads The fingers and thumb remain free As shown in the figure, the arm should