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Immobilisation - Digital splinting

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Indications

Fractures of distal and middle phalanx

Volar plate injury

Post reduction of dorsal PIP dislocation

Mallet injury (distal phalanx extensor tendon rupture with or without avulsion fracture)

Contraindications (absolute in bold)

Open fractures and injuries

Neurovascular compromise

Alternatives

Position of safe immobilisation backslab

Informed consent

Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications

Contact dermatitis

Abrasions

Pressure sores

Neurovascular compromise

Procedural hygiene

Standard precautions

PPE: non-sterile gloves

Area

Anywhere

Staff

Procedural clinician

Equipment

Aluminium finger splint

Trauma shears

Tape

Positioning (injury-dependent)

Distal phalanx fracture: DIP extended, splint from tip of finger to PIP (leaving PIP free)

Middle phalanx fracture: IPs extended, splint from tip of finger to MCP (leave MCP free)

Volar plate injury: PIP slightly flexed, extended DIP, splint from tip of finger to MCP (leaving MCP free)

Post relocation of PIP: PIP slightly flexed, extended DIP, splint from tip of finger to MCP (leaving MCP free)

Mallet injury: finger extended, splint from tip of finger to PIP dorsally (leaving PIP free)

Sequence

Cut aluminium splint to correct length

Tape over sharp splint edges or bevel smooth with trauma scissors

Bend splint at level of PIP to create flexion if required

Apply dorsally over digit

Secure with tape

Post-procedure care

Check X-ray, circulation and limb function:

Confirm fracture or dislocation reduction with post-procedure X-ray

Check capillary refill and comfort (loosen tape or re-splint if required)

Check planned position maintained

Check MCP free to move (and PIP for distal phalanx or mallet injuries)

Provide care instructions:

Elevate finger when possible using high arm sling for three days (decreases swelling and pain)

Advise to remove sling regularly and move non-immobilised joints (to prevent stiffness)

Return for assessment if increasing pain, numbness or skin colour changes

Tips

Avoid the common pitfalls of bandaging too tight or impairing function with splints that are too long

Dorsal splints should preserve tactile sense and function while providing immobilisation

Always round the edges for patient safety (use trauma shears to bevel/blunt sharp edges)

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.

References

NSW Agency for Clinical Innovation. Orthopaedic/musculoskeletal. Sydney: ACI; 2020. Available from https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/orthopaedic-and-musculoskeletal

Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.

Dunn RJ, Borland M, O’Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.

Eiff MP, Hatch R. Fracture management for primary care. 3rd ed. Philadelphia PA: Saunders; 2011.

Stracciolini A. Basic techniques for splinting of musculoskeletal injuries In: UpToDate. Waltham (MA): UpToDate. 2019 April 18. Available from: https://www.uptodate.com/contents/basic-techniques-for-splinting-of-musculoskeletal-injuries

Liverpool hospital emergency department: Plaster booklet (2019)

© Agency for Clinical Innovation 2021