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Immobilisation - Digital buddy strapping

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Digital ligament sprains

Contraindications (absolute in bold)

Open wounds

Another injury requiring digital splinting

Neurovascular compromise


Digital splinting

Position of safe immobilisation

Informed consent

Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications

Contact dermatitis


Pressure sores

Neurovascular compromise

Procedural hygiene

Standard precautions

PPE: non-sterile gloves




Procedural clinician


Cotton padding


Positioning (injury-dependent)

Injured and adjacent digit extended


Place cotton padding between injured and adjacent digit

Strap digits together proximal and distal to injured joint

Post-procedure care

Check X-ray, circulation and limb function:

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

Check planned position maintained

Provide care instructions:

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


The normal adjacent finger protects its injured neighbour

Buddy strapping supports injured ligaments, but does not immobilise them

Peer review

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

Emergency Care Institute

Please direct feedback for this procedure to


NSW Agency for Clinical Innovation. Orthopaedic/musculoskeletal. Sydney: ACI; 2020. Available from

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:

Liverpool hospital emergency department: Plaster booklet (2019)

© Agency for Clinical Innovation 2021