When is a splint not advised in cases of avulsion injury of the knee joint and distal tibial and fibular fracture?

When Splinting is Not Advised in Avulsion Injury of the Knee and Distal Tibial/Fibular Fractures

Splinting should not be applied by first aid providers when they lack proper training in splint application, when the injury involves an open chest wound requiring different management, or when immediate extrication is needed without proper training in immobilization devices. 1

Absolute Contraindications to Splinting

Life-Threatening Conditions Take Priority

• If the fracture is associated with severe external bleeding, hemorrhage control must be addressed first before any splinting consideration 1
• When a fractured extremity appears blue, purple, or extremely pale, activate emergency medical services immediately rather than attempting splinting, as this indicates vascular compromise requiring urgent professional intervention 1
• In cases of hemorrhagic shock with severe limb trauma complicated by vascular injury or mangled extremity, a damage control strategy should be applied rather than routine splinting 1

When First Aid Providers Should Not Splint

• First aid providers should not use immobilization devices unless they have been properly trained in their use 1
• General first aid providers should not move or attempt to straighten an injured extremity, as this may cause additional harm 1
• Routine application of splints by untrained first aid providers can lead to complications including improper immobilization and delayed definitive care 1

Clinical Scenarios Where Splinting Approach Changes

Open Fractures with Severe Bleeding

• When open wounds are present with active severe bleeding, the priority shifts to hemorrhage control using direct pressure or tourniquet application for life-threatening extremity bleeding 1
• Only after bleeding is controlled should covering the wound with a clean dressing be considered to reduce contamination risk 1

Vascular Compromise Indicators

• Blue, purple, or pale extremities indicate poor perfusion—a limb-threatening injury requiring immediate professional medical care rather than field splinting 1
• These color changes may indicate complete vascular disruption requiring immediate surgical intervention, making splinting a secondary concern 1

Complex Injury Patterns

• In cases of complete traumatic amputation, large loss of substance making skin coverage impossible, or proven tibial nerve section, the clinical decision shifts toward damage control and potential amputation consideration rather than routine splinting 1
• Multiple fractures with bone loss or ischemic vascular lesions require advanced surgical planning rather than simple splinting 1

When Splinting May Be Harmful

Improper Technique Risks

• Moving or attempting to straighten an injured extremity without proper training can cause additional neurovascular injury, increased pain, and further tissue damage 1
• There is no evidence that straightening an angulated fracture shortens healing time or reduces pain prior to definitive fixation 1

Special Circumstances Requiring Caution

• In the presence of suspected spinal injury, immobilization devices should not be used by first aid providers, and the person should remain still awaiting EMS arrival 1
• When dealing with distal tibial and fibular fractures at the same level, particularly if there is concern for non-union, definitive surgical fixation planning takes precedence over prolonged splinting 2

Appropriate Splinting Indications (When NOT Contraindicated)

When Splinting Can Be Beneficial

• Splinting may be useful to reduce pain, reduce risk for further injury, and facilitate transport to a medical facility when properly trained providers are available 1
• It may be reasonable to treat a deformed fractured extremity in the position found unless straightening is necessary to facilitate safe transport 1
• If far from definitive healthcare (wilderness settings, remote locations), stabilize the extremity with a splint in the position found to limit pain and prevent further injury 1

Key Principles When Splinting IS Appropriate

• Splints should be padded to cushion the injury 1
• The injured extremity should be immobilized in the position found rather than attempting realignment 1
• Covering open wounds with clean dressing before splinting may be useful to lower infection risk 1

Critical Pitfalls to Avoid

• Never delay activation of EMS for vascular compromise (blue/pale extremity) to apply a splint 1
• Do not manipulate the ankle or knee prior to radiographs in the absence of neurovascular deficit or critical skin injury, as this may cause remanipulation or complications 1
• Avoid applying splints when hemorrhagic shock is present without first addressing the bleeding 1
• Do not use immobilization devices for suspected spinal injury unless properly trained 1