What conditions require a splint?

Conditions Requiring Splint Immobilization

Splints are indicated for suspected or confirmed fractures, acute sprains and strains, certain joint injuries requiring immobilization, and specific chronic conditions where joint stabilization reduces pain and facilitates healing.

Acute Traumatic Injuries Requiring Splinting

Fractures and Suspected Fractures

• Any suspected extremity fracture should be splinted in the position found to reduce pain, prevent further injury, and facilitate safe transport 1
• Specifically indicated for:
  • Long bone fractures (femur, tibia, humerus, radius, ulna) - splint without attempting to straighten angulated fractures 1
  • Phalangeal (finger) fractures - use rigid finger splints for displaced or unstable middle/proximal phalanx fractures, or buddy taping for non-displaced fractures 2
  • Toe fractures including comminuted proximal phalanx fractures - buddy tape to adjacent toe with padding between toes 3
  • Suspected scaphoid fractures - thumb spica splint even when radiographs are negative 4, 5
  • Patellar fractures or dislocations - knee immobilizing splint 4, 6

Acute Soft Tissue Injuries

• Ankle sprains - functional ankle brace is more effective than immobilization or compression wrap alone 4, 7
• Severe sprains and strains with significant swelling - splints accommodate swelling better than casts 6
• Quadriceps rupture or patellar tendon rupture (presurgical management) - knee immobilizing splint 4
• Medial collateral ligament rupture (acute management) - knee immobilizing splint 4

Chronic Musculoskeletal Conditions Requiring Splinting

Hand and Wrist Conditions

• Carpal tunnel syndrome - neutral wrist splint worn full-time provides short-term symptom improvement 4, 7
• De Quervain tenosynovitis - thumb spica splint effectively reduces pain 4, 5
• Thumb carpometacarpal osteoarthritis - thumb spica splint for pain reduction 4
• Flexor tendon repairs (zone I/II) - custom rehabilitation splints post-surgically 8

Knee Conditions

• Medial compartment knee osteoarthritis - medial unloading (valgus) knee brace for pain reduction, though long-term benefit evidence is limited 4, 7
• Patellar tendinopathy - patellar tendon strap effectively treats pain 4
• Post-knee surgery - knee immobilizing splint to prevent reinjury 4

Critical Situations Requiring Immediate Splinting and EMS Activation

• Blue, purple, or extremely pale extremity distal to injury - indicates vascular compromise requiring immediate EMS activation 1, 3
• Open fractures - cover wound with clean dressing and splint before transport 1, 3
• Suspected spinal injury with extremity involvement - immobilize and await EMS (cervical collars not recommended for first aid providers) 1

Splinting Technique Principles

Application Standards

• Splints must be padded to cushion the injury and prevent skin breakdown 1, 6
• Extend splint beyond fracture site to include adjacent joints for adequate stability 3, 6
• Apply comfortably tight but not constrictive - should allow a finger to slip underneath 1, 2
• Immobilize injured joint while allowing unaffected joints to move when possible 2, 6

Duration of Immobilization

• Rigid splinting typically continued for 3-4 weeks with radiographic follow-up 2
• Limit immobilization duration to prevent complications including joint stiffness, muscle atrophy, chronic pain, and complex regional pain syndrome 6
• Begin active motion exercises immediately for all unaffected joints to prevent stiffness 2

Common Pitfalls to Avoid

• Over-immobilization - using rigid splinting when buddy taping would suffice leads to unnecessary joint stiffness 2
• Attempting to straighten angulated fractures - do not move or straighten injured extremities unless absolutely necessary for safe transport 1
• Inadequate padding - increases risk of pressure sores and skin breakdown 1, 6
• Excessive tightness - overtightening compression wraps compromises circulation 3
• Prolonged continuous immobilization - excessive use leads to chronic complications that are difficult to treat 6

Conditions Where Splinting May Be Harmful

• Functional neurological disorder with dystonia or limb weakness - splinting may prevent restoration of normal movement, increase attention to symptoms, promote compensatory patterns, cause muscle deconditioning, and increase pain 1
• Open chest wounds - occlusive dressings are contraindicated in first aid settings due to tension pneumothorax risk 1