Can You Get a Good X-Ray with a Splint in Place?
Yes, you can obtain diagnostic-quality radiographs through most modern splinting materials, though image quality varies significantly by splint composition—plaster-of-Paris produces the most interference while cotton, polyester, and polypropylene-based splints cause minimal degradation of bony detail. 1
Splint Material Impact on Radiographic Quality
The radiolucency of splinting materials directly affects your ability to visualize fractures:
- Plaster-of-Paris (POP) splints produce the greatest X-ray attenuation and cause the most interference with interpretation of bony detail 1
- Polyurethane resin-impregnated fabric bandages are superior to POP, with cotton, polyester, and polypropylene fabrics producing the lowest attenuation and least radiographic interference 1
- Glass fiber bandages fall in the intermediate range—better than POP but not as radiolucent as non-glass fabrics 1
- Coarse knit patterns can create distracting mesh artifacts on radiographs even when the material itself is radiolucent, particularly with polyester bandages 1
Clinical Utility of Post-Splinting Radiographs
For non-displaced or minimally displaced fractures (<5mm displacement, <10° angulation) that were not manipulated, post-splinting radiographs provide no clinical value:
- In a study of 204 non-displaced and minimally displaced fractures, zero fractures changed alignment following splinting 2
- Post-splinting radiographs contributed to longer emergency department wait times (average 3 hours additional), increased radiation exposure (average of 3 additional radiographs per patient), and increased healthcare costs without providing helpful information 2
- All fractures maintained alignment on follow-up radiographs obtained weeks later 2
When Post-Splinting Radiographs ARE Indicated
Post-splinting imaging should be obtained in specific circumstances:
- After closed reduction or manipulation of displaced fractures to confirm adequate alignment 3
- When rigid immobilization is used for displaced distal radius fractures requiring ongoing radiographic evaluation for 3 weeks and at cessation of immobilization 3
- At follow-up intervals (approximately 3 weeks) to monitor fracture healing and detect late displacement 4, 5, 6
Common Pitfalls to Avoid
- Do not routinely obtain post-splinting radiographs for non-displaced or minimally displaced fractures that were not manipulated—this practice should be discouraged 2
- Avoid using coarse-knit splinting materials when post-splinting radiographs are anticipated, as the mesh pattern interferes with visualization 1
- Consider splint material selection when radiographic follow-up through the splint is planned—choose cotton, polyester, or polypropylene-based materials over POP 1
- Ensure proper positioning is maintained in the splint, as conventional palmar splints can lose the "safe position" over time as bandages stretch 7
Practical Algorithm for Decision-Making
If fracture was manipulated or reduced: Obtain post-splinting radiographs to confirm alignment 3
If fracture is non-displaced or minimally displaced AND was not manipulated: Skip post-splinting radiographs and proceed directly to clinical follow-up with repeat imaging at 3 weeks 2
If using rigid immobilization for displaced fractures: Plan serial radiographic evaluation at regular intervals through 3 weeks 3