Management of Splints Covering Open Wounds
When a splint is too long and will cover an open wound, you should modify the splint by cutting a window over the wound site or shortening the splint to expose the wound, allowing for direct wound care while maintaining fracture stabilization. 1
Primary Management Strategy
Create a window in the splint or shorten it to expose the wound completely. This approach allows you to:
- Maintain immobilization of the fracture site while keeping the wound accessible for inspection and care 1
- Prevent bacterial contamination and infection that occurs when wounds are covered by occlusive materials 2, 3
- Enable regular wound cleansing with sterile normal saline and debridement as needed 4
- Monitor for signs of infection progression (increased erythema, purulence, systemic symptoms) 4
Wound Care Priorities
Never close or cover infected wounds with the splint material. 4 The wound requires:
- Cleansing with sterile normal saline before any dressing application 4
- Debridement of superficial debris, with deeper debridement performed cautiously to avoid enlarging the wound 4
- Application of non-adherent interface layers if using any advanced wound therapy 4
- Daily inspection at minimum, or more frequently if infection is suspected 4
Alternative Splinting Techniques
If modifying a traditional splint is not feasible, consider these evidence-based alternatives:
For hand/digit injuries: Use buddy taping to an adjacent uninjured digit with padding between to prevent skin maceration, which provides adequate immobilization without covering wounds 1
For complex wounds requiring both immobilization and wound management: Negative pressure wound therapy (NPWT) can simultaneously promote wound healing and provide functional splinting 5, 6. NPWT has demonstrated significant infection reduction (RR: 0.590,95% CI: 0.458-0.760) compared to standard dressings 6
Critical Considerations for Infected or High-Risk Wounds
In patients with diabetes, peripheral vascular disease, or signs of infection, prioritize wound access over rigid immobilization. 4
- Use removable offloading devices rather than non-removable splints when moderate-to-severe infection is present 4
- For diabetic foot ulcers with infection, removable devices allow necessary wound inspection and treatment while still providing protection 4
- Elevation of the injured extremity accelerates healing and should be maintained whenever possible 4
Infection Prevention Protocol
Assess infection severity before finalizing your splinting approach: 4
- Obtain wound cultures from the debrided base (not swabs of drainage) if infection is suspected 4
- For wounds with systemic signs (fever, leukocytosis), obtain blood cultures 4
- Initiate empirical antibiotics based on wound characteristics and previous antibiotic exposure 4
- Re-evaluate within 24-48 hours or sooner if worsening 4
Common Pitfalls to Avoid
Do not:
- Apply splints directly over open wounds without modification 1, 2
- Use occlusive dressings or materials that prevent wound inspection 2, 3
- Overtighten compression wraps, which can compromise circulation 1
- Delay wound care to maintain splint integrity 4
The fundamental principle is that wound healing and infection prevention take precedence over perfect immobilization in most clinical scenarios. 4 A slightly less rigid splint with an accessible wound will yield better outcomes than perfect immobilization with a covered, deteriorating wound.