How do I properly apply an above‑knee splint?

How to Apply an Above-Knee Splint

Splint the injured extremity in the position found without attempting to straighten or realign it, unless there is documented neurovascular compromise (blue, pale, or pulseless extremity) that requires immediate intervention. 1, 2

Immediate Pre-Splinting Assessment

Before applying any splint, perform a rapid neurovascular check:

• Check for vascular compromise: Look for blue, purple, or extremely pale coloration of the extremity 1, 2
• Assess pulses: Palpate distal pulses (dorsalis pedis and posterior tibial) 3
• Test sensation and motor function: Check for numbness, tingling, or inability to move toes 2, 3
• Inspect for open wounds: Cover any open fracture with a clean dressing before splinting 2

Critical decision point: If the extremity shows signs of vascular compromise (absent pulses, blue/pale coloration), activate EMS/orthopedics immediately and consider gentle realignment to restore perfusion while awaiting definitive care. 1, 2 This is the only exception to the "splint as found" rule.

Splinting Technique

Materials Needed

• Padded splinting material (pre-fabricated or plaster/fiberglass) 4
• Stockinette 4
• Padding (cotton or synthetic) 4
• Elastic bandage for securing 4

Application Steps

1. Apply stockinette over the entire length of the extremity from mid-thigh to foot 4

2. Add generous padding, particularly over bony prominences (knee, ankle, malleoli) to prevent pressure necrosis 2, 4

3. Position the splint along the posterior aspect of the leg, extending from the upper thigh (just below the buttock) down to the toes, maintaining the leg in the position found 1, 2

4. Secure with elastic bandage in a spiral fashion, ensuring the wrap is snug but not constrictive 4

   • The splint should be comfortably tight but allow for swelling 2
   • Avoid overtight application that could compromise circulation 2, 4

5. Leave toes exposed for ongoing neurovascular monitoring 3, 4

Post-Splinting Management

Immediate instructions to patient:

• Strict non-weight bearing until orthopedic evaluation 2
• Elevate the extremity above heart level 2
• Apply ice in 20-minute intervals, 3-4 times daily with a barrier between ice and skin 2

Return precautions (instruct patient to seek immediate care for):

• Increasing pain not relieved by medication 2
• Numbness or tingling 2
• Color changes (blue, pale, or dusky appearance) 2
• Inability to move toes 2
• Tight or constricting sensation from the splint 4

Critical Pitfalls to Avoid

• Do NOT attempt to straighten angulated fractures unless there is documented neurovascular compromise that cannot wait for specialist consultation 1, 2 There is no evidence that straightening shortens healing time or reduces pain prior to definitive fixation 2

• Do NOT apply circumferential casts in the acute setting—splints are preferred because they allow for natural swelling during the inflammatory phase 4

• Do NOT over-tighten the elastic bandage—this can lead to compartment syndrome 2, 4

• Do NOT delay EMS activation if the extremity is blue, pale, or pulseless 1, 2

Monitoring for Complications

Watch for signs of compartment syndrome: severe pain out of proportion to injury, pain with passive stretch, paresthesias, pallor, and pulselessness 4 This requires immediate splint removal and emergent fasciotomy.