This power point slide show is developed for the sole purpose to assist in providing a basic education to orthopedic splint application and identification of the various splints as well as their uses. This is particularly helpful when a hands-on approach is taken during each graphic illustration and is demonstrated via a live setting with appropriate materials available. This slide show illustration is also designed to educate the learner on various types of splinting materials, splint padding and patient preparation as well as instruct them at a very basic level to the hazards of inadequately applied splints.

2.  Purpose of splinting
 Pre-splinting Requirements
 Selecting the appropriate splint
 Type of splinting material
 Where the splint is to be placed
 Type of injury
 Hands-on splinting
 Short arm thumb-spica splint
 Short arm radial gutter splint
 Short arm volar splint
 Short arm sugar tong splint
 Long arm posterior splint
 L and U splint (TriPod)
 Instructor demos
 Short arm fiberglass cast
 Bulky Jones MAC splint

3.  Attain a basic knowledge as to what orthopedic
injury gets what type of splint
 Develop an understanding of proper splint
application to avoid the hazards associated
with improper splinting technique(s)

4.  Demonstrate an understanding of learned
objectives as to which splint goes to which injury
by
 giving correct answers to questions asked by your
presenters
 Demonstrate learned objectives with a hands-on
(beginners level) application of upper and lower
extremity splinting
 Show an ability to discern the difference between a splint
with appropriate padding and placement vs. one that
would cause irritation through improper application

5.  A splint should be defined as an object or
body part that is utilized to support or
immobilize an injured limb or other body
part.
 A splint can be premanufactured or custom
fabricated with material that is rigid or semi-
rigid in design and have in it’s construction
some sort of softer padding that will be a
barrier between the skin and splint to prevent
further injury, chafing or other discomfort.

6. Some examples of immediate action splints utilizing available materials:

7.  To provide immobilization to the injured area
 To protect the injured area
 To prevent further injury
 To help reduce pain
 To provide a means for the injury to have room
for swelling
 To offer a sense of security

8.  Introduce yourself to your patient; try to build a rapport
 Inspect circulation
 Check for neurovascular continuity
 Use the 5 P’s (pain, pallor, pulse, paresthesia, paralysis)
 Treat wounds and slow/stop any bleeding
 Remove jewelry!
 Ideally, if the injury is an acute fracture, immobilize the joint
proximal to the injury and the joint distal the injury (if
possible)
 Before application of splint, gather ALL materials first!
 Don’t leave your patient alone to go get more stuff!
 Give the patient a brief description of the process and what
to expect. If you leave them anxious, you may be picking
them up off the floor.

9.  Upper Extremity Splints
 Volar splint
 Thumb Spica splint
 Radial Gutter splint
 Ulnar Gutter splint
 Short Arm Sugar Tong splint
 Long Arm Double Sugar Tong splint
 Long Arm Posterior splint
 Coaptation splint
 Lower Extremity Splints
 Short Leg Posterior splint
 Short Leg L and U splint
 Long Leg Posterior splint
 Long Leg Posterior w/ Medial and Lateral Slabs

10. The Rigid Dressing Materials:
 Plaster of Paris
 Casting tape roll
 Pre-cut splinting slabs
 Fiberglass
 Casting tape roll
 Pre-cut splinting slabs
Soft Underpadding:
 Synthetic cast padding
 Cotton Webril
 Stockinette
Overwrap:
 Bias-cut stockinette
 ACE bandage
 CoBan

12. The Volar Splint
a.k.a. Carpal Tunnel Splint, Cock-up
Splint (non- DME) and Wrist Splint
Application/Location: Applied on volar
aspect of the arm and circumvents the thumb
proximally to the Thenar eminence,
proximally approaches both the proximal and
distal palmer creases and completes
approximately one inch distal the Antecubital
Fosse. Usually applied with wrist dorsally
extended from 0 - 30 degrees.
Utilization: Used for wrist sprains/strains
and fractures, post-surgical fracture repairs as
well as carpal tunnel releases. With
appropriate splint modification, this splint can
be used to treat metacarpal and phalangeal
issues as well.
Thoughts before application:
Is this a removable or non-removable splint?
Will this splint need a modification? If so,
what?
Is this for treating a patient for an initial injury
or is this for post-operative treatment?

13. The Thumb Spica Splint
Also known as Radial Gutter Spica Splint
Application/Location: Applied on radial aspect
of the arm and includes the thumb from its most
distal tip and completes approximately one inch
distal the Antecubital Fosse. Usually applied with
wrist dorsally extended from 0 - 30 degrees and
thumb in direct opposition of the index finger (as
if holding a soda can).
Utilization: Used for thumb sprains/strains and
fractures, post-surgical fracture repairs as well as
DeQuervains Tendonitis/Tenosynovitis and
Scaphoid injuries/fractures.
Thoughts before application:
Is this a removable or non-removable splint?
Will this splint need a modification? If so, is it IP
free or IP frozen?
Is this for treating a patient for an initial injury or
is this for post-operative treatment?

14. The Radial Gutter Splint
Application/Location: Applied on radial aspect of
the arm circumventing the thumb from it’s web
space crease to it’s base and includes the 1st and 2nd
digits from their most distal tip and completes
approximately one inch distal the Antecubital
Fosse. Usually applied with wrist dorsally
extended from 0 - 30 degrees and fingers flexed
from 70 – 90 degrees of intrinsic position (position
of function) at the MPJs.
Utilization: Used for 1st and 2nd metacarpal
fractures and/or finger fractures, post-surgical
fracture repairs as well as tendon repair.
Thoughts before application:
Is this a removable or non-removable splint?
Will this splint need a modification? If so, what?
What digits will be necessary to include in splint?
Is this for treating a patient for an initial injury or
is this for post-operative treatment?
70◦ - 90◦ Flexion
at MPJ’s
0◦ - 30◦
Extension of
Wrist

15. The Ulnar Gutter Splint
Also known as Boxer’s Fracture Splint
Application/Location: Applied on ulnar aspect of
the arm and includes the 5th and 4th digits from
their most distal tip and completes approximately
one inch distal the Antecubital Fosse. Usually
applied with wrist dorsally extended from 0 - 30
degrees and fingers flexed from 70 – 90 degrees of
intrinsic position (position of function) at the
MPJs.
Utilization: Used for 4th and 5th metacarpal
fractures, post-surgical fracture repairs as well as
tendon repair. (Initial Boxer’s fracture treatment
of choice).
Thoughts before application:
Is this a removable or non-removable splint?
Will this splint need a modification? If so, what?
What digits will be necessary to include in splint?
Is this for treating a patient for an initial injury or
is this for post-operative treatment?
70◦ - 90◦ Flexion
of MP’s
0◦ - 30◦
Extension of
Wrist

16. The Short Arm Sugar Tong Splint
Application/Location: Applied on the dorsum
and volar aspects of the arm from proximal the
palmer creases volarly, around the elbow
posteriorly and completes proximal the
metacarpal heads dorsally. Usually applied
with wrist dorsally extended from 0 - 30 degrees
(a.k.a. neutral position) and 90 degrees of flexion
at the elbow. The finish product resembles a “sugar
tong” which is used to pick up sugar cubes from a
dish.
Utilization: Used for various radial and ulnar
fractures, post-surgical fracture repairs as well
as tendon repair. Quite often the pre-casting
treatment of choice for Colle’s, Smith’s and
Galeazzi’s fractures because it allows for
swelling. This splint usually requires an arm
sling.
Thoughts before application:
Will this splint need a modification?
Will the wrist need supination or pronation?
Is this for treating a patient for an initial injury
or is this for post-operative treatment?

17. The Long Arm Double Sugar Tong Splint
Application/Location: A Short Arm Sugar Tong
is applied first, then a second “sugar tong” will
start approx. 2” distal from the Axilla, continue
around the elbow and finish laterally on the
head of the biceps. Usually applied with wrist
dorsally extended from 0 - 30 degrees (a.k.a.
neutral position) and 90 degrees of flexion at the
elbow. The finish product resembles two
intersecting “sugar tongs”.
Utilization: Used for various radial and ulnar
fractures, post-surgical fracture repairs as well
as tendon repair. Quite often the pre-casting
treatment of choice for Monteggia’s and various
radial head fractures because it allows for
swelling. The bicipital Sugar Tong may even go
above the biceps and become a Coaptive-type
splint. This splint usually requires an arm sling.
Thoughts before application:
Will this splint need a modification?
Will the wrist need supination or pronation?
Is this for treating a patient for an initial injury
or is this for post-operative treatment?

18. The Long Arm Posterior Splint
Application/Location: Applied on posterior
aspect of the arm from proximal the distal
palmer crease ulnarly and completes
approximately two inches distal the Axilla
posteriorly. Usually applied with wrist
dorsally extended from 0 - 30 degrees (a.k.a.
neutral position) and 90 degrees of flexion at
the elbow.
Utilization: Used for various radial and ulnar
fractures, elbow fractures, post-surgical
fracture repairs as well as tendon repair. This
splint usually requires an arm sling.
Thoughts before application:
Is this a removable or non-removable splint?
Will this splint need a modification?
Will the wrist need supination or pronation?
Ask what digits to be included in splint.
Is this for treating a patient for an initial injury
or is this for post-operative treatment?

19. The Coaptation Splint
Also referred to as a “Sarmiento” splint
Application/Location: Usually applied by
starting about 2-3 inches distal the Axilla
medially upon the humeral aspect of the upper
arm, continue around the elbow and finish
anteriorly over the humeral head to include as
much of the shoulder as possible without
encroaching upon the neck. Applied with
wrist dorsally extended from 0 - 30 degrees
(a.k.a. neutral position) and 90 degrees of
flexion at the elbow. This splint can also become
a “long arm sugar tong coaptive splint by simply
adding the sugar tong splint.
Utilization: Used primarily for various
proximal humerus fractures, post-surgical
fracture repairs as well as tendon repair. This
splint usually requires an arm sling, cuff-n-
collar or shoulder immobilizer.
Thoughts before application:
Will this splint need a modification?
What type of fracture is being treated?
Sling, shoulder immobilizer or Cuff-n-Collar?

21. The Short Leg Posterior Splint
a.k.a “L” splint or Short Leg Splint
Application/Location: Usually applied slightly
distal to the most prominent of the digits on the
plantar aspect bending posteriorly around the
heel and terminating distally 2 - 3 inches of the
Popliteal Fosse. Usually applied with foot in
neutral position of the ankle and the ankle is at
90 degrees. ALWAYS NON-WEIGHT
BEARING! Patient will need Crutches or other
ambulatory assistance!
Utilization: Used for foot and/or ankle
sprains/strains and fractures, post-surgical
fracture repairs as well as tendon repair. With
appropriate splint modification, can be used to
treat acute Achilles tendon injuries.
Thoughts before application:
Is this a removable or non-removable splint?
Will this splint need a modification? If so, what?
Is this for treating a patient for an initial injury
or is this for post-operative treatment?

22. The Short Leg Posterior w/Sugar Tong
Splint
a.k.a “L & U” splint, an AO (German) Splint, Short Leg
Posterior with Stirrup and a “Jones” or “Bulky Jones” Splint
Application/Location: Usually a Short Leg Posterior
Splint is applied first. At this time a “sugar tong” is
applied by centering casting material under the
midfoot and occupying both the medial and lateral
aspects of the ankle to the most proximal end of the
previous splint bilaterally or slightly less than and
without closing the anterior aspects of the extremity.
ALWAYS NON-WEIGHT BEARING! Patient will
need Crutches or other ambulatory assistance!
Utilization: Used for foot and/or ankle
sprains/strains and fractures, post-surgical fracture
repairs as well as tendon repair. Usually applied with
bulky cotton to treat severely swollen acute foot
and/or ankle fractures.
Thoughts before application:
Is this a removable or non-removable splint?
Will this splint need a modification? If so, what?
Is this for treating a patient for an initial injury or is this
for post-operative treatment?

23. The Long Leg Posterior Splint
Also known as Long Leg Extension Splint
Application/Location: Usually applied slightly
distal the most prominent of the digits on the
plantar aspect bending posteriorly around the
heel and terminating distally 2 - 3 inches of the
Gluteal Sulcus (Fold of the Buttock). Usually
applied with foot in neutral position of the ankle
and the ankle is at 90 degrees and the knee at 0 –
10 degrees of flexion. ALWAYS NON-WEIGHT
BEARING! Patient will need Crutches or other
ambulatory assistance!
Utilization: Used for midshaft and/or high
tib/fib fractures, tibial plateau fractures, acute
femur fractures and knee injuries/fractures.
Thoughts before application:
Is this a removable or non-removable splint?
Is there a preference on the type of casting
material?
Will this splint need a modification? If so, what?
Is this for treating a patient for an initial injury?

24. The Long Leg Posterior Splint With
Medial/Lateral Slabs
Application/Location: Usually a Long Leg Posterior
Splint will be applied first. The “slabs” are then
applied by centering casting material under the
midfoot and occupying both the medial and lateral
aspects of the ankle to the most proximal end of the
previous splint bilaterally or at least above the knee
without closing the anterior aspects of the extremity
unless required. ALWAYS NON-WEIGHT BEARING!
Patient will need Crutches or other ambulatory
assistance!
Utilization: Used for midshaft and/or high tib/fib
fractures, tibial plateau fractures, acute femur fractures
and knee injuries/fractures.
Thoughts before application:
Is there a preference on the type of casting material?
Will this splint need a modification? If so, what?
Is this for treating a patient for an initial injury?

25.  Before and after every splint: check for distal circulation!
 All rings and bracelets should be removed from the affected limb.
 All wounds, rashes and other skin compromises should be treated prior
to splinting
 Splint should go from joint to joint from the epicenter of the injury
 Affix an appropriate amount of padding (whether to the splint or to the
skin) to prevent splint rub and pad extra over boney prominences as well
as obvious irritations
 Pay special attention to the ends of the splint to ensure that all rough and
sharp edges are well padded
 Avoid all wrinkles in padding as well as in the splinting material as these
can cause skin irritations
 Avoid using fingers to form any molding into the splint as your fingers
will leave “a lasting impression” that may not be well tolerated
 Ensure if fingers or toes are secured together, a padding is placed
between them before securing them

26.  Don’t just dunk your plaster and then quickly laminate with the “two finger slide” technique that many do
 This removes most of the plaster from the splint
 Splint hasn’t been properly moistened for needed lamination strength
 Don’t use too many layers
 As a general rule:
 Upper Extremity splints 10 – 15 layers
 Lower Extremity splint 15 – 25 layers
 You lose working time for the needed mold
 Don’t over work the lamination!
 Over worked plaster is weak
 You lose working time for the needed mold
 Don’t use overly hot water! (keep water temp between 70-75 F)
 Exothermic reaction is exponentially increased with hotter temp water – this can cause the splint to be too
hot to apply to the patient
 Set time is increased; the plaster may not be usable if set time is compromised
 Change water between splint applications
 Exothermic reaction is exponentially increased due to the salts from the previous plaster in the water – this
can also cause the splint to be too hot to apply to the patient
 Set time is increased; the plaster may not be usable if set time is compromised (knowing this can be to your
advantage)
 Saline water will speed up set time and LR water will slow set time
 While allowing the splint to dry, ensure that adequate ventilation around the splint has been made
 Plastic, naugahyde, vinyl and like materials will reflect heat back to the patient and can cause severe burns
 Terry cloth towels, linens and like materials work best for letting the splint cool down from its reactive
process
˚

27.  Use room temperature water to allow for longer molding time
 Do not let fiberglass spend longer than a few seconds (about 5 secs) in the water,
then squeeze and ready yourself to apply it
 If the fiberglass is cut, ensure that all fiberglass frays are concealed in some sort of
padding or edging material
 The cut edges of fiberglass splints can cut into a patient’s skin
 The small frays can break off into the splint and cause a great deal of itching
and other discomfort
 Take care to not laminate with too many layers
 Upper Extremity: 5 – 10 layers
 Lower Extremity: 8 – 12 layers
 Do not allow splint to become stuck to itself in a manner that encircles or encloses
the extremity (this goes for any splint) unless it is absolutely necessary
 Doing so makes it extremely difficult to remove the splint later
 Could cause vascular compromise or even muscular compartment issues
 Ensure to place a protective barrier between patient and the area being splinted
 Fiberglass resin does not come out of clothes
 Fiberglass resin on skin requires immediate action to remove which can
compromise splinting process
 Always wear gloves as a protective measure to prevent fiberglass resin from
getting onto your skin

28. The Short Arm Sugar Tong Splint
And
The L and U Splint

29. • What a splint is
• What purpose a splint serves in treating injuries
• What materials can be considered for splinting
• How to conduct pre-splinting procedures
• How to select the appropriate splint for the injury
• What precautions and hazards are associated with
improper splinting
• With hands-on application, the objectives for training
were clearly illustrated through individual
experience

31. Benny just fell off his mountain bike and sustained a
nasty forearm injury. He is 19 years old in good
shape and healthy. Which splint would be most
appropriate if you suspect a forearm fracture?
Short arm thumb spica splint
Coaptation splint
Long arm posterior splint
Short arm volar splint
Short arm sugar tong splint

32. Which splint would you fabricate on an
octogenarian with a radiologically
confirmed distal humerus fracture?
Short arm thumb spica splint w/ cuff-n-collar
Short arm sugar tong splint
Long arm posterior splint
Short arm volar splint w/ sling
Coaptation Splint w/ cuff-n-collar

33. Which splint would be most appropriate
for an unknown status of a status post
MVA Left ankle injury with deformity?
DME Ankle lace-up
DME Air splint
Long leg posterior splint
Short leg posterior splint
Short leg L and U splint

34. A plaster splint sets slower with sugar in
the water and faster with salt in the
water.

35. If a person has a 20 layer plaster short leg
posterior splint that has been allowed to set
upon a naugahyde covered exam table, a 3rd
degree burn is possible.

36. Which splint is most appropriate for most
all ankle and foot injuries?

37. Which splint is most appropriate for most
all wrist, forearm and elbow injuries?

38. What is the very first and last assessment
that should be made prior to and after
applying a splint?

39. Match the splint to its most appropriate
injury treatment:
Short Leg Posterior Splint
Volar Splint
Ulnar Gutter Splint
Short Leg L and U Splint
Thumb Spica Splint
DeQuervain’s Tenosynovitis
Boxer’s Fracture
Ankle Sprain
Carpal Tunnel Symptoms
Bi-malleolar Fracture

40. Jim “Buzz” Land, CSA, OT
jland@opaak.com
Or
Robbie “Robo” Fenton, OT
rsfenton@opaak.com