Splinting 101: Bone, Muscle, and Joint Injuries
The main focus of the assessment of a bone, muscle or joint injury is to determine if the injury is significant enough to require a visit to a medical professional (hospital/clinic) or if it can be managed by the patient with self care.
To simplify this assessment we classify bone, muscle and joint injuries into two categories Stable and Unstable. The main assessment criteria is the patient's ability to use the affected limb:
With stable injuries the patient is able to use the affected limb (stand and walk with leg, lift an object with arm).
For unstable injuries the patient is unable to use the affected limb (cannot walk or stand on leg, cannot grasp and lift an object with the arm).
Stable injuries can be self monitored and usually treated at home by the patient and rarely require further medical intervention.
When assessing a patient with a stable injury they are able to use the affected limb (walk and stand on leg or grasp and lift an object with the affected arm). There is no obvious deformity or angulation of the injured area. Pain is manageable (may take a few minutes for the patient to calm down following the injury event). Swelling and redness may be present and do not effectively indicate whether the injury is stable or unstable.
To treat stable injuries the patient can be advised to follow the acronym RICE listed below:
Rest: pain free activity, possible modification of activity to avoid undue stress on the injured area. Example reduce weight of backpack hiking, switch roles in canoe if paddling, etc.
Ice: Applying an ice pack, ice in a bag, or cold compresses to the affected area can reduce swelling an blood pooling which can reduce pain. Always make sure ice is wrapped in a cloth and avoid placing ice directly on the skin. Ice can be applied for 10-15 minutes every couple hours as needed.
Compression: Wrapping the area (especially joints such as wrist, ankle, knee) with a elastic bandage (also known as a Tensor Wrap) snugly can reduce swelling and pooling of blood and reduce pain. Make sure you assess CSM; circulation (is the skin below the injury the same colour as the rest of the skin and warm), sensation (can the patient feel touch below the elastic wrap, does the patient feel any numbness or tingling), movement (can the patient wiggle their toes or fingers). If there is any compromise to the CSM remove the elastic wrap and reapply looser and reassess CSM. Always remove elastic wraps before going to sleep as sensation when sleeping is limited and swelling increases, this has the potential to reduce circulation below the injury and cause damage to the limb.
Elevate: Elevating affected limb when possible can reduce swelling by pooling blood at the site of injury. You do this by advising the patient raise affected leg or arm onto object when sitting or lying down.
Patients can consider taking medications that reduce swelling and pain as needed. These medications are classified as NSAIDs (Non-Steroidal Anti-inflammatory Drugs). Examples of easily available over the counter NSAID medications are: Advil, Ibuprofen, Motrin, Midol, Naproxen, Aleve. Advise the patient follow the dosing instructions on the bottle including the maximum daily recommended dose not to exceed. Patients with bleeding disorders, recent head injuries, ulcers and those on multiple chronic medication should consult their doctor before taking NSAID medications if they are unsure if they will cause harm.
If the patient experience increasing pain, a loss or decrease in CSM, or limited function of the affected limb they should consult a Doctor or Nurse Practitioner for further assessment and treatment recommendations.
Patients with unstable bone, muscle and joint injuries may present with the following findings. Patients are unable to use the affected limb (leg unable to stand or walk, arm unable to grasp and lift object such as a water bottle). Patients may be experiencing sever pain. There may be obvious deformity or angulation of the injury site. Swelling and redness may or may not be present. A reduction of CSM may be noted below the injury.
To treat unstable injuries the first aider can follow the acronym CAST listed below:
Check CSM: Assess CSM before and after application of a splint:
- Circulation: is the skin below the injury the same colour as the rest of the skin and warm
- Sensation: can the patient feel touch below the elastic wrap, does the patient feel any numbness or tingling
- Movement: can the patient wiggle their toes or fingers below the injured area.
***If there is any compromise to the CSM call 9-1-1 EMS for emergency transportation to the hospital as their is risk of permanent damage to the affected limb. ***
Above and Below: Application of a splint above and below the affected bone, muscle or joint injury should be considered to protect from further damage during transport to medical care. The splint should extend above and below the injured area. If the injury is to a long bone then immobilize the joint above and below (ex. lower leg bone injury requires the knee and ankle to immobilized). If the injury is to a joint then immobilize the bone above and below the injury (ex. elbow immobilize upper arm and lower arm)
Soft and Adjustable: Splints should be padded to avoid pressure points on the patient. You can wrap splint with cloth, extra clothing, blankets etc. Securing the splint to the patient should be done with an adjustable material such as roller gauze, self adherent (vet) wrap, elastic wrap, triangular bandages, cord/rope or webbing with padded and adjustable knots. The injured area will likely swell over time and may require the splint to be loosened during long transportation to the hospital.
Transport and Monitor: Unstable injuries should be assessed by a medical profession in a clinic or hospital as soon as possible as these injuries may result in permanent damage and reduction of function of the affected limb if left untreated.
Montior CSM after applying splint and throughout transportation. If any reduction in CSM noted remove loosen splint and reassess. If CSM is still reduced call 9-1-1 EMS for emergency transportation to the hospital as their is risk of permanent damage to the affected limb.
Splinting Arm injuries:
Sling and Swathe: Triangular Bandage
Tubular Sling: Shoulder/Collar Bone:
Splinting Lower Leg Injuries:
Lower Leg (shin/Knee) Splint: