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Posterior Long Arm Splinting

Posterior Long Arm Splinting

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Posterior long arm splinting is used in the management of multiple upper-extremity injuries. Splints stabilize injuries by decreasing movement and providing support, thus preventing further damage. Splinting also alleviates extremity pain and edema and promotes soft-tissue and bone healing. Splints can be used either for immobilizing an extremity before surgical treatment or as a temporizing measure before orthopedic consultation.

Unlike casts, which are circumferential, splints are often the treatment of choice in the emergency department (ED) because they allow for swelling that may be present at the site of injury and thereby decrease the risk of compartment syndrome. After a splint is placed, follow-up for definitive care with an orthopedist should occur within 1-5 days. [1]

Upper-extremity injuries for which posterior long arm splinting is indicated include the following [1] :

There are no absolute contraindications for posterior long arm splinting. However, there are certain injuries that, though not constituting actual contraindications, call for immediate evaluation or intervention by a consultant. Patients with the following injuries should not undergo splinting and should be discharged home for follow-up:

Chudnofsky C. Splinting techniques. Roberts JR, Custalow CB, Thomsen TW, et al, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia: Elsevier Saunders; 2014. 999-1027.

Cuomo AV, Howard A, Hsueh S, Boutis K. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?. Pediatr Emerg Care. 2012 Nov. 28 (11):1150-3. [Medline].

Moraleda L, Valencia M, Barco R, González-Moran G. Natural history of unreduced Gartland type-II supracondylar fractures of the humerus in children: a two to thirteen-year follow-up study. J Bone Joint Surg Am. 2013 Jan 2. 95 (1):28-34. [Medline].

Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, et al. The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg. 2012 May. 20 (5):320-7. [Medline]. [Full Text].

Naik AA, Xie C, Zuscik MJ, Kingsley P, Schwarz EM, Awad H, et al. Reduced COX-2 expression in aged mice is associated with impaired fracture healing. J Bone Miner Res. 2009 Feb. 24 (2):251-64. [Medline].

Matsumoto MA, De Oliveira A, Ribeiro Junior PD, Nary Filho H, Ribeiro DA. Short-term administration of non-selective and selective COX-2 NSAIDs do not interfere with bone repair in rats. J Mol Histol. 2008 Aug. 39(4):381-7. [Medline].

Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. 2008 Jan. 102(1):10-4. [Medline].

Reichman EF, Sloas HA. Casts and splints. Reichman EF, ed. Emergency Medicine Procedures. 2nd ed. New York: McGraw-Hill; 2013. Chap 91.

Chow YC. Elbow and forearm injuries. Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York: McGraw-Hill; 2016. 1816-27.

Halanski MA, Halanski AD, Oza A, Vanderby R, Munoz A, Noonan KJ. Thermal injury with contemporary cast-application techniques and methods to circumvent morbidity. J Bone Joint Surg Am. 2007 Nov. 89(11):2369-77. [Medline].

Halanski M, Noonan KJ. Cast and splint immobilization: complications. J Am Acad Orthop Surg. 2008 Jan. 16(1):30-40. [Medline].

Abzug JM, Schwartz BS, Johnson AJ. Assessment of Splints Applied for Pediatric Fractures in an Emergency Department/Urgent Care Environment. J Pediatr Orthop. 2017 Jan 5. [Medline].

Lisa Jacobson, MD Attending Physician, Department of Emergency Medicine, Washington Hospital Center

Lisa Jacobson, MD is a member of the following medical societies: American College of Emergency Physicians, Physicians for Social Responsibility, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Jessica Freedman, MD Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Consulting Staff, Department of Emergency Medicine, Mount Sinai Hospital

Jessica Freedman, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Vaishali Patel, MD Assistant Clinical Professor, Co-director of Quality Assurance/Continuing Quality Improvement, Department of Emergency Medicine, Mount Sinai School of Medicine; Consulting Staff, Department of Emergency Medicine, Mount Sinai Medical Center; Director of ED PAs, Department of Emergency Medicine, Mount Sinai Medical Center

Disclosure: Nothing to disclose.

Suzanne Bentley, MD, MPH Assistant Professor, Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai; Medical Director, Simulation Center at Elmhurst Hospital Center

Suzanne Bentley, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Womens Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Posterior Long Arm Splinting

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