Case 2
A 14 year old boy comes into the ED with a laceration on his hand. He had been going down the stairs hold a glass soda bottle and slipped on the carpet. He fell and smashed the bottle in his hand. Besides the hand he was otherwise unharmed. His left hand has a large laceration over the thenar eminence. It is now only oozing blood but had previously been gushing. He has no other medical problems. Immunizations are up to date.
Physical exam shows a 2 inch jagged horizontal laceration over the left thenar eminence on the palmar surface of the hand. Rull ROM is still present in all the digits and thumb. Sensation is normal in the left hand and pulses are intact.
Xray L hand - laceration noted with soft tissue inflammation. No bony damage seen.
You proceed to numb, irrigate and suture the wound successfully. You decide to put a splint on the boy's L. hand as motion of the thumb seems to pull on the suture line; and you fear he may split the wound back open.
What type of splint would you use?
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- Thumb Splica splint
- Immobilizes the wrist and thumb
- Location
- One wide piece runs along the extensor surface of the hand and forearm beginnning at the MC heads
- Half of another piece is placed from the tip of the thumb and overlaps with the other piece on the forearm.
- The pieces are molded together to make a sturdy dressing
- The optimal poisition is keeping the wrist in neutral position and the tips of the thumb and index finger in an Okay sign.
- The wrist should be slightly dorsiflexed at 10-15 degrees.
- Uses
- Fractures of the scaphoid bone
- Fractures of the thumb metacarpal or procximal phalynx
- DeQuervain tenosynovitis
- Any necessary immobilization of thumb for cellulitis or sutures.
Picture
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What should I tell the patient to do when they get home?
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- Splint aftercare
- Elevate, rest and ice the affected limb. Stress elevation for edema prevention.
- Instruct the patient to return if there is weakness, numbness, discoloration, increasing pain or pressure, redness or any other new symptoms.
- Keep the splint clean and dry.
- Don't stick anything into the splint as it can cause infection and limb loss
- Follow up with a consultant or in the ED in 2-3 days.
- Pain control is important.
What are some complications that can occur with splinting?
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- Complications of splinting include:
- Ischemia - Compartment syndrome
- Make sure the dressing isn't too tight
- Clear instructions to patient to call if pain increases.
- Heat injury
- Peak temperature of splint made with lukewarm water is 5-15 minutes after plaster wetting
- TAKE IT OFF immediately if patient describes burning or pain!
- Pressure Sores
- Can be caused by wrinkles or Fingerprints
- Take it off and resplint if patient complains.
- Infections
- Clean and debride all wounds prior to placement of splint.
- Dermatitis
- Rare - can be allergic to splint material
- Take it off them.
- Joint Stiffness
How long does a patient need to be splinted?
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- Length of splinting
- Contusions, abrasions: 1-3 days
- Puncture wounds and cellulitis: 3-5 days
- Soft tissue lacs and tendonitis: 5-7 days
- Mild sprains: 5-7 days
- Fractures: Variable, to see a specialist
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