Splinting a Joint: Purpose, Principles, and Step-by-Step Guide

How Do You Splint a Joint?

Splinting a joint is a crucial first-aid technique used to immobilize an injured limb, preventing further damage, reducing pain, and facilitating safe transport for professional medical attention.

Understanding the Purpose of Splinting

Splinting is the process of immobilizing an injured body part, most commonly a suspected fracture, dislocation, or severe sprain. Its primary goals are to:

• Prevent Further Injury: By restricting movement, splinting reduces the risk of sharp bone ends damaging surrounding tissues, nerves, or blood vessels.
• Reduce Pain: Immobilization often significantly lessens the discomfort associated with movement of an injured area.
• Minimize Swelling and Bleeding: Limiting motion can help control internal bleeding and subsequent swelling.
• Facilitate Safe Transport: A properly splinted limb is less likely to cause additional harm during patient movement.

It's vital to understand that splinting is a temporary, first-aid measure, not a definitive treatment. Professional medical evaluation is always required after a serious injury.

When Is Splinting Necessary?

Splinting should be considered in situations where there is a suspected:

• Fracture: A break in a bone.
• Dislocation: When bones at a joint are forced out of alignment.
• Severe Sprain: Ligament damage that causes significant instability and pain.
• Strained Muscle: In cases of severe muscle tears where movement exacerbates pain.

Always err on the side of caution; if you suspect a serious injury, it's safer to splint the area.

Key Principles of Effective Splinting

Adhering to these principles ensures the splint is effective and safe:

• Immobilize Above and Below the Injury: For a suspected fracture in a long bone (e.g., forearm), the splint should extend beyond the joints immediately above and below the injury (e.g., wrist and elbow). For a joint injury (e.g., ankle), the splint should immobilize the bones above and below the joint.
• Splint in the Position Found: Unless there is severe angulation compromising circulation, do not attempt to straighten or realign a deformed limb. Splint it in the position of greatest comfort or in the anatomical position if possible without causing undue pain.
• Pad Bony Prominences: Use soft material (e.g., gauze, cloth, clothing) to cushion areas where the splint material might press against bones, preventing pressure sores and increasing comfort.
• Check Circulation, Sensation, and Movement (CSM/CMS): Before and after applying the splint, always check the pulse, sensation (can the person feel your touch?), and ability to move fingers or toes distal (further away) to the injury. Changes may indicate the splint is too tight or nerve/blood vessel damage.
• Do Not Overtighten: A splint should be snug enough to prevent movement but not so tight that it restricts blood flow.
• Do Not Cover Open Wounds: If there's an open wound, control bleeding and dress it with sterile material before applying the splint.

Materials Needed for Splinting

You can improvise splinting materials from common items:

• Rigid Support (Splint Material):
  • Rolled newspapers or magazines
  • Sticks or branches
  • Cardboard or plastic sheeting
  • Pillows or blankets (for soft splints)
• Padding:
  • Gauze pads or bandages
  • Clean cloths or towels
  • Clothing
• Ties/Binders:
  • Adhesive tape (medical, duct, electrical)
  • Strips of cloth, scarves, or belts
  • Rolled bandages
• Tools (Optional): Scissors, pen for marking time of CMS check.

Step-by-Step Guide to Splinting a Joint

This general guide can be adapted for various joints. Always prioritize safety and comfort.

1. Assess the Situation and Patient:

   • Ensure Scene Safety: Make sure the environment is safe for both you and the injured person.
   • Assess the Injury: Gently inspect the injured area for deformity, swelling, bruising, and open wounds. Note any severe pain.
   • Check CMS/CSM: Before touching the injury, check the pulse, sensation, and movement distal to the injury. For an ankle injury, check the foot/toes. For a wrist injury, check the hand/fingers. Document your findings if possible.

2. Gather Materials: Collect all necessary rigid supports, padding, and ties.

3. Position the Injured Limb:

   • Support the Limb: Have someone gently support the injured limb above and below the injury, minimizing movement.
   • Position of Comfort: If the limb is severely deformed or causes extreme pain when moved, splint it in the position it was found. Otherwise, gently maneuver it into a more natural, comfortable, or anatomical position if possible without causing undue pain.

4. Apply Padding:

   • Place padding generously around bony prominences (e.g., ankles, wrists, elbows, knees) and between the limb and the rigid splint material. This prevents pressure points and skin breakdown.

5. Position the Rigid Support:

   • Place the rigid splint material alongside or around the injured limb. Remember to extend the splint beyond the joints immediately above and below the injury. For example, for an ankle injury, the splint should extend from below the knee to past the toes. For a wrist injury, from below the elbow to past the fingertips.
   • You may need two rigid supports (one on each side of the limb) for better immobilization.

6. Secure the Splint:

   • Using your ties (tape, bandages, cloth strips), secure the rigid support firmly but not tightly.
   • Tie above and below the injury first, then add ties in between. Avoid tying directly over the injury itself.
   • Ensure the ties are snug enough to prevent movement but loose enough to avoid compromising circulation. You should be able to slide a finger under the ties.

7. Re-Check CMS/CSM:

   • Immediately after the splint is applied, re-check the pulse, sensation, and movement distal to the injury.
   • Look for signs of impaired circulation: pallor (paleness), cyanosis (bluish discoloration), coldness, numbness, tingling, or increased pain. If any of these occur, loosen the splint immediately and re-check CMS.

8. Elevate and Immobilize Further (If Appropriate):

   • If possible and not painful, elevate the splinted limb slightly above heart level to help reduce swelling.
   • Consider using a sling for upper extremity injuries to provide additional support and comfort.

Important Considerations and Precautions

• Never attempt to reduce a dislocation or realign a fracture. This can cause severe nerve, blood vessel, or tissue damage.
• Do not move the injured person unnecessarily before the splint is applied, especially if a spinal or head injury is suspected.
• Monitor the patient continuously. Re-check CMS frequently, especially during transport.
• Seek immediate professional medical attention. Splinting is a temporary measure. Transport the injured individual to an emergency room or call for emergency medical services (EMS).

After Splinting: Next Steps

Once the joint is splinted, the immediate next step is to ensure the injured person receives prompt medical evaluation. This will involve X-rays or other imaging to accurately diagnose the injury and determine the appropriate long-term treatment plan, which may include casting, surgery, or physical therapy. Remember, proper first aid, including effective splinting, can significantly impact the recovery process and prevent complications.