Posterior Long Leg Splinting
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Posterior long leg splinting is used to stabilize injuries by decreasing movement and providing support, thus preventing further damage. Splinting also alleviates extremity pain, edema, and further soft-tissue injury and promotes wound and bone healing. Splints can be used for immobilization of an extremity before surgery or as a temporizing measure before orthopedic consultation.
Splints, rather than circumferential casts, are often the treatment of choice in the emergency department (ED) because they allow for continued swelling and thus are associated with a lower risk of compartment syndrome. Follow-up for definitive care with an orthopedist should occur 1-5 days after splint application.
In addition to immobilization, posterior long leg splinting may offer additional benefits specific to the particular injury or problem being treated. Examples include the following:
Posterior long leg splinting is indicated for the immobilization and support of various knee injuries. [2] In many EDs, the use of prefabricated knee immobilizers has replaced traditional posterior long leg splinting [3] ; however, the plaster long leg splint remains particularly useful when knee immobilizers are unavailable and in the following situations [1] :
There are no absolute contraindications for posterior long leg splinting. However, there are some situations that, though not constituting contraindications, are likely indications for surgical intervention, in which case splinting is only a temporary treatment. Examples include the following:
Chudnofsky CR. Splinting techniques. Roberts JR, Custalow CR, Thomsen TW, et al, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia: Elsevier Saunders; 2014. 999-1027.
Arkader A, Warner WC Jr, Horn BD, Shaw RN, Wells L. Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop. 2007 Sep. 27(6):703-8. [Medline].
Gravlee JR, Van Durme DJ. Braces and splints for musculoskeletal conditions. Am Fam Physician. 2007 Feb 1. 75(3):342-8. [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].
Tintinalli JE, Gabor D, Kelen J, Stapczynski S. Initial evaluation and management of orthopedic injuries. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw Hill; 2003. 1657-63.
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].
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.
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.
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.
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.
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.
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 Leg Splinting
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