A splint is a temporary device used to immobilize a suspected broken or severely injured arm before professional medical help arrives. This first-aid intervention prevents movement of fractured bone ends, reducing the risk of further damage to surrounding tissues, nerves, or blood vessels. Splinting significantly reduces pain and makes the injured person more comfortable during transport. A temporary splint is not definitive medical treatment and requires professional evaluation at a hospital.
Initial Assessment and Safety Checks
Ensure the safety of the environment for both the injured person and the rescuer, then immediately call for emergency medical services. While waiting for help, assess the injured arm for severe, life-threatening conditions, such as heavy bleeding or an open wound with protruding bone. Control any severe bleeding with direct pressure and a clean dressing before beginning the splinting process.
Establish a baseline by checking the circulation, sensation, and motor function of the hand below the suspected fracture site. Check the radial pulse at the wrist and perform a capillary refill test by briefly pressing on a fingernail until it turns white; color should return within two seconds. Ask the person if they can feel your touch and gently check for finger movement, but never force the limb to move if it causes pain.
Gather materials for the improvised splint, focusing on rigid supports and soft padding. Rigid materials include wooden slats, rolled-up magazines, or thick cardboard. Padding should consist of soft clothing, towels, or cotton material to prevent pressure sores. Never attempt to push a protruding bone back under the skin or realign a visibly deformed limb, as this risks severe nerve and blood vessel damage.
Step-by-Step Splinting Procedure
Splint the arm in the position it was found, as movement can increase pain and injury. For many forearm injuries, the most comfortable position is often with the elbow bent at a 90-degree angle and the hand resting across the chest. Before applying rigid support, place soft padding material against the skin to protect the entire area.
Bony prominences, such as the wrist bones and the elbow, require extra padding to distribute pressure and prevent skin breakdown. The rigid splint materials must be long enough to extend beyond the joints immediately above and below the suspected fracture site. For example, a forearm fracture requires immobilizing both the elbow and the wrist joints.
Place the rigid supports, such as two padded boards, on opposite sides of the arm (e.g., palm side and back side). Secure these supports using cloth strips, belts, or tape, tying them firmly but not tightly enough to restrict blood flow. Place the ties away from the fracture site, usually above and below the injury, and check circulation immediately after securing the splint.
Once the rigid splint is secured, elevate and support the arm using a sling to reduce swelling and manage pain. Fashion an improvised sling from a large piece of cloth, positioning it so the elbow rests in the corner. The sling should hold the forearm at a slight angle, ensuring the hand is slightly higher than the elbow to aid in venous return and decrease swelling.
Monitoring and Next Steps
Continuous monitoring of the injured limb is necessary until professional medical personnel take over. Re-evaluate the limb’s neurovascular status to ensure the splinting materials are not compromising blood flow or nerve function. This observation is often remembered by the “5 P’s”:
- Pain
- Pallor (color)
- Paresthesia (numbness/tingling)
- Paralysis (movement)
- Pulselessness
If the person reports a sudden increase in pain, or if the fingers become pale, cold, or develop a blue tinge, the splint may be too tight. New or worsening numbness indicates possible nerve compression requiring immediate adjustment. Promptly loosen the ties closest to the heart, or the entire splint if necessary, until normal color and sensation return.
Keep the person warm and calm to mitigate the effects of shock, which can accompany significant trauma. Continue to elevate the injured arm in the sling position to control swelling. The injured person requires immediate transport to a medical facility, as a final diagnosis requires imaging such as an X-ray. Do not remove the splint unless directed by medical professionals or if restricted circulation requires correction.