With the continuous development of modern orthopaedic technology, more and more new techniques and methods are being used in the treatment of orthopaedic diseases. However, the improvement of internal fixation techniques and the update of external fixation devices are not as common as the use of splint fixation and its special function in the treatment of fractures. However, just as things are not perfect, the use of splinting for fractures is not a panacea, and it has many advantages as well as some disadvantages. In this paper, we will discuss the advantages and disadvantages of splinting.
I. Overview of splinting.
After the fracture is repositioned, different materials such as willow board, bamboo board, cedar bark, cardboard, etc. are selected and shaped according to the shape of the patient’s limb to make a splint suitable for each part and tied with a ligature to keep the position of the fracture repositioned with a fixation pad, which is called splint fixation.
1. The principle of small splint fixation.
The principle of small splinting fracture fixation is based on the functional requirements of the limb, according to the principle of body kinematics, through the appropriate traction and counter-traction, with small splinting fixation bandage, to achieve the role of fracture end reset, transport and release muscle spasm, to regain the balance of internal dynamics of the limb. Therefore, splint external fixation is a kind of external fixation method to achieve power balance by transportation.
2.The indications and contraindications of small splint fixation.
(1) Indications
(1) Closed fractures of the extremities;
(2) Open fractures of the extremities with small trauma or closed wounds by treatment;
(3) old fractures of the extremities using manipulation.
(2) Contraindications
①Serious open fractures;
(ii) Intra-articular fractures that are difficult to be repaired;
(3) Fractures that are difficult to fix;
④Severe swelling of the limb with blisters;
(⑤) Weak pulse in the distal part of the injured limb, poor peripheral blood circulation, or with arterial or venous injury.
3, the use of splints strictly choose small splints. The material of the small splint should be selected according to the curvature of the physiological curve of the limb, otherwise it will probably cause skin pressure sores, or the fixation will not work. To choose the appropriate padding to protect the limb, and clip bandage selection cloth bandage 1/3 width, long wrap splint more than 2 weeks, about 15cm, tie tied after, to be able to move up and down in the splint 1cm appropriate. The method of splint fixation has a simple bandage method and continue to increase the bandage method.
4, small splinting after fixation precautions.
(1) Elevate the affected limb to facilitate the swelling to subside.
(2) Closely observe the blood flow of the injured limb, especially the changes in skin color, temperature, sensation and swelling of the limb within 3 to 4 days after fixation. If any blood flow obstruction is found, it is advisable to deal with it urgently and properly to avoid ischemic necrosis.
(3) Pay attention to asking whether there is burning pain at the skeletal prominence to prevent the occurrence of pressure ulcers.
(4) Pay attention to frequently adjusting the check tightness of the ligature. Generally, the swelling reaches its peak within 4 days after the injury, and attention should be paid to relax the ligature appropriately. Later, when the swelling begins to subside and the ligature is relaxed, the tightness of the ligature should be adjusted promptly. Maintain a normal mobility of 1cm.
(5) Perform X-ray examination regularly. Especially within 2 weeks of fixation, it should be checked frequently and dealt with promptly if there is any displacement.
(6) Instruct the patient to carry out reasonable functional exercise, and explain the precautions and practice methods after fixation to the patient and family members clearly to obtain the cooperation of the patient.
Second, the advantages of small splints.
1.Non-invasive fixation. The clinical choice of incision surgery reset, due to incision surgery reset sometimes need to strip the periosteum, if not handled properly may lead to bone does not heal, osteonecrosis and other complications, and the internal fixation in the fracture healing or to remove, which undoubtedly in the original surgical trauma and add a new trauma! The use of small splint fixation method to fix the fracture is just to make up for the shortcomings of surgery, and can also achieve the effect of fixing the fracture.
2. Convenient to take out materials. Chinese medicine orthopedics in the use of small splint fixation method has a long history, mainly in the splint material above. As a kind of external fixation, the small splint material is very convenient, can be willow board, bamboo board, cedar bark, cardboard, etc. can also be certain plastic plastic board. Because of the convenient material, in the orthopedic emergency, it will not be difficult to find effective fixation and delay treatment, thus greatly facilitating the efficiency of orthopedic surgeons in the treatment of patients.
3.Simple operation. Small splints have the advantage of simple operation, especially in the treatment of tibial fractures, forearm fractures and other aspects of the fixed treatment, so small splints fixed by the majority of primary care doctors welcome and widely used
4, because the small splint fixation than the plaster bandage fixed range is small, generally does not include the upper and lower joints of the fracture, and facilitate the early functional exercise of the injured. The splint fixation will not hinder the longitudinal contraction movement of muscles. When the muscle contraction, it can make the fracture ends squeeze each other, which is beneficial to the fracture healing, and can avoid the disuse muscle atrophy and osteoporosis caused by the limb movement limitation.
5. It is convenient for the doctor’s examination and adjustment, because the splint is fixed outside the limb by using bandage to splint the fracture, so it has high adjustability. If the patient has a problem with blood circulation in the limb during fixation or once the alignment of the fracture is found to be poor, the doctor can make timely adjustments to prevent more serious consequences!
6, the small splint fixation is inexpensive. In the case of inflated medical prices now, inexpensive small splint fixation method is much more real than the expensive incision surgery reset method. A fracture if treated by incision internal fixation method, although the fracture can be fixed to achieve a better alignment to the line, but the price of up to thousands or even tens of thousands of people often make many people feel the burden of strain, while the small splint fixation is no concern in this regard, the treatment of fractures at the same time, the price is one tenth or even one percent of the former, so that the entire patient’s medical costs are greatly reduced. Patients are therefore happy to be treated with a small splint. Or the whole delivery.
Third, the disadvantages of small splint fixation.
1, small splint fixation of muscle-rich parts of the fracture and long oblique short reduction of displaced fractures, fixed force is insufficient. The fixation force of the small splint mainly comes from the double force of the outside bandage and the inside of the limb, compared with the incisional surgical repositioning, the small splint fixation does not have its strong fixation using steel plates and steel nails, so to a certain extent, the fixation force of the small splint is relatively insufficient, especially in the muscle-rich parts and long oblique short displaced fractures, such as femoral stem fractures, femoral neck fractures, etc.
2. The pressure pad and split bone pad used for small splint fixation can easily cause pressure sores. Because of the need to use bandages to tightly affix the splint and pad to the injured limb and thus reduce the permeability of the limb, it often leads to complications such as pressure trauma of the limb due to airtightness problems.
3, small splint improper use can also cause osteo-fascial syndrome, resulting in serious disability. Due to the long-term compression of the osteofascial compartment of the injured limb by the small splint fixation, the pressure in the osteofascial compartment is increased, resulting in impaired blood circulation in the limb, necrosis of muscles and nerve tissue due to ischemia, and the formation of ischemic myoclonus. This is often seen in fracture injuries of the forearm and lower leg.
4. Small splints tend to loosen and lose their fixation effect and displace the repositioned fracture. Because the splint is fixed to the fracture site of the injured limb by the bandage, there is a certain instability, and the movement of the limb may cause the bandage to loosen, thus causing the splint to lose its fixation effect and dislocating the repositioned fracture again.