Pneumatic splints: operating principle and features
For rapid and reliable limb fixation in modern practice, pneumatic splints are often used. Structurally, they are a double-layered hermetic cover equipped with a zipper and a special tube designed for pumping air.
The operating principle of this device is extremely simple and effective. The splint is carefully put onto the patient's injured limb, after which the zipper is closed. Then, air is pumped into the cover through the tube. Due to the increased pressure, the structure acquires the necessary rigidity, reliably immobilizing the traumatized segment.
The main advantages of a pneumatic splint lie in its ease of handling and radiolucency (the material effortlessly transmits X-rays, making it possible to take images without removing the immobilization). This type of splint is successfully used for fixing various areas:
- hand and forearm;
- elbow joint;
- foot and lower leg;
- knee joint.
Neck immobilization: cotton-gauze Schanz collar
In case of suspected neck injuries, the primary means of transport immobilization is the cotton-gauze Schanz-type collar. This soft yet voluminous bandage provides sufficient support for the cervical spine, restricting dangerous movements.
The application technique requires care: three or four layers of cotton are bandaged tightly around the victim's neck, but without excessive compression. A crucial aspect of proper application is adhering to the support points, which guarantee the stability of the structure:
- The upper edge of the collar must rest securely against the occiput and the mastoid processes of the skull.
- The lower edge of the structure must have a firm support against the patient's chest.
Despite its effectiveness, the Schanz collar has strict contraindications. Its use is unacceptable if the patient is vomiting or experiencing breathing difficulties, as a tight neck bandage can worsen these life-threatening conditions.
Fixation of the upper limb with a Kramer wire ladder splint
A classic means of upper limb immobilization is the wire ladder splint, also known as the Kramer splint. The process of its application is divided into two strictly consecutive stages: shaping and direct application.
Stage 1: Splint shaping Splint preparation must be performed exclusively before its application to the victim. The doctor or rescuer forms the necessary bends of the structure, guided by the patient's healthy limb or, as an alternative, their own limb. The goal of this stage is to replicate the natural anatomical contours of the body as closely as possible. It is important to remember the immutable rule: it is strictly forbidden to shape and bend a rigid splint directly on the injured limb, as this will cause severe pain and may displace bone fragments.
Stage 2: Application rules The ready, pre-bent splint is applied in compliance with the following principles:
- Fixation must capture at least two adjacent joints (in case of a shoulder injury, these are the shoulder and elbow joints, while the wrist joint is also often included in the bandage).
- The injured arm is fixed in a so-called physiologically favorable position, meaning the arm must be bent at the elbow joint.
- The splint is tightly and evenly bandaged not only to the limb itself, but also to the torso to prevent any displacement.
- A soft cotton-gauze pad must be placed into the axillary region on the injured side. This is done to prevent skin maceration and eliminate the risk of compressing the neurovascular bundle with the edge of the splint.
- The finishing touch is additional fixation (suspension) of the limb, which is carried out across the patient's neck or back.
The rule for shaping the Kramer splint: "Template — healthy arm. Injured arm — taboo."
Class and exam questions
Can the Schanz collar be used if the patient has difficulty breathing?
No, breathing difficulties, just like vomiting, are an absolute contraindication to applying a cotton-gauze Schanz collar to the neck.
Which joints must be immobilized during upper limb immobilization?
A properly applied splint must immobilize at least two adjacent joints. For the upper limb, these are usually the shoulder and elbow joints, and often the wrist joint is captured as well.
Why is a pad needed in the axillary region when applying a Kramer splint?
A cotton-gauze pad is placed into the axillary region in order to prevent skin maceration in this area and avoid dangerous compression of the neurovascular bundle by the rigid edge of the splint.
What else to study on this topic
- Mechanisms of maceration development during prolonged wear of immobilizing bandages.
- Anatomy of the axillary neurovascular bundle and the risks of its compression.
- Physiologically favorable positions for other segments of the musculoskeletal system.
- Features of X-ray diagnostics through various materials of immobilizing means.
Master the entire topic in the "General Surgery" course
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Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.