Dieterichs splint: indications and design
The Dieterichs splint is a specialized device used for femoral fractures, as well as in case of injury to the hip or knee joints. It is a complex structure that provides not only fixation of the injured segment, but also limb traction.
The structure includes the following mandatory components:
- A wooden sole plate (base for the foot).
- Two telescopic crutch sidepieces: outer and inner plates.
- Twisting stick with a special cord, necessary to create traction.
Algorithm for applying the Dieterichs splint
To ensure correct and safe fixation, it is necessary to strictly follow a nine-step sequence:
- Fixation of the sole. Work begins by bandaging the sole plate directly to the victim's footwear. A secure figure-eight bandage is used for this.
- Size adjustment. The length of the crutch sidepieces is adjusted individually by moving them in special brackets and securing them with a pin. The upper edge of the outer sidepiece must rest snugly against the axillary fossa, and the inner one into the inguinal region. The lower ends of both sidepieces must extend beyond the edge of the sole by 10–12 cm.
- Assembly of the structure. The sidepieces are carefully threaded through the brackets located on the sole plate, after which they are secured with a clamp.
- Preparation of traction. A cord is passed through a special hole in the sole, which is then tied to the twisting stick.
- Protection of soft tissues. To prevent painful tissue compression, cotton-gauze pads are placed on the crutch plates (at the pressure points) and in the ankle area.
- Preliminary fixation. The splint is secured to the patient's torso with special straps, and the sidepieces themselves are fixed to each other.
- Traction. The injured leg is carefully pulled while holding the brackets on the sole plate, after which the twisting stick is turned to the required tension.
- Final fixation. The entire assembled structure is tightly bandaged to the victim's leg and torso.
- Additional immobilization. A Kramer splint must be placed under the posterior surface of the injured leg and bandaged. This is necessary to prevent sagging and posterior displacement of the leg within the splint.
Application of Kramer wire ladder splints
Kramer ladder splints are a universal means and can be used to immobilize the entire lower extremity.
For thigh injuries They serve as an alternative to the Dieterichs splint. Several splints are connected together and applied from three sides: lateral, medial, and posterior. The main rule for such injuries is mandatory and strict immobilization of all three joints at once: the hip, knee, and ankle.
For lower leg fractures Three ladder splints are used to create reliable immobility. The application technique implies mandatory fixation of two adjacent joints — the knee and the ankle.
Pneumatic splints and improvised means
In addition to rigid structures, pneumatic splints are used in medical practice. Their main purpose is the immobilization of the lower leg, as well as the knee joint.
If standard transport splints are unavailable (which often happens when providing first aid at the scene of an accident for femoral or lower leg fractures), the tactics shift to using non-standard approaches:
- Using improvised means: boards, pieces of plywood, skis, or even a tightly rolled blanket can be used as a rigid frame.
- "Leg-to-leg" method: if there are no objects at all capable of acting as a splint, auto-immobilization is used. The injured limb is simply but firmly bandaged to the patient's healthy leg, thereby giving it the necessary immobility during transportation.
Fixation rule for femoral fractures: "Three joints, three sides" — for reliable immobilization with Kramer splints, the hip, knee, and ankle joints must be captured, applying the splints laterally, medially, and posteriorly.
Class and exam questions
How to properly select the length of the Dieterichs splint sidepieces?
The outer sidepiece must rest against the axillary fossa, and the inner one against the inguinal region. At the same time, their lower ends must extend beyond the edge of the foot by exactly 10–12 cm.
Why is a Kramer splint needed when applying the Dieterichs splint?
The Kramer ladder splint is placed under the posterior surface of the leg and bandaged to prevent posterior displacement of the limb within the splint (sagging).
Which joints need to be fixed in a lower leg fracture?
In a lower leg fracture, it is necessary to create complete immobility in two adjacent joints: the knee and the ankle, by fixing the limb with three Kramer splints.
What to do if there are no medical splints at hand?
Any improvised means can be used: boards, pieces of plywood, skis, or a tourniquet-rolled blanket. In extreme cases, the "leg-to-leg" auto-immobilization method is used — bandaging the injured limb to the healthy one.
What else to study on this topic
- Peculiarities of applying a figure-eight bandage to the foot to fix the sole plate
- The mechanism of creating traction using a twisting stick
- Technique of joining several Kramer splints together
- Rules for applying cotton-gauze pads to protect soft tissues
- Indications and limitations for the use of pneumatic splints
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