Upper extremity immobilization

Immobilization for clavicle fracture

The primary goal of care in clavicle injuries is reliable fixation of bone fragments. Specialized desmurgy techniques are used for this purpose.

The following types of bandages are used in clinical practice:

• Desault bandage — ensures reliable fixation of the entire upper extremity to the torso.
• Sling bandage (triangular sling) — its application requires strict adherence to the rule: a dense cotton-gauze pad must be placed in the axilla on the injured side.
• Figure-eight bandage — allows pulling the shoulder girdles backward, thereby reducing and holding the clavicle fragments in the correct position.

Injuries of the humerus and joints

Indications for this type of immobilization include diaphyseal humeral fractures, as well as any injuries to the shoulder or elbow joints. The primary device of choice is a large Cramer wire ladder splint.

Algorithm for applying the Cramer splint:

1. Modelling: The physician pre-bends and shapes the splint on themselves, using their own healthy limb, so as not to cause pain to the patient.
2. Patient preparation: A pad is placed in the axilla on the injured side.
3. Extent of fixation: The splint must encompass and rigidly fix all three joints of the injured upper extremity (shoulder, elbow, and wrist).
4. Securing: The upper and lower ends of the ladder splint are connected to each other using bandage ties.
5. Passing the ties: One end of the bandage tie is passed across the front of the chest, and the other across the back, passing through the axilla on the side of the healthy arm.
6. Suspending: The lower end of the splint (in the forearm and hand region) is additionally suspended from the patient's neck using a triangular sling or an ordinary belt.

Immobilization of the forearm and hand

For injuries of the distal upper extremity, a small ladder splint is used. If standard-issue devices are not available, rigid improvised materials are permitted: boards, thick cardboard, or plywood.

Application technique:

1. The injured arm is carefully bent at the elbow joint into a physiologically favorable position.
2. The hand and forearm are tightly bandaged to the prepared splint.
3. Extent of fixation: In these injuries, it is mandatory to immobilize two adjacent joints — the wrist and the elbow.
4. After bandaging is complete, the limb along with the splint is suspended from a sling to ensure rest and reduce edema.

Immobilization with improvised means

In the absence of standard splints (e.g., in field conditions) and in the presence of a fracture of the humerus in its upper third, the triangular sling method with additional rigid fixation to the torso is used.

Step-by-step technique:

• A small cotton-gauze pad is placed in the axillary fossa of the injured arm.
• This pad is securely bandaged to the chest, with the turns of the bandage passing over the patient's healthy shoulder.
• The injured arm is bent at the elbow joint at an acute angle of 60°.
• The entire limb is suspended from a sling, ensuring maximum rest.

Class and exam questions

What else to study on this topic

• Technique of applying the Desault bandage
• Technique of applying the figure-eight clavicle bandage
• Rules for creating cotton-gauze pads
• Methods of limb suspension (sling, belt)
• Features of immobilization in wrist joint injuries

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.