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Coaptation Splint

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Other Names

Basic illustration of the the coaptation splint[1]
The coaptation splint with demonstration of the cuff and collar created from the stockinette[2]
(A) The stockinette can be used to pull the plaster into the axilla and (B) placement of the stockinette on the wrist for adduction of the arm.[3]
Before and after placement of the ace wrap. The final splint is seen on the right.[4]
The modified coaptation splint for a patient who developed wrist drop. A and B show the coaptation component. C an D demonstrate the sugar tong with careful attention to the wrist being placed in extension[5]
  • Coaptation splint
  • Modified coaptation splint

Background

  • This page refers to the coaptation splint
    • This splint roughly extends from the proximal deltoid, down the arm to the elbow and back up to the axilla
    • Think of it as a sugar tong for the upper arm
  • Will this splint, uniquely the splinting material is placed inside the stockinette
    • The extra length of stockinette will be used to create a sling
  • Alternatively, can be supported by a sling or swath

Indications


Contraindications

  • Absolute contraindications
    • None
  • Relative contraindications
    • Open fractures
    • Injuries with neurovascular compromise

Procedure

Equipment

Preparation

  • Use the patients unaffected arm to measure the length of the splint
  • The splint extends from the axilla, along the medial arm, around the elbow, and up the arm to the AC joint or base of the neck
    • Measure along this distribution
  • Cut a 6 foot length of stockinette for this procedure.

Technique

  • See: General Splinting Technique
  • Patient position
    • If possible, have the patient seated or standing to optimize access
    • Elbow is bent to 90°
  • Stockinette
    • Place the splint material inside the 6 foot length of stockinette
    • Pull the stockinette to the end of the splint so all the slack is on one side
  • Apply generous cast padding especially in the axilla
  • Splint application
    • Apply the splint starting high in the axilla or above the fracture site
    • Avoid causing discomfort or compression of the sensitive soft tissues or neurovascular structures
    • Provisionally secure with cast padding at the middle of the arm, then the elbow
    • Place the loose end of the stockinette around the neck
  • Wrap the splint with more cast padding
  • Then apply the ace wrap to definitively secure the splint
    • Wrap around the arm and the splint
  • Apply the desired mold
  • Complete the stockinette into a sling, sometimes called a cuff and collar

Pearls and Pitfalls

  • An abdominal pad can be placed in the axilla to prevent direct compression from the splint
  • Coaptation splints have a reputation for being poorly made and sliding down the arm
    • The key to preventing this is to ensure that the splint comes above the arm and up onto the shoulder
  • During the application process, have the patient turn head to contralateral side
    • This prevents the neck from pushing down on the splint during the application process
  • Optional: place a cast padding wedge under the arm to counteract varus displacement of the fracture
  • Optional: A posterior slab can be added to control elbow for more distal fractures

Aftercare

  • Try to elevate extremity for the first few days to prevent more swelling
  • Advise patient to keep cast or splint clean and dry
  • Do not insert objects into splint/ cast
  • Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
  • Seek further care if unable to control pain at home
  • Typically converted to a sarmiento brace 1-2 weeks after the injury as the patients pain permits

Complications

  • Plaster burn/ thermal injury
  • Pressure sores
    • The epicondyles and olecranon process are particularly vulnerable.
  • Nerve palsy
    • Use extra padding to protect the subaxillary area.
    • The ulnar nerve is vulnerable to compression at the posterior lateral epicondyle
    • The radial nerve is vulnerable at the anterior medial epicondyle.
  • Vascular compromise
    • The axillary/brachial artery is vulnerable to compression from bone fragments, swelling, or splinting.
  • Splint dermatitis
  • Permanent joint stiffness

See Also


References

  1. Image courtesy of wikiem.org
  2. Image courtesy of aliem.com, "SplintER Series: A Case of Arm Pain"
  3. Lightsey IV, Harry M., Caleb M. Yeung, and Arvind von Keudell. "A Brief Guide to Initial Management of Orthopedic Injuries in the Emergency Department." The Orthopaedic Journal at Harvard Medical School 20 (2019): 52-61.
  4. Altman, Kyle M., Gregory K. Faucher, and M. Christian Moody. "Technique Spotlight: Nonoperative Management of Humeral Shaft Fractures." Skeletal Trauma of the Upper Extremity. Elsevier, 2022. 264-269.
  5. Harris, Andrew P., et al. "Modified coaptation splint with sugar tong intrinsic plus extension for initial management of wrist drop." The American Journal of Emergency Medicine 3.34 (2016): 659-663.
Created by:
Jesse Fodero on 14 July 2019 20:27:04
Authors:
Last edited:
14 June 2023 17:46:56
Category: