Posterior Short Leg Splint

Other Names

• Posterior Ankle Splint
• Posterior Slab
• Posterior Short Leg
• Short-Leg Posterior Splint
• Posterior short leg with side gussets

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Depiction of distribution of splint

Posterior Short Leg Splint

Posterior short leg splint (light green) with stirrup (dark green).

Novel splinting to prevent pressure ulcers. Image showing 2 small rolls of Webril (Covidien, Mansfield, Massachusetts) placed posterior to the heel between the Webril padding and splint material (A). After an elastic bandage is applied and the splint hardens (B), the ACE wrap is windowed to allow the 2 small rolls of Webril to be removed (C). The ACE wrap is readjusted back to its original position (D)

Background

• This page describes the posterior short leg splint
• Splinting technique which generally can immobilize pathology at
  • Ankle
  • Foot
• Can be administered with Stirrup Splint
  • Provides significantly more medial and lateral stability

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Indications

Stable Injuries

• Ankle
  • Ankle Sprain if severe enough
  • Distal Fibula Fracture
  • Distal Tibia Fracture
  • Achilles Tendon Rupture (in slight plantar flexion)
• Foot
  • Stable Tarsal Fracture
  • Stable Lisfranc Injury
  • Metatarsal Fracture

Unstable requiring addition of Stirrup Splint

• Ankle
  • Ankle Fracture (& Dislocation
  • Subtalar Dislocation
• Foot
  • Unstable Lisfranc Injury

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Contraindications

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

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Procedure

Equipment

• See: Splinting Materials

Preparation

• Document pulse, motor, sensation
• Measure plaster length
  • Start: 2 inches below fibular head (avoid common peroneal nerve
  • End: Plantar surface of metatarsal heads
  • Can extend to end of digits but must have exposure of toes dorsally
  • Use 10-15 layers for lower extremity

Technique

• Number of people
  • Typically, at least 2
• Patient Position
  • Knee is bent to 90°
  • Ankle is at 90° (unless achilles tendon rupture, then 60-70°)
• Stockinette
  • Apply stockinette slightly longer than desired splint length
• Web roll/ cotton padding
  • Apply cotton padding starting proximally and working distally
  • Apply extra padding around calcaneus
• Splint material
  • Immerse splinting material in lukewarm water, squeeze out excess water
  • Apply plaster from just below fibula head to metatarsal heads
  • Add stirrup at this time if indicated
• Can apply more cast padding, then ace wrap
• Hold in place until hardened
• Be certain to leave toes exposed for neurovascular examination
• Reassess pulse, motor, sensation

Pearls and Pitfalls

• Splint is much easier to apply if patient is prone
• If injury is unstable, holding reduction is key during splinting and hardening process

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Aftercare

• Typically non-weight bearing until re-evaluated
• 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

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Complications

• Acute Compartment syndrome
• Plaster burn/ thermal injury
• Pressure sores
• Nerve palsy
• Vascular compromise
• Splint dermatitis
• Permanent joint stiffness
• Skin infection
  • Cellulitis from underlying wound, pressure ulcers

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See Also

• Splinting Main
• Procedures Main

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