Apps provide primer on splinting techniques, but could be improved
This month’s Ortho Apps column, we review two apps that help clinicians place properly formed splints. Orthopedic trainees, emergency staff, ancillary office staff and anyone learning the fine art of splinting will likely find them useful as a primer. While helpful in their current state, they have the potential to be improved. Like splints themselves, these apps are not definitive treatment, but a good start.
Splinting has been a mainstay in orthopedic treatment for centuries. Prior to the advent of internal fixation, splints and casts were some of the reliable means of maintaining fracture reduction. As internal fixation techniques have proliferated, many would contend that the splinting and casting techniques of the average clinician have suffered a commensurate decline. These techniques are no less important today, however, because they often remain the first line of treatment for orthopedic trauma and can have a measurable effect on subsequent definitive care.
Although often learned in a one–on-one environment, splinting is a skill whose acquisition can be aided significantly by visual media. While it is possible to find YouTube videos for different splinting techniques, the advantage of these splinting apps is obvious – time saved in the search for multiple techniques, videos and supportive documentation.
iSplint (free on iTunes) is an app developed by physicians in the Department of Emergency Medicine at George Washington University. It is a simple app that guides the user through the steps of placing seven common upper and lower extremity splints: thumb spica, triple S, radial gutter, dorsal hand, sugar tong upper extremity, posterior ankle and sugar tong lower extremity. Touching the “iSplint” icon on the bottom left of the app takes the user to a menu with the seven listed splint techniques.
Choosing one of the splint types takes the user to a simple menu with choices of “video clip” and “discussion.” The videos run in the 5-minute to 10-minute range, have clear audio and good visual quality, and serve as a solid teaching guide. The instructor does a nice job of taking you through splint placement in each of the videos. The discussion sections gave a link to a brief outline of proper indications, application technique and pictures of the splint technique.
eSplint ($0.99 on iTunes) is another splinting app brought to us by Charles Perkins, “an emergency room nurse.” The app includes a few more splints than iSplint, however, each app covers a few splints specific to the other. There is one menu in this app making it intuitive. Just touch the splint type that you are looking for and the app will take you to an illustrated step-by-step approach to placing the splint. At the end of each description is a short video. The videos in this app are about 90 seconds, which works well for the clinician on the go. They do not contain narration, so some context is lacking. However, when combined with the text descriptions, the videos do a nice job of providing a comprehensive review of each technique. A nice aspect of the app is that it has a section on general splinting technique.
Both apps are good general introductions to most splinting techniques but appear to be focused on emergency room treatment and can be improved for the orthopedic provider. The apps demonstrate splinting techniques with premade fiberglass splints. Although these are widely used, many orthopedic surgeons still prefer plaster and a discussion of merits of plaster vs. fiberglass would be enlightening. Additionally, the emphasis in both apps was on the fiberglass placement. Other issues that deserve mention in proper splinting include the importance of padding and proper molding to hold a reduction.
The eSplint app mentions in the splint technique section that one to two layers of padding should be used. Certainly there are times when more padding may be justified, and neither app demonstrates the application of bulky cotton commonly used for lower extremity fractures. Most orthopedic providers would agree that padding techniques may be one of the more underappreciated, but critical aspects, of splinting.
Additionally, some more points about the difference between placing a splint on an injured patient vs. a model patient should be made. For instance in the eSplint app, the coaptation splint was placed on a woman with her arm 90° abducted. Unless sedated, this is usually not possible. Future editions might show strategies for working under some of these limitations, including the use of assistants, finger traps, prone positioning or “edge-of-bed” techniques.
Overall, these apps give a good overview of multiple basic splinting techniques. At their low cost, they are worth recommending to beginners and ancillary staff tasked with performing the important task of splinting. However, to better appeal to orthopedic providers, we would like to see them include a focus on soft tissue padding, use of plaster, reduction molding and casting.
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Matthew DiPaola, MD, is an assistant professor and shoulder and elbow specialist in the Department of Orthopedics at Wright State University in Dayton, Ohio. He is a writer for iMedical Apps and co-founder of Touch Consult, a developer of team-based medical software to improve signout. He can be reached at firstname.lastname@example.org.
Orrin I. Franko, MD, is a PGY4 orthopedic resident at UC San Diego. He has an interest in promoting mobile technology within orthopedic surgery and founded the website www.TopOrthoApps.com to help surgeons and trainees find the most relevant orthopedic apps for their mobile devices. He can be reached at email@example.com.