Comminuted humeral shaft fracture

1. Patient A

Image 2. Author’s annotation. Case courtesy of Piotr Gołofit, Radiopaedia.org, rID: 46128

Comminuted humeral shaft fracture. Traditionally, these are splinted using a coaptation splint. This is placed with the elbow in 90 degrees of flexion, with the origin in the axilla and then extending to the acromion or over both shoulders. The softer part of the splint materials can also be continued to join it into a sling [1]. However, more recent, albeit limited, studies show that functional humerus braces can be as effective in fracture immobilization and result in better functional outcomes [2-4].

Supracondylar fracture

2. Patient B

Image 3. Author’s Annotation. Case courtesy of Naim Qaqish, Radiopaedia.org, rID: 73315

Supracondylar fracture. There are 2 reasonable splint choices here. The first is a double sugar tong splint. In this case, the first sugar tong is placed from the elbow to wrist and the second extends from the proximal humerus around the elbow. This splint provides excellent control over supination and pronation and is generally preferred in fractures that are unstable or complex. The second splint, and the better choice in this patient, is a posterior long arm splint which extends from the proximal humerus to distal forearm. This splint is better tolerated by patients and is preferred in simple fractures that demonstrate stability [1,5].

Distal radius fracture

3. Patient C

Image 4. Author’s Annotation. Case courtesy of Bruno Di Muzio, Radiopaedia.org, rID: 36732

Distal radius fracture with extension into the radiocarpal joint. Given that this is an isolated distal radius fracture it can be splinted with a single sugar tong splint. This splint will limit, but not completely eliminate supination and pronation. More complex fractures, specifically those with a radial-ulnar component should be further immobilized using a double sugar tong splint. Conversely, isolated radial injuries without an intra-articular component can be effectively immobilized using a volar splint or wrist brace [1,5-6].

Scaphoid fracture

4. Patient D

Image 5. Author’s Annotation. Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 18269

Scaphoid fracture. This is most appropriately splinted with a thumb spica splint which originates at the mid-forearm and wraps around the thumb. This splint can also be used in fractures of trapezium, lunate, and first metacarpal [1,5,7].

• Pearl: A scaphoid fracture may not be immediately apparent on plain film. Patients with a high index of suspicion should also be placed in a thumb spica splint and have repeat xrays in 1-2 weeks [6].

Distal third metatarsal fracture

5. Patient E

Image 6. Author’s Annotation. Case courtesy of Mohammad Osama Hussein Yonso, Radiopaedia.org, rID: 93486

Distal 3rd metatarsal fracture. There are two options to splint this fracture. The first is a volar wrist splint, which extends from the middle of the forearm to the distal metacarpals. This splint is generally more applicable to proximal metacarpal or carpal fractures. In this case, a radial gutter splint is more appropriate because it reduces the articulation between the distal metatarsal head and the proximal phalanx. This is accomplished by a splint that extends from the mid-forearm all the way to the distal phalanx [1,5,8].

Distal fifth metacarpal fracture

6. Patient F

Image 7. Annotation by Author. Case courtesy of Mohammad Osama Hussein Yonso, Radiopaedia.org, rID: 93173

Distal 5th metacarpal fracture. This is best splinted with an ulnar gutter splint, which extends from the mid-forearm to the distal phalanx of the 4th and 5th digits, with the MCP joint in 70-80 degrees of flexion. Similar to the radial gutter splint, this splint reduces the articulation between the distal metacarpal and proximal phalanx. 

• Pearl: Proximal phalanx fractures can be treated similar to distal metatarsal fractures: via radial or ulnar gutter splints. In contrast, distal phalanx fractures are treated with buddy taping or aluminum U splints, though read here for common complicating factors [1,8,9].