Background

Posterior long leg splinting is used to stabilize injuries by decreasing movement and providing support, thus preventing further damage. Splinting also alleviates extremity pain, edema, and further soft tissue injury and promotes wound and bone healing. Splints can be used for immobilization of an extremity before surgery or as a temporizing measure before orthopedic consultation.

Splints, rather than circumferential casts, are often the treatment of choice in the emergency department (ED) because they allow for continued swelling and thus are associated with a lower risk of compartment syndrome. Follow-up for definitive care with an orthopedist should occur 1-5 days after splint application.

In addition to immobilization, posterior long leg splinting may offer additional benefits specific to the particular injury or problem being treated. Examples include the following:

• Splinting deep lacerations that cross the knee joint reduces tension on the wound and helps prevent wound dehiscence
• Immobilizing tendon lacerations may facilitate the healing process by relieving stress on the repaired tendon
• The discomfort of inflammatory disorders such as tenosynovitis or acute gout is greatly reduced by immobilization
• Cellulitis over the joint should be immobilized for comfort
• Limiting early motion also may reduce edema and, theoretically, improve the immune system’s ability to combat the infection
• Patients with multiple traumatic injuries should have fractures and reduced dislocations adequately splinted while other diagnostic and therapeutic procedures (eg, focused assessment with sonography for trauma [FAST] examination or computed tomography [CT]) are completed; immobilization decreases blood loss, minimizes the potential for further neurovascular injury, decreases the need for opioid analgesia, and may decrease the risk of fat emboli from long bone fractures^[1]

Indications

Posterior long leg splinting is indicated for the immobilization and support of various knee injuries.^[2] In many EDs, the use of prefabricated knee immobilizers has replaced traditional posterior long leg splinting^[3] ; however, the plaster long leg splint remains particularly useful when knee immobilizers are unavailable and in the following situations^[1] :

• Extremities that are too large for knee immobilizers
• Treatment of angulated fractures
• Temporarily immobilization of knee injuries that require immediate operative intervention or orthopedic referral

Contraindications

There are no absolute contraindications for posterior long leg splinting. However, there are some situations that, though not constituting contraindications, are likely indications for surgical intervention, in which case splinting is only a temporary treatment. Examples include the following:

• Multiple or complicated fractures
• Open fractures
• Injuries associated with neurovascular compromise