Overview
Treating fractures non-surgically requires choice of an immobilising device, depending on the type of injury. In general, acute injuries benefit from a backslab (splint), which allows for swelling while stabilising a joint or fracture, which is replaced later with a more immobilising cast.
Upper limb
Phalangeal fractures
Remove splints/casts after 4-6 weeks.
Refer all intra-articular fractures or unstable fractures.
Metacarpal fractures
- Thumb (digit 1): thumb spica splint.
- Fingers (digits 2-5): dorsal/volar forearm splint with buddy taping.
- Intraarticular or unstable fractures: refer.
Remove splints after 4-6 weeks.
Carpal fractures
- Undisplaced carpal fractures: below elbow splint extended to the metacarpal heads for 6 weeks and refer to physio and OT.
- Displaced, intraarticular or unstable fractures, and all lunate and scaphoid fractures: refer due to high risk of nonunion.
Radial & ulnar fractures
Humeral fractures
Lower limb
Tarsal, metatarsal & phalangeal fractures
- Distal metatarsal fractures: below knee cast/splint for 4-6 weeks.
- Phalangeal fractures: buddy strapping to the adjacent uninjured toe.
- Undisplaced tarsal & metatarsal shaft fractures: below knee cast/splint for 4-6 weeks.
- Intra-articular or unstable fractures: refer. Obtain a standing X-ray to assess for instability and displacement of tarsal or tarso-metatarsal fractures and dislocations to exclude a Lisfranc injury.
Tibial & fibular fractures
- Ankle fractures: below knee cast for 6-8 weeks.
- Fibular fractures: below knee splint for 6-8 weeks.
- Tibial or tibia & fibula fractures, use an above knee cast/splint for 6-8 weeks and then convert to a below knee cast, patella bearing for another 6-8 weeks.
- Intra-articular, unstable or displaced fractures: refer.
References
- Boyd AS, Benjamin HJ, Asplund C. Splints and Casts: Indications and Methods. Am Fam Physician. 2009 Sep 1;80(5):491-499. Available from: https://www.aafp.org/afp/2009/0901/p491.html
- Held M. Orthopaedics for Primary Health Care. Available from: https://www.ortho.capetown/primary-care-orthopaedics