Immobilization of a shoulder with a wire ladder splint

Authors: Rednenko VV, Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• wire ladder splint 120 cm long
• 2 rolls of bandage
• 4 soft pads

• or a wire ladder splint with fixing belts and soft lining

Clinical situation:      

• A casualty has a shoulder injury. Carry out a immobilization of the arm with fixation of the shoulder, elbow and wrist joints with a wire ladder splint

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
• Obtain informed consent to the procedure
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.

Main stage:

• Prepare the splint, laying on it cotton wool and fixing it with a bandage (The splint is usually prepared for work in advance) or take the commercial  wire ladder splint with soft lining
• Model the splint:
  • place the splint along the patient's healthy arm from the fingertips to shoulder joint;
  • put marks on the splint at the levels of elbow and shoulder joints;
  • bend splint at a right angle (90°) at the level of the elbow joint;
  • bend the splint at an obtuse angle (115°) at the level of the shoulder joint .

• Take a comfortable position for this manipulation, If it's possible, use the help of an assistant.
• Ask the assistant to gently slightly lift the injured arm, keeping it in a physiological position

• Place the splint on the injured arm

• Give the physiological position of the hand, inserting in it a bandage roll

• Fix the splint to the arm with bandages or special straps

• Hang the splint with slings or triangular bandage or special  straps

Final stage:

• Check the quality of immobilization.
• Ask the patient about the comfort of the arm position, the presence of discomfort in the immobilized area (pressure on the protruding parts of joints and bones).
• If necessary, put soft pads under these protruding parts