Authors of section


Florian Gebhard, Phil Kregor, Chris Oliver

Executive Editor

Chris Colton, Richard Buckley

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Temporary long leg splint

1. Principles

General considerations

Long leg splintage is a useful technique for temporary immobilization of a fracture involving the distal femur. It can be used in the emergency room to immobilize the limb of a patient with an isolated injury.

It can also be used as a temporary aid to fracture stabilization in the multiple injured patient.

Care should always be taken with any splint to protect pressure areas, such as the Achilles tendon, lateral and medial malleoli and the heel, as ulceration in these areas can be extremely difficult to treat.

Fixed splints should not be applied to patients that have other pathological conditions in the lower limb, neurological compromise that causes sensory defects, such as spinal injury, or diabetes with peripheral neuropathy, or in patients who are unconscious.

Types of splint

The splint is both inexpensive, and both easy and quick to apply. It is not possible, however, to obtain good three point immobilization of distal femoral fractures with any splint. The conical shape of the thigh will not allow for close apposition of a splint.

For treatment of distal-femur fractures alone the ankle does not need to be immobilized and therefore a cylinder splint can be used. If there is an ipsilateral ankle, or foot, fracture, the long leg cylinder splint can be converted to one that incorporates the ankle and foot. A cylinder long leg splint is described here, as it is the most commonly used.

2. Splint application

Manual traction

A preliminary reduction of the distal femoral fracture is performed. An assistant is needed to provide manual traction through the ankle while the splint is being applied.

long leg cast then hinged knee brace

Splint padding

With the leg under manual traction and the knee flexed 20°, ample splint padding is then placed around the leg. The padding starts at the supramalleolar region and extends up to the top of the thigh. It is important to make this several layers thick above the ankle and at the upper thigh to reduce the risk of pressure problems in these areas.

temporary long leg splint

12.5 cm wide plaster slabs are used medially, laterally, and posteriorly. Medially and laterally, 5 layers of plaster are used. Posteriorly, 10 layers of plaster are used. The plaster is wetted, placed on the leg and then secured with additional cast padding and elastic bandages.

temporary long leg splint

While the plaster is drying supracondylar molding is performed and held until the splint material is hard.

temporary long leg splint

Elastic bandage

The elastic bandage should not be placed too tightly around the leg. The advantage of the non-circumferential splint is that it allows for swelling and it is therefore ideal during the early days following a fracture.

complete articular fracture multifragmentary articular

3. Aftercare following long leg splint application

The splint is intended for provisional stabilization and can be used for up to 2-3 weeks. In general, it is taken off in the operating room before operative management. In the rare case of definitive nonoperative treatment, it can be converted to a long leg cast at 1-2 weeks, after the swelling has subsided.

Thrombo-embolic prophylaxis
Consideration should be given to thrombo-embolic prophylaxis, according to local treatment guidelines.