Splints

General Principles

Splint, don't cast, in the ED — accommodates swelling and reduces compartment-syndrome risk.
Layers: stockinette → cotton padding (overlap 50%) → plaster/fiberglass (8–10 layers UE, 12–15 LE) → elastic wrap (not too tight).
Use lukewarm water — hot water causes thermal burns under setting plaster.
Mold with palms (not fingertips) and hold position until set.
Document neurovascular exam BEFORE and AFTER application.
Discharge instructions: elevation, ice over splint, no weight-bearing unless specified, return precautions for numbness, increasing pain, color change, or splint problems.

Open fractures → IV antibiotics, tetanus, urgent ortho.
Neurovascular compromise → emergent reduction & ortho consult.
Compartment syndrome (pain out of proportion, pain with passive stretch) — do NOT splint over a tense compartment.
High-energy mechanism, suspected Lisfranc, scaphoid, or hip fracture → low threshold for advanced imaging.