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Long Bone Immobilization (Splinting)

Category: Procedures Sources: raw/nremt/psychomotor-skills.md Last updated: 2026-04-03

Overview

Long bone immobilization uses splinting to stabilize fractures of the long bones — femur (thigh), tibia/fibula (lower leg), humerus (upper arm), radius/ulna (forearm). The same core principles as joint-immobilization apply, with key differences: for a bone fracture, you immobilize the joint above AND the joint below the fracture site. PMS assessment before and after is mandatory.

Key Points

  • Long bones in EMT-B scope for splinting: Humerus, radius, ulna, femur (traction splint for isolated mid-shaft femur), tibia, fibula
  • Immobilization principle for bone fractures: Splint must immobilize the joint above AND the joint below the fracture. For a mid-shaft tibia fracture, the splint must extend from above the knee to below the ankle.
  • Femur fractures — special considerations:
  • Mid-shaft femur fracture may qualify for traction splint (Hare, Sager, or equivalent) — significant blood loss can occur into the thigh (1–2 liters). Assess for shock (see bleeding-control-shock).
  • Traction splint is NOT indicated for: hip fracture, knee injury, open femur fracture, partial amputation. Use standard long splint instead.
  • Angulated fractures: If the fracture is angulated (bent), a gentle, single attempt at realignment toward anatomical neutral is acceptable if distal PMS is absent. If resistance is met or the patient has severe pain, splint in position found.
  • Open fractures: Cover the wound with a sterile dressing before splinting. Do not push exposed bone back in.
  • PMS assessment: Pulse (distal), motor (movement of distal digits), sensation (feeling in distal digits) — before AND after.
  • Padding: Essential. Fill voids to prevent pressure necrosis and maintain position.

Assessment Relevance

Long bone fractures are identified during secondary-assessment — DCAP-BTLS examination of extremities reveals deformity, swelling, tenderness, and crepitus. Baseline PMS is recorded here and becomes the reference for all subsequent checks.

Femur fractures deserve particular attention during primary-assessment due to potential for significant internal hemorrhage. A mid-shaft femur fracture should raise the index of suspicion for developing or existing shock — check vitals and skin signs.

Splinting is not an immediate life-threat intervention. Complete primary-assessment and manage ABCs before applying splints. For priority patients, splint en route.

Procedures

Standard Long Bone Splinting

  1. BSI/PPE.
  2. Expose the injury — cut clothing if needed.
  3. Assess baseline PMS distal to injury: pulse, motor, sensation.
  4. Control any bleeding (open fracture): apply sterile dressing before splinting.
  5. Select splint type and size:
  6. Must span from joint above to joint below the fracture
  7. Rigid board, SAM splint, vacuum splint depending on location and availability
  8. Pad the splint thoroughly — bony prominences, voids at the fracture site.
  9. If the fracture is significantly angulated with no distal pulse: one gentle attempt to realign toward neutral. If resistance or severe pain: stop and splint in position.
  10. Position splint along the limb; maintain traction-in-line if needed.
  11. Secure with bandage wraps from distal to proximal. Snug, not constrictive.
  12. Reassess PMS after application. Compare to baseline.
  13. If PMS worsens: loosen splint and reassess immediately.
  14. Elevate if appropriate; apply cold pack over splint if available.
  15. Document: fracture site, splint type, PMS before and after, time.

Traction Splint (Femur — Mid-Shaft)

Note: Traction splint is a separate but related skill. Indications: isolated mid-shaft femur fracture, no contraindications (see above). Setup and application are device-specific (Hare, Sager) — follow device-specific procedure and ensure adequate training.

Key points: - Secure ankles for traction - Apply traction until pain relief or approximately 10% of body weight - Secure proximal and distal straps - Reassess PMS after application

NM Protocol Notes

  • NM EMT-B scope includes standard long bone splinting and traction splinting for femur fractures.
  • Traction splint devices (Hare or Sager) are standard on NM BLS units.
  • For femur fractures with signs of shock: initiate shock management (bleeding-control-shock) simultaneously with splinting. Do not delay fluid resuscitation attempts (if in scope) or transport for splint application.
  • Open fractures should be dressed sterilely and the patient transported; field wound management beyond dressing is not in EMT-B scope.

NREMT Relevance

Long bone immobilization is a NREMT psychomotor skill station (distinct from joint immobilization). Examiners assess: - PMS assessment before splinting - Splint size: joint above AND joint below the fracture - Adequate padding - Secure but not constrictive wrapping - PMS reassessment after application

Key distinction from joint-immobilization: for bone fractures, you immobilize two joints (above and below the fracture). For joint injuries, you immobilize two bones (above and below the joint). The principle is the same; the landmarks differ.

Common miss: splint that is too short — does not extend to the joints above and below the fracture site.

  • joint-immobilization — closely related; same PMS principle applied to joint vs bone injuries
  • secondary-assessment — fracture identified during DCAP-BTLS extremity exam; baseline PMS recorded
  • bleeding-control-shock — femur fractures can cause significant internal hemorrhage; shock management co-indicated
  • reassessment — PMS check at each vital sign interval during transport

Sources

  • raw/nremt/psychomotor-skills.md — Long Bone Immobilization (Splinting)