Emergency spica, meta and back splints of newspaper: an economical way to manage fractures, luxations

My experience with using newspaper to make spica, meta and back splints spans more than 30 years, but I still encounter many practitioners unfamiliar with these techniques. Because of continued success with them and the present economic climate that focuses on whatever is practical and economical, it seems a good time to discuss these procedures again.

When faced with fractures of the humerus or femur, I was taught that it was best to let the dog or cat rest in a cage and not to try to splint them until surgery could be performed. While some still choose to do that, what we know today about pain management tells us that even small movements can cause intense pain and muscle spasm. When the fracture is not immobilized, there is a continued risk for further neurovascular compromise or injury.

Therefore the very old tenets, "splint them where they lay" and "include the immobilization of both the joint above and the joint below the fracture," are still valid — when they can be accomplished safely.

And they usually can be done safely, effectively and economically — even with fractures of the humerus and femur — with newspaper spica splints. (Click here for a step-by-step image gallery.)

Indications for the use of newspaper splints are listed here.

Materials needed to construct newspaper splints include 1-in. or 2-in. adhesive tape, three to six rolls of 3-in. to 6-in. cast padding, a stack of newspaper, three to six rolls of 3-in. to 6-in. brown gauze (preferred over white stretch gauze) and some type of flexible outer wrap material.

Quick emergency application of newspaper splints, taking only two to three minutes, can be used in obvious extremity fractures to provide immediate temporary immobilization to prevent further soft-tissue and neurovascular injury. These require only the newspaper, a few strips of adhesive tape and possibly some gauze used to bind the newspaper to the limb. Radiographs can then be taken through these to assess the fracture without loss of much detail but with the prevention of additional injury from unstable fracture ends.

Before splint application it is important to first sedate and provide analgesia, particularly after recent trauma if pain is clinically apparent or anticipated. Emergency patients that are obtunded and remain unresponsive after beginning manipulation of the affected limb are exceptions.

In cases where some closed reduction of a fracture will be attempted prior to the splint's application, general anesthesia and muscular relaxation, along with the analgesia, will be needed prior to any limb manipulation.

I also recommend clipping and inspecting the fracture area to assess the skin for penetration. This does not curtail use of the splint but signals the need for additional care (debridement, dressing application) and possible creation of a trap door in the splint to allow wound inspection and treatment.

Regional or epidural anesthesia and analgesia as well as continuous Doppler blood-flow audio monitoring also are helpful and recommended. Application of most newspaper splints can be accomplished within 30 minutes.

Newspaper spica splints

Pectoral limb ("shoulder spica") and pelvic limb ("hip spica") newspaper splints span the entire limb, beginning at the level of the vertebral column and ending near the bottom of the toes. They usually are applied for temporary immobilization of joints above and below fractures, including those of the humerus and femur, until open reduction and rigid internal fixation can be achieved.

They have been used successfully for "definitive" fracture immobilization when owners were not willing or able to have the fracture treated with surgery and displacement of the fracture ends is not severe.

They provide enough immobilization to allow fracture healing with replacement being done as needed. Most last at least several weeks, with a range of one to six weeks, depending on the degree of general splint care the owner provides.

To help apply shoulder spica splints to large, heavy patients that have been sedated or anesthetized, patients can be positioned in lateral recumbency with the affected limb up and with part of the body resting on a gurney and part on a table of similar height. The gurney is then positioned so that the shoulder area can be accessed 360 degrees. To keep the patient from slipping between the table and gurney, either apply duct or other tape to hold the patient in place or have two assistants hold the patient.

Newspaper meta splints

These are used to immobilize the distal radius, carpus, metacarpal and phalangeal bones of the foot. The splint is made by taking a bar section of newspaper and folding it so as to make a trough or gutter that is later applied to the posterior aspect of the pectoral limb.

The splint should extend from the distal end of the second pharynx of the middle two toes, proximally to just distal to the elbow joint. The applied meta splint extends from the toes distally to the elbow proximally.

As mentioned earlier, quick emergency application, using only a few strips of tape and possibly some brown gauze, is an excellent splint to apply prior to taking radiographs of patients with suspected fractures of radius and ulna because it prevents additional injury during film process. Application of this type of splint has been taught in pet first-aid classes, and owners have remarked how they even have used the technique on human fractures as well.

In radial fractures involving their diaphyseal section or up to the proximal one-third section, an extended meta splint to immobilize the elbow can be attempted. In this case the newspaper is brought proximally to the level of the midsection of the humerus.

Newspaper V or tent splints

These splints usually are indicated for spinal-column immobilization when faced with suspected fracture and luxation or subluxation where displacement has not been significant. It is recommended to span as many vertebra to each side of the injury as possible, with five or six being ideal.

The keys to providing enough resistance to bending by the body are to add a second V support "beam" (by taping) to the section of the V splint at its peak, and adding a tight roll of newspaper to each side of the V.

These same additions to increase structural strength and integrity can be used in spica and meta splints, too, if necessary. They are particularly helpful in working with large animals.

Application is similar to that of the newspaper meta splint.

Take care, however, not to bind the splint so tightly to the body that breathing is impaired. Apply 2-in. or 3-in. adhesive tape or other adhesive bandage material at the splint ends so that it is partly on the patient's hair and partly on the splint, keeping it from slipping.

Follow-up care

Radiographs can be taken through the newspapers to assess fracture alignment and healing. Re-check exams are recommended the first day after application and then at least weekly (in those that are going to be used for long-term treatment of the fracture). This is to ensure that there is no problem with circulation, slippage, wetness, odor or loosening that would compromise immobilization.

It is essential that splints do not get wet.

If some weakness is noted, more newspaper layers can be added. Loosening sometimes can be corrected by applying more outer adhesive bandage product.

Questions? Call Crowe at (706) 296-7020 or e-mail him at traumadoc@dtimcrowe.com