Splinting Principles and Devices: Rigid, Formable, Vacuum, and Traction Splints and Positions of Function Practice Questions

25 multiple-choice questions on Splinting principles and devices: rigid, formable, vacuum, and traction splints and positions of function for paramedic and EMT students, from Chapter 38 (Orthopaedic Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Which is NOT a goal of prehospital splinting of a fracture?

   1. A. Reducing the fracture to normal
   2. B. Reducing pain from bone movement
   3. C. Preventing a closed fracture opening
   4. D. Limiting damage to vessels and nerves
   Show answer

   Answer: A. Reducing the fracture to normal

   Splinting immobilizes the injury to limit pain, bleeding, and further damage to soft tissue, vessels, and nerves, and to keep bone ends from piercing the skin. Anatomic reduction of a fracture is definitive care done in the hospital, not a field goal.

2. When splinting a midshaft fracture of the forearm, the splint should immobilize:

   1. A. The fracture site itself
   2. B. The wrist and the elbow
   3. C. The elbow and the shoulder
   4. D. The wrist and the fingers
   Show answer

   Answer: B. The wrist and the elbow

   A long-bone fracture is immobilized by including the joint above and the joint below, which keeps the fragments from moving. Splinting the fracture site alone lets muscle pull and joint motion shift the bone ends.

3. When splinting an injured elbow, the splint should immobilize:

   1. A. The humerus and forearm bones
   2. B. The elbow joint by itself
   3. C. The wrist and the hand
   4. D. The shoulder and the clavicle
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   Answer: A. The humerus and forearm bones

   For a joint injury, the bones above and below the joint are immobilized so the joint cannot move. Splinting the joint alone allows the long bones to act as levers on it.

4. A 30-year-old has an angulated closed fracture of the midshaft humerus with intact PMS. Your protocol calls for realigning angulated long-bone shaft fractures to ease splinting. You should:

   1. A. Push the bone ends firmly into place
   2. B. Rotate the arm to check for crepitus
   3. C. Keep pulling past severe resistance
   4. D. Apply gentle traction along the bone
   Show answer

   Answer: D. Apply gentle traction along the bone

   Realignment uses gentle, steady manual traction along the long axis of the bone while a partner supports the limb above the fracture, which brings the shaft back toward its normal line, eases splinting, and often relieves pain; a humerus is then usually secured with a sling and swathe or a padded rigid splint. Recheck PMS afterward. Pushing the bone ends into place uses force across the fracture and can tear the radial nerve, which lies against the humeral shaft. Rotating the arm to feel crepitus causes pain and adds nothing. Resistance or a sharp increase in pain means stop and splint the limb in the position reached; pulling through it can injure vessels and nerves. Note that some protocols splint a fracture with intact PMS as found, so follow local protocol.

5. A 45-year-old has a deformed, painful knee held in flexion with a strong distal pulse and normal sensation. You should:

   1. A. Straighten the knee before splinting
   2. B. Apply a traction splint to the leg
   3. C. Splint the knee in the position found
   4. D. Have her bear weight to test stability
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   Answer: C. Splint the knee in the position found

   Joint injuries with intact distal PMS are splinted as found, because moving them can damage the vessels and nerves that run close to the joint. A traction splint is contraindicated for knee injuries.

6. An open tibia fracture has a bone end protruding from the wound. Before splinting, you should:

   1. A. Push the bone end back under the skin
   2. B. Irrigate the bone with tap water
   3. C. Cover it with a sterile dressing
   4. D. Leave the wound open to the air
   Show answer

   Answer: C. Cover it with a sterile dressing

   Cover the exposed bone with a sterile, moist or dry dressing to limit contamination, then splint. Deliberately pushing bone back in drags contaminants deep into the wound; if it retracts during realignment, tell the hospital.

7. After you splint a knee, the patient reports numbness on the top of his foot and cannot lift his toes. A splint pressing just below the outside of the knee may be compressing the:

   1. A. Peroneal (fibular) nerve
   2. B. Femoral nerve in the groin
   3. C. Radial nerve of the arm
   4. D. Sciatic nerve in the buttock
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   Answer: A. Peroneal (fibular) nerve

   The peroneal nerve wraps around the head of the fibula just below the lateral knee, where it is easily compressed by splints, straps, or casts, causing foot drop and numbness on the top of the foot. Pad this area and loosen the device. The other nerves are not at this location.

8. Splints should be padded mainly to:

   1. A. Keep the limb warm
   2. B. Compress swelling at the fracture
   3. C. Let the straps be applied loosely
   4. D. Fill voids and pad bony areas
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   Answer: D. Fill voids and pad bony areas

   Padding fills spaces between the limb and the splint so the limb cannot shift, and it prevents pressure injuries over bony prominences. It is not meant to keep the limb warm or to compress swelling, and padding does not replace securing the splint; the straps still need to be snug.

9. A splint made of a malleable aluminum sheet with foam lining, which can be shaped to the limb, is an example of a:

   1. A. Traction splint
   2. B. Formable splint
   3. C. Vacuum splint
   4. D. Air splint
   Show answer

   Answer: B. Formable splint

   Formable splints such as SAM-type and ladder splints can be molded to an angulated limb. A vacuum splint also conforms but becomes rigid when air is removed from a bead-filled chamber.

10. A vacuum splint is especially useful for:

    1. A. Midshaft femur fractures
    2. B. Deformed joint injuries
    3. C. Pelvic ring fractures
    4. D. Rib fractures in adults
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    Answer: B. Deformed joint injuries

    Bead-filled vacuum splints mold to the limb in its found position and then become rigid, which suits angulated joint injuries. Midshaft femur fractures usually call for a traction splint.

11. A pneumatic (air) splint has a significant disadvantage because its pressure:

    1. A. Stays constant in all conditions
    2. B. Cannot be adjusted once applied
    3. C. Is too low to support any bone
    4. D. Varies with altitude and heat
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    Answer: D. Varies with altitude and heat

    Air expands at altitude and with warming and contracts in cold, so the splint may become too tight or too loose; check it frequently, especially in aircraft. It also cannot conform to angulated injuries.

12. The position of function for an injured hand is:

    1. A. Fingers gently curved over a roll
    2. B. Fingers fully straight and spread
    3. C. Hand clenched into a tight fist
    4. D. Wrist fully flexed toward the palm
    Show answer

    Answer: A. Fingers gently curved over a roll

    Placing a roll of gauze in the palm keeps the wrist slightly extended and the fingers gently flexed, which protects the tendons and joints. A tight fist or full flexion stresses those structures.

13. A 50-year-old has a fractured clavicle after a bicycle crash. The most appropriate immobilization is:

    1. A. A traction splint
    2. B. A long padded board
    3. C. A sling and swathe
    4. D. A rigid cervical collar
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    Answer: C. A sling and swathe

    A sling supports the arm's weight and a swathe binds it to the chest to limit shoulder motion. A long board cannot immobilize the shoulder girdle effectively.

14. Before applying a traction splint to a midshaft femur fracture, you should size the splint against the:

    1. A. Injured leg as it lies
    2. B. Patient's uninjured leg
    3. C. Patient's stated height
    4. D. Length of the long board
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    Answer: B. Patient's uninjured leg

    The fractured thigh is shortened by overriding bone ends and muscle spasm, so the splint is measured against the uninjured leg, from the ischial tuberosity or groin to beyond the heel as the device directs. Sizing it against the injured leg as it lies makes the splint too short to restore length. A patient's height does not give the length of the leg. The long board's length has nothing to do with the leg and would make the splint far too long.

15. A 20-year-old has a midshaft femur fracture and an obviously deformed ankle on the same leg. You should:

    1. A. Use a rigid splint on that leg
    2. B. Apply a traction splint at once
    3. C. Pad the ankle hitch more thickly
    4. D. Put traction on the opposite leg
    Show answer

    Answer: A. Use a rigid splint on that leg

    An ankle or lower leg injury is a contraindication to a traction splint on that leg because the ankle hitch pulls through the injured joint. Use a rigid or long-board splint instead; extra padding does not remove the traction force.

16. Which injury is a contraindication to applying a traction splint?

    1. A. Midshaft femur fracture in an adult
    2. B. Muscle spasm in the injured thigh
    3. C. A closed femur fracture in a teen
    4. D. Partial amputation of the lower leg
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    Answer: D. Partial amputation of the lower leg

    Traction can complete the separation of a partial amputation or avulsion. Muscle spasm in the thigh is actually one of the reasons a traction splint helps.

17. When applying a splint, the patient's skin should be checked afterward for:

    1. A. The color of the splint material
    2. B. The length of the straps used
    3. C. Pressure points and circulation
    4. D. The brand of padding applied
    Show answer

    Answer: C. Pressure points and circulation

    Reassess distal PMS and look for tight straps or pressure points that can cause ischemia or skin breakdown. Checking only the device ignores the limb it protects.

18. In a critically injured trauma patient with multiple fractures, the most efficient way to splint is often:

    1. A. Applying a separate splint to each limb
    2. B. Using air splints on each injured limb
    3. C. Securing the body to a long board
    4. D. Waiting until the patient is stable
    Show answer

    Answer: C. Securing the body to a long board

    In a time-critical patient, a long backboard, scoop, or vacuum mattress immobilizes all injuries at once so transport is not delayed. Splinting each limb individually on scene wastes minutes the patient may not have.

19. A pillow splint is a reasonable choice for:

    1. A. An ankle or foot injury
    2. B. A midshaft femur fracture
    3. C. An unstable pelvic fracture
    4. D. A suspected cervical spine injury
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    Answer: A. An ankle or foot injury

    A pillow wrapped around the ankle and secured with straps immobilizes it comfortably in place. A pillow cannot provide the support needed for a femur or pelvis. A suspected spine injury needs spinal motion restriction, not a pillow.

20. After splinting an injured extremity, which measure will further reduce swelling and pain?

    1. A. Heat packs and massage
    2. B. Keeping the limb dependent
    3. C. Frequent range-of-motion tests
    4. D. Cold packs and elevation
    Show answer

    Answer: D. Cold packs and elevation

    Cold limits bleeding and swelling, and elevating a splinted limb improves venous return. A dependent limb accumulates more swelling.

21. When realigning a long-bone fracture, you should stop and splint the limb as found if:

    1. A. The patient has a strong distal pulse
    2. B. Pain spikes or you meet resistance
    3. C. The bone fragments line up smoothly
    4. D. Swelling is present at the fracture site
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    Answer: B. Pain spikes or you meet resistance

    Resistance or a sharp increase in pain means further movement may injure vessels, nerves, or soft tissue. Swelling is present with nearly every fracture and is not a reason to stop.

22. At a remote trailhead with no commercial splints, a hiker has a closed lower leg fracture with good distal PMS. The best improvised option is to:

    1. A. Leave it unsplinted until help arrives
    2. B. Pad it and tie it to the uninjured leg
    3. C. Wrap it tightly with an elastic bandage
    4. D. Have him walk out using a crutch
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    Answer: B. Pad it and tie it to the uninjured leg

    The uninjured leg makes an effective anatomic splint: pad the space between the knees and ankles, then tie the legs together above and below the fracture without knots over the injury, and recheck PMS. Leaving the fracture unsplinted lets the bone ends move, adding pain, bleeding, and nerve or vessel damage. A tight elastic wrap does not immobilize the bone and can constrict a swelling limb. Walking out loads the fracture and can displace it or push a bone end through the skin.

23. Why should you avoid securing a splint strap directly over a fracture site?

    1. A. It can push the bone ends together
    2. B. It makes the splint easier to remove
    3. C. It prevents swelling at the fracture
    4. D. It improves distal circulation
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    Answer: A. It can push the bone ends together

    Pressure over the fracture causes pain and can displace fragments or damage soft tissue. A strap over the injury does nothing to improve circulation or limit swelling.

24. When should a patient with a fractured forearm and no life threats be splinted?

    1. A. After transport to the hospital
    2. B. Once in the ambulance moving
    3. C. Before moving the patient
    4. D. Only after IV access is placed
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    Answer: C. Before moving the patient

    In a stable patient, splint the fracture before moving the patient to prevent further injury and pain during lifting and extrication. Waiting until the patient reaches the hospital leaves the limb unprotected through every move, and waiting until the ambulance is moving exposes it to the jostling of the transfer. IV access for analgesia is helpful but should not delay a quick splint; you can splint first and start the line afterward.

25. While your partner applies a rigid splint to a fractured lower leg, your role is to:

    1. A. Grip it firmly right over the fracture
    2. B. Hold the foot and let the knee rest
    3. C. Hold the thigh while the foot rests
    4. D. Steady it above and below the fracture
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    Answer: D. Steady it above and below the fracture

    Manual stabilization holds the limb still by supporting it above and below the injury, so both fragments and the joints next to them move as one unit while the splint is placed and secured. Gripping directly over the fracture is painful and pushes on the fragments. Holding only the foot leaves the upper fragment free to move, and holding only the thigh lets the lower fragment sag and grind at the fracture.