What is the Difference Between a Splint & a Cast?

Instructor: Lisa Cauthen

Lisa is a Registered Nurse with a 14 years of experience and a Masters Degree in Nursing Education. She has certifications in CPN, ACLS, PALS, and NRP.

Both splints and casts are used to stabilize injuries while the body heals. So why choose one over the other? This lesson will review splints and casts including the reasons for use, materials, and pros and cons of each.

What's the Difference Between a Splint & a Cast?

Medical professionals working in urgent cares and emergency departments care for countless patients with musculoskeletal injuries such as sprains and fractures. Some will be sent home with a splint while others will receive a cast. Some patients, like six-year-old Paige, have injuries that are treated with both a splint and a cast. Splints and casts both provide a stabilizing and protective environment for healing, but the reasons for choosing a splint instead of a cast, or vice-versa, can be very meaningful. Here we will follow Paige's story as we learn more about splints and casts, including reason for use, materials, and pros and cons of each.

Paige

Paige fell from the monkey bars at the playground and broke her right forearm. She was seen at the orthopedic urgent care in town and placed first in a splint. At her follow up a week later, the splint was removed and she was placed in a cast. She wore this for six weeks until it was removed and another splint was placed. After two weeks in that splint, she was declared healed and all supportive materials were removed and she was released to return to full gymnastics activity. Paige's story illustrates how neither a splint or cast is better than the other, but either can be the better choice depending on the circumstances.

Splint

A splint is a device designed to immobilize an area of the body to allow for healing. Splints are frequently used with soft tissue injuries such as a sprain, overuse injuries like tendonitis, and traumatic injuries such as joint dislocation or complex bone fractures. Fractures such as open, displaced, or those needing surgery where large amount of swelling is expected would be appropriately treated with a splint.

Materials

Splints can be custom made or preformed. Custom splints are often made with plaster, fiberglass, or aluminum, each secured with an elastic or self-adhesive wrap. Preformed splints are often made of hard plastic and Velcro. These can include the air splints (or air casts) and walking boots.

Pros

Splints permit swelling, potentially preventing neurovascular compromise, a reduction of blood flow to the injured part of the body. There are preformed splints for nearly every part of the body available for purchase at retail stores. This can allow for treatment of an injury without a visit with a medical provider.

Cons

A preformed splint, such as those bought off the shelf, does not provide the same level of immobilization as a custom built one. In addition, all splints can be removed which can delay healing and potentially cause further damage to the body. Although it was listed as a pro, it is also a con that many splints can be bought over the counter and a visit with a medical provider is not necessary. This could lead to improper treatment or even further damage to an injury.

Paige's Splint

After a cotton arm covering was placed to protect her skin, Paige's custom splint was crafted out of plaster and secured with a self-adhesive wrap. The provider chose to place her arm in a custom splint because it was a new traumatic injury and he (the provider) wanted to ensure that there was room for swelling without risking a reduction of blood flow to her hand and fingers (neurovascular compromise). Because she fractured both bones in her forearm, Paige's splint extended from her fingers to above her elbow to prevent any movement of either of those bones. A preformed splint would not have allowed for that much immobility.

Cast

A cast is the treatment of choice in fractures where a minimal amount of swelling is expected. These include closed fractures (where there is no open wound), fractures that are non-displaced (haven't moved within the body) and in situations after a displaced fracture has been reduced (put back in the right place). In more complicated fracture cases such as Paige's, a splint may be placed initially followed by a cast after the swelling has subsided.

Materials

Casts today are usually made of either fiberglass or plaster of Paris. Fiberglass casts are lighter, stronger and more breathable than plaster casts; however, fiberglass is a skin irritant and can cause some adverse reactions. Plaster can be molded more uniformly and may be preferred in the case of a fracture reduction.

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