A BRIEF SPLINT-TECHNOLOGY FOR SURGEONS. 
BY 
EDWARD A. TRACY, M.D , 
of boston; 
FELLOW OF THE MASSACHUSETTS MEDICAL SOCIETY. 
FROM 
THE MEDICAL NEWS, 
March 17, 1894. [Reprinted from The Medical News, March 17, 1894.) 
A BRIEF SPLINT-TECHNOLOGY FOR SURGEONS1 
By EDWARD A. TRACY, M.D., 
OF BOSTON ; 
FELLOW OF THE MASSACHUSETTS MMMCAL SOCIETY. 
The objects of this paper are to treat in detail 
-of a new material and method devised for surgical 
splint-making; to aid the surgeon to become the 
maker of suitable splints for cases occurring in prac- 
tice; and to indicate lines of procedure in appa- 
ratus-making that promise rich results in general and 
orthopedic surgery. 
The Material.—The basis of the material em- 
ployed is wood-pulp, made preferably from the 
crushed fiber of the poplar tree, and rolled in such 
fashion that the broken fibers intertwine in every 
direction and loosely, so that an increase of plas- 
ticity is thus given to the product. These sheets 
are further strengthened by having a fabric intro- 
duced between the layers of the pulp, or by inter- 
weaving with the short, crushed wood-fiber, a long 
ute or other tough fiber. 
The sheets are rolled of different thicknesses, for 
adaptability to all splint-conditions. For conve- 
nience I shall designate the thickness by number, 
each unit representing a thickness of one millimeter; 
1 An abstract of a paper read before the first Pan-American 
Medical Congress, at Washington, 1893. 2 
thus, sheet i represents the material with a thick- 
ness of one millimeter; sheet 2, with a thickness of 
two millimeters, and so on. 
Characteristics of the Material.—The chief 
characteristics of this material are stiffness or rigid- 
ity when dry, and plasticity when moist. Its rigidity 
can be increased ad libitum by the use of a silicate 
solution as a moistener. Its plasticity has a limit. 
The limit is rarely experienced and only when 
molding the material over certain complex curved 
surfaces. To exemplify: A splint cannot be di- 
rectly molded over the ankle-joint anteriorly, for 
there are two large curves in opposite directions to 
be followed simultaneously, the convex curve from 
malleolus to malleolus, and the concave curve from 
above downward over the leg and instep. This 
difficulty, when met, can be obviated in various 
ways. I shall mention three of them. Take the 
case of the ankle-joint: An anterior splint is re- 
quired for it. The proper-shaped blank should be 
cut from sheet No. 1 and moistened with one of the 
solutions to be described later. It should then be 
applied to the limb, care being taken to keep its 
outer border-in contact with the skin, while the super- 
fluous material over the anterior aspect of the joint 
should be pinched between the thumb and forefinger, 
and all of it laid or pressed over to one side; a 
bandage should be snugly applied to perfect the 
molding of the splint. (This method of “pinching 
and folding over” has an important application in 
the making of spinal jackets.) A second way con- 
sists in cutting away the superfluous material, in this 
case an elliptic figure, and bringing the edges of 3 
the cut portion together, and so retaining them by 
means of a strip of the material pasted over the cut 
edges. A third method is to cut a blank for each 
important curve and, after molding, to properly 
unite them. 
Besides the foregoing characteristics, the material 
possesses that desideratum of a splint-material—ex- 
treme lightness. Its cheapness also deserves a pass- 
ing mention. 
Moisteners.—Water or a stiffening solution can 
be used to moisten the material. The advantage of 
water is its omnipresence. A serviceable splint can 
be made with its help. Such a splint should be 
protected from perspiration or other moisture, lest 
it be softened and its usefulness destroyed. It can 
be so protected by a covering of oiled paper or 
silk, by mackintosh, or best by a coat of varnish. 
A stiffening solution, with several qualities to re- 
commend its use, is that of silicate of potassium ; 
silicate of soda is almost as serviceable. Any de- 
sired degree of rigidity can be imparted to a splint 
by using this solution—the amount of rigidity 
depending on the strength of the solution. A splint 
rendered rigid in this manner is not affected by 
perspiration, or indeed by momentary contact with 
fluids, as in washing. Another advantage, espe- 
cially in cases of compound fracture, is that this 
solution renders the splint antiseptic. 
In practice, the solution of silicate of potassium 
generally sold for surgeons’ use, and further diluted 
with water, can be employed. The commercial 
solution is regarded as a ioo per cent, solution, and 
the percentage solutions spoken of in this paper are to be made by diluting the commercial solution 
with the proportion of water called for by the per- 
centage; thus a 70 per cent, solution is made by 
mixing 70 parts of the commercial solution of sili- 
cate of potassium with 30 parts of water. The 
commercial solution should have a specific gravity 
of from 1.3 to 1.4. 
Another useful stiffening solution is that of dex- 
trin, in the proportion of about §viij to Oj of water. 
This solution adds some tenacity, besides stiffness, 
to the material treated with it. A splint made with 
its aid can be remoistened with water and remolded— 
quite an advantage in cases in which, from disappear- 
ance of swelling or other cause, a closer approxima- 
tion of splint and limb is desired. In practice, 
dextrin (to be had of paint-wholesalers) can be 
carried in powder form, and a solution in water 
extemporized when needed. (An addition of 8 gr. 
of corrosive sublimate to Oj of the dextrin solution 
will render it antiseptic.) 
Moistening Process.—A few descriptive words 
should be added concerning the proper manner of 
moistening the material. The aim should be to get 
barely sufficient moisture into the material to render 
it semiplastic. If more moisture be absorbed, it 
becomes more difficult to maintain the molded 
splint in the desired shape while drying, and it also 
unnecessarily lengthens the time required to dry 
the splint. I find the best manner of moistening 
the splint-blank is to apply the fluid used, on each 
side of it, alternately, by means of a flat paste- 
brush. A little practice will enable one to judge 
4 5 
the precise amount of moistening best suited for 
the purpose. 
Drying. — The time required for drying the 
molded blank varies, for the different sheets em- 
ployed, from ten to forty minutes; the thicker 
sheets, holding the more moisture, require a longer 
exposure to heat. Any source of sufficient heat can 
be employed; a good kitchen fire is very efficient 
and, generally, convenient. While the splint is 
drying it is serviceable to have yarn or string wound 
around the moistened form after its removal from 
the body, to aid it to maintain the desired form, 
until permanent drying fixes it. 
I shall briefly consider the application of splints 
to the human body, under the headings— 
1. Head splints. 
2. Trunk splints. 
3. Upper limb splints. 
4. Lower limb splints. 
This simplicity of classification will necessarily be 
violated in specific cases in which compound splints, 
embracing parts of different systems, are constructed. 
[The following four descriptions are selected from 
the original paper for illustration in this abstract.] 
1. A Cervical Spine Splint.—This splint is 
devised for fixation of the cervical vertebrae. The 
blank is cut from sheet No. 2 or from sheet No. 3, 
according as the case is that of a child or an adult. 
The head of the patient should be supported in the 
desired position while the moistened blank is being 
molded over the back, shoulders, neck, and occi- 
put ; the molding is facilitated by the use of a 6 
gauze bandage applied snugly over the blank. After 
a short retention the molded blank should be re- 
moved and dried. The neck-piece can be rein- 
forced if desired. The complete splint is pictured 
in Fig. 1. 
Fig. i. 
A cervical spine splint. 
2. A Spinal Jacket.—I shall here briefly suggest 
a technique for a simple, cheap, and serviceable 
jacket. 
The blank is to be cut from sheet No. i and 
moistened with a 75 per cent, solution of silicate 
of potassium. This blank is of the simplest pattern, 
being sufficient to envelop the patient’s body, once 7 
and a quarter around, and its width governed by 
the amount of spine we desire to control. The 
needful trimming of the blank can be done upon 
its first application to the body. The patient should 
be placed in the same position as for the applica- 
tion of a plaster jacket; he should have on him a 
Fig. 2. 
A spinal jacket. 
tight-fitting woollen undershirt. The blank is to be 
applied to the body by commencing on the front 
about two inches beyond the median line, and keep- 
ing that portion in place, guiding the rest of it 
around the body so as to overlap considerably in 
front. A vertical line should be drawn on the over- 
lapping piece, from the armpit; the object of this 8 
line is to give position to the hinge-joint which we 
require in the jacket to facilitate removal and re- 
application. The joint is made by bending the 
moistened blank backward and forward along this 
line until the pulp is sufficiently broken—the fabric 
imbedded in the sheet forming the hinge. After 
drying the jacket, this hinge should be strengthened 
by gluing strips of chamois skin, one inch wide, 
over the hinge, inside and outside. 
The blank having been applied to the body as 
described, we proceed to make it conform to the 
body-surface as accurately as possible. We place 
over the spines a large pad (two large rolled band- 
ages, each four inches in diameter and six inches 
long, placed end to end, do well), which serves to 
press the blank well into the hollow of the back. 
Further conformation to the body is obtained by 
the “ pinching and folding over ” method described. 
Here this method is particularly advantageous, for 
it adds threefold to the vertical strength of the 
jacket, without a material increase of its weight. A 
gauze roller-bandage should be so applied over the 
whole blank as to hold it in snug apposition to the 
body. After a few minutes’ retention the bandage 
should be taken off and the jacket carefully removed; 
in doing so the hinge described should be made 
use of, so as to disturb as little as possible the 
form imparted to the jacket. If the blank has been 
properly moistened, but slight aid to hold its form 
need be given to the jacket, till drying permanently 
fixes it. Thus, the foundation for a good spinal 
jacket is completed. It can be reinforced as de- 
sired. Straps can be fastened to it for its adjustment, 9 
or lacing bands can be applied to it for the same 
purpose. Fig. 2 illustrates a spinal jacket which 
was molded on and worn by a boy of six years. 
The binding and fasteners are made of chamois skin, 
glued by means of a cheap liquid glue directly to 
the jacket. The hinge-joint is here omitted, the 
natural resiliency of the material sufficing for the 
removal and reapplication of the jacket. The 
jacket was made at the child’s home in about forty 
minutes. 
3. A Palmar Forearm Splint.—This is a very sim- 
ple but important splint. It meets the indications 
that Cheever emphasizes in the treatment of a 
Colles’ fracture. That accurate surgeon says: “The 
important point would seem to be . . . . not 
to press the back of the wrist down in such a way, 
by splints, that we shall lose sight of this arch, which 
is so marked, under the radius This 
arch must be well supported The splint 
should terminate at the head of the metacarpal 
bones, and the thumb and fingers should be left 
free.1” 
The position of the forearm for the splint pic- 
tured in Fig. 3 was that of semi-pronation ; that of 
the wrist, semi-extension—its natural position of rest. 
The pattern should slightly overlap the ulnar side 
of the forearm, so that there will be sufficient mate- 
rial in the blank to be molded over that side of the 
forearm. The blank should be cut from sheet No. 
1 and moistened carefully with a 75 per cent, solu- 
1 Lectures on Surgery. By David W. Cheever, M.D. See 
Lecture X. Boston Medical and Surgical Journal, vol. cxxix, 
p. 2. tion of silicate of potassium. The blank should be 
applied to the palmar surface of the forearm, so that 
the ulnar side is overlapped by the blank. The 
blank should then be carefully molded over the 
forearm in the position described. After snugly 
applying a roller bandage over the splint, com- 
mencing at the wrist, then enrolling the hand, and 
finally the arm, pressure should be applied by squeez- 
ing the forearm and splint between the thumb and 
fingers at a point one inch and a quarter above the 
styloid process of the radius, where the arch of the 
10 
Fig. 3. 
A palmar forearm splint. (Right, viewed from radial side.) 
radius is most pronounced. The direction of the 
pressure, it need hardly be mentioned, is from the 
palmar to the dorsal side of the forearm; its object 
is to give the splint an arch approximating that of 
nature. After squeezing in the manner described 
for a moment, the splint should be removed and 
dried. A side or radial view of the completed splint 
is pictured in Fig. 3. 
The curve of the splint caused by the arch of the 
radius is there imperfectly illustrated. The curve of 
the splint, made by molding the overlapping por- 11 
tion of the blank over the ulnar side of the fore- 
arm, is important, because it is the main source of 
the strength of this splint. 
4. A Latero-posterior Knee Splint.—This 
splint is for fixation of the knee-joint. It is a modi- 
Fig. 4. 
A latero-posterior knee splint. (Left.) 
fication of the so called ham-splint. It differs from 
the ham-splint in having a surface that is applied 
to the lateral surface of the limb (preferably the 
inside), as well as to the posterior aspect. This 
addition greatly strengthens the splint and aids its 
fixation. The blank should be cut from sheet No. 12 
2 (sheet No. 3 for a very powerful limb), and moist- 
ened with a silicate solution. The blank should be 
applied to the limb so that the portion correspond- 
ing to the shaded part of the pattern lies over the 
internal aspect of the limb. The molding of the 
splint is perfected by applying a roller bandage 
snugly about it; after a moment’s retention to the 
limb the splint should be removed and dried. A 
completed splint for the left knee is pictured in 
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