Category: Quick Guide

Humeral Brace – Application

Inclusion Criteria – All closed neurovascular intact adult humeral shaft fractures

Exclusion Criteria – Intra-articular fractures of either the proximal or distal humerus, and surgical neck of humerus.

SizeTP-6401(normal)
Length (cm)		TP-6402(short)
Length (cm)		Humeral Circumference (cm)
127.522.522.5 – 26
229.524.526 – 29.5
3322729.5 – 33
4332833 – 36.5
5353036.5 – 40

Packet contains black humeral brace and blue sling. Size is based on mid humeral circumference and brace length, as per chart.

The hypoallergenic fabric casing holds two plastic shells – the inner shell should be removed and trimmed if concerns of pressure to inner elbow BEFORE applying the brace to the patient (either measure or try opposite arm).

Lengthen the chest strap as long as possible and unclip the clip that will be fastened behind the patient.

Crocodile Velcro fasteners are on the end of each strap. 

In order to stretch the brace to make it easier to apply, curl the crocodile fastener back on each adjustment strap and place your hands in the brace to stretch it out.

Place underneath clothing so that the patient does not attempt to remove it at home. Encourage the patient to drop the affected arm down by their side and glide the brace up the arm. If there’s a lot of resistance, a change in brace size may be required. Bring the brace up so that the outer shell is covering the shoulder and hold in place.

Holding the brace in position, clip the chest strap around the body. Ensuring it is over the chest and not beneath breast tissue. Tighten the chest strap by using the crocodile fastener. If the crocodile fastener ends up in the axillary area, it may cause friction. Remove the crocodile fastener completely and trim the chest strap so that the fastener ends up on the back.

Use the adjustment straps on the brace to tighten the brace, making sure that opposite straps and pulled at the same time to maintain tension. Both upper and lower adjustment straps must be tightened

Towelled side of the sling to skin, attach to the posterior aspect of the brace and bring over the opposite shoulder.

Bring the elbow of the braced arm to 90 degrees flexion and rest in the sling using the Velcro to attach the sling to itself. The wrist must be resting in the sling, not the forearm, to prevent wrist drop.

Thomas Spint – how to apply

Invented by a Welshman ‘Hugh Owen Thomas’, the introduction of this simple device in World War 1 went on to reduce the mortality of #femurs from 80% to 16%.

The Kit

  • Measuring Tape
  • Thomas splint – Adult or Paediatric (depending on size)
  • Hoop – Sizing guide can be found here
  • Slings
  • Hoop Pad
  • Skin Traction – Adult or Paediatric
  • Padding rolls x 2
  • Bandages (wide) x 2
  • Tape
  • Scissors
  • Tongue Depressors x 2

Printable application guide

Measuring

Measure the Inside Leg (unbroken leg) and add 30cm/12inch (to give room for the traction)

Adjusting Splint

Adjust length to the above measurement. ensuring the Hoop is at an angle with the lateral (outside leg) higher than the medial (inside leg).

Set up

  • Apply the hoop Pad (to reduce pressure and secure to tight)
  • Apply the 4 slings (lowest should be 40cm from base)
  • Apply padding along slings
  • Creat a small padding for behind the knee

Application

  • Ensure Adequate analgesia (this hurts) – typically Opiates and entonox
    • Femoral nerve block may be helpful (however, this is variable due to the innovation of the femur and reduces the more distal the fracture)
  • Check Genitals not trapped – by the hoop
  • Apply skin traction & and bandage from ankle to thigh
  • Secure the tight Clip – remembering to put the padding under the clip and velcro round

The Knot

1. take the strings and pass one over and one under the sides of the frame.

2. secure tightly with a Reef Knot

3. pass strings down (one over and one under) around the base, bringing them back over the Reef Knot and  back around the base. This makes a pulley system.

4. Tension the pulley system and tie-off using a bow

5. Pass the tongue depressors (2 tongue depressors tapped together), twist the tongue depressors to achieve the required tension, and lock off against the side.

 

Bandage & Elevate

  • Bandage the leg to the sling using the bandage – to keep secure
  • Place a pillow or blankets under the splint to elevate the heel – To prevent pressure sores