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So let's take a look now, the box splints, they should come as a kit, the splint itself, packing from the hollows, if we have a fracture. And then straps to actually strap the good leg and the bad leg together for extrication purposes or moving purposes. The box itself is a foam soft pack with a hard base to give it some stability and support and a hard footplate to again, give the foot some support. Held together with Velcro straps which lock over the injury itself and fix the leg in place. They come in two sizes. There is a short box splint and this one is a long box splint. They are for low limb fractures, below the knee. Long box splints are never put on a fracture that's above the knee because all we do if we put it on a fracture above the knee is add weight and pain to the patient. They are for below the knee fractures, feet and toes. Fitting the measuring box splint to a lower-limb-fracture. Remember what we said that for a fracture below the knee to the tip of the turn.

Two or three important things, if we put this on to a fracture above the knee, all we're doing is adding weight and flexation to the fracture itself. So it's always below the knee, with a false splint and if we've only got an ankle injury, we can use the small box splint, just to immobilize the ankle itself. On this occasion, what we're doing is we've got a mid-shaft fracture. The important thing is that we have to move it, but we have to move it with care. If we just lift the foot the fracture will flex and the pain will be excruciating, and we don't want to put the patient through any more pain than we can help. This is all about taking it nice and steady and being careful. We need to support the fracture, so when we lift the leg we only lift it a fraction, just enough to slide the splint underneath, and to reduce any flexation in that fracture to its absolute minimum, because all bones have arteries, blood vessels, nerves, so any flexation can create further problems for the patient.

So the best position to actually move the leg is to use the underside of the ankle itself, where it comes away from the floor because we can quite easily go under there without moving whatsoever, and the other one is at the back of the knee, again, where we've got a hollow in the limb, and we can then slide our hands together slightly underneath the hand underneath the leg to actually support the fracture itself. The splint will then be slid underneath whilst the leg is slightly raised. So, Keith, give me a hand, hand underneath the ankle, hand underneath the knee, slide your hands towards the fracture and then gently lift, slide the splint underneath. And then, lower gently into the box. If there are any hollows, dips or anything that we need to support, we have the packing to allow us to do that. And quite often it's good to use gauze as packing underneath the hollows. We would use the clothing initially as a support mechanism to lift the limb completely, but now we would cut the clothing to actually expose, and have a look at what's going on to make sure there are no injuries, no bleeds going on that we currently can't see. We would also take the shoe off, by cutting the lace and exposing the toes so we can check for pedal pulses and we can check the cap refill to make sure that the fracture is not restricting blood flow to the foot or toes.

Once we're happy with all that the splint is then tightened up. So basically the Velcro straps cross the box and lock on to the opposite Velcro on the other side. If there is a fracture area where a Velcro strap is, sometimes it's advisable not to tighten that particular Velcro strap up, because we don't want to apply pressure directly over the fracture itself. Once all of the straps are done, the foot plate comes up and the two Velcro straps cross over the bridge of the foot from one side to the other, and then the last strap goes over the bridge of the foot to lock everything in place. We have immobilised the foot, the ankle, the tibia and fibula to the upper limb. We would then either move the patient with the splint as they are or we could then go to the next stage where we move the good leg to the bad leg. We can splint both legs together and move as one solid fixed unit.