The Splint Script: A Technical Tip Regarding Patient Instructions for Splint Immobilization

Introduction

Splinting or casting is a strong pillar of foot and ankle orthopaedics. In patients with foot and ankle issues whether treated conservatively or surgically, splinting or casting plays a critical role in the process. Most patients with foot and ankle fractures are placed in splints initially. Of these, some are treated with cast for certain period whereas others are surgically fixed with postoperative splinting or cast application. Similarly, many deformity correction surgeries require postoperative splint or cast application. Total contact cast is another scenario where casting is done for extended time frames.

Problems and complications are not unusual after application of cast or splints in the lower extremity. Some of the known issues are pressure sores and wetting of the cast or splint. Patient noncompliance to splint or cast care instruction is another problem commonly faced by many surgeons.

We would like to describe a technique that we have used with good results to curtail these issues. We have had good results and were able to limit cast- or splint-related problems, especially patient compliance to instructions with a small modification in our practice.

Technique

Whenever a patient is placed in a splint or a cast, we provide with instructions on cast/splint care. Classically, this included a printed note with directions on what is expected in terms of cast or splint care.

In addition, we have started writing core instructions on the dorsal aspect of the foot/ankle of the patient over the cast. First step is to place the splint or cast in a regular fashion, mold it as required, and let it dry. Once it is complete and the patient is ready, we then place a 4- or 6-inch soft cloth surgical tape on top of the splint or cast. The surgical tape is placed in long axis of the leg and on the dorsal aspect of the foot and lower extremity. Once the tape is stuck, we then would write instructions on cast/splint care. These are written using a thick nonerasable marker in bold and large fonts so that these are easily readable to the patient. The instructions are also written in a way that they are not upside down for the patient (Figure 1).

Figure 1.

Splint script.

The cloth surgical tape is used as it sticks well to the underlying splint or cast material and the written instructions do not get distorted easily. We have attempted with silk tape but noticed that the ink can easily spread on silk tape, making the words illegible.

The content of the instructions is variable depending on individual circumstances but consistent for similar conditions. Some of the common instructions that are used are elevation, nonweightbearing, float heel in air, keep dressing clean and dry, and wiggle toes. This is not an exhaustive list and changes depending on individual patient requirements. A quality improvement project is currently ongoing assessing the impact of the practice. We are currently working on developing pre-typed instructions on a soft cloth tape that can be instantly placed on the splint or cast.

Discussion

Patient instructions play a pivotal role in patient care bridging the gap between office visits and provide important etiquette on how patients are to care for themselves while immobilized. These instructions can be instrumental in helping a patient discern normal post-casting or post-splinting symptoms vs what is a potential cause for concern. To accomplish this, discharge instructions should be succinct, properly communicated, and easy to understand, which can facilitate a smooth transition for the patient when being discharged.

Literature demonstrates that treatment compliance and patient safety can be compromised if the patients do not have a full understanding of their discharge instructions. Written instructions given to patients are oftentimes cumbersome and lengthy, making it difficult to locate the crucial information for postvisit care. ² Therefore, making the discharge instructions more concise and improve the readability of the discharge instructions can help with patient understanding.

Communication between the provider and the patient is also a factor in patient comprehension of discharge instructions. It has been observed that adequate communication at discharge can decrease readmission rates and improve patient compliance. ¹ This demonstrates the importance of proper communication of patient instructions prior to discharge and how it affects patient compliance.

Lastly discharge instructions should be easy for patients to understand across the spectrum of health literacy. Patients with low health literacy have less insights to their disease and lack adequate understanding to manage their condition properly. ³ Creating uniform instructions geared to basic health literacy levels could increase with patient compliance and improve patient outcome.

The splint script is tailored to be specific toward patient pathology and their respective nonoperative or postoperative care, emphasizing important information they can be continually referenced. Having this information readily accessible serves as a reminder that, as a result, will increase patient compliance and thus successful patient outcomes. The authors of this article offer this resource as a means to improve communication with their patients, having clear and concise information regarding weightbearing restrictions, elevation and positioning precautions, and hygiene instructions.