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Joint immobilization is a fundamental component of acute musculoskeletal care and is widely used in prehospital and emergency department settings. Musculoskeletal injuries account for a substantial proportion of emergency medical service calls and emergency department visits, making early stabilization a critical intervention. Effective immobilization stabilizes suspected fractures or dislocations, minimizes motion at the injured site, and reduces the risk of further skeletal, neurologic, or soft-tissue injury during patient movement and transport. Immobilization also plays an important role in pain management by limiting painful motion and supporting injured structures. A wide range of techniques and devices may be used depending on the injury pattern and clinical context, including slings, rigid and soft splints, traction devices, and air or vacuum splints. Appropriate selection and application require an understanding of injury mechanisms, anatomic considerations, and potential complications associated with inadequate or improper stabilization. Through this course, the participant develops a structured understanding of the indications, selection strategies, and proper application of commonly used immobilization techniques. Emphasis is placed on the clinical reasoning behind device selection, recognition of complications associated with insufficient stabilization, and adherence to best practices for patient safety and comfort. The course highlights the importance of collaboration among interprofessional teams, including prehospital healthcare professionals, emergency clinicians, nurses, orthopedic specialists, and rehabilitation professionals. Effective communication and coordination among team members support timely interventions, consistent reassessment, and appropriate transitions of care. Strengthening competence in early stabilization and interprofessional collaboration enhances functional recovery, reduces complications, and improves overall patient outcomes across the continuum of care. Objectives: Identify the benefits of prehospital immobilization for orthopedic traumatic injuries. Compare different splints and braces commonly used to immobilize traumatic orthopedic injuries. Determine how to properly place and use commonly used splints and braces in patients with orthopedic traumatic injuries.

Through this course, the participant develops a structured understanding of the indications, selection strategies, and proper application of commonly used immobilization techniques. Emphasis is placed on the clinical reasoning behind device selection, recognition of complications associated with insufficient stabilization, and adherence to best practices for patient safety and comfort. The course highlights the importance of collaboration among interprofessional teams, including prehospital healthcare professionals, emergency clinicians, nurses, orthopedic specialists, and rehabilitation professionals. Effective communication and coordination among team members support timely interventions, consistent reassessment, and appropriate transitions of care. Strengthening competence in early stabilization and interprofessional collaboration enhances functional recovery, reduces complications, and improves overall patient outcomes across the continuum of care. Objectives: Identify the benefits of prehospital immobilization for orthopedic traumatic injuries. Compare different splints and braces commonly used to immobilize traumatic orthopedic injuries. Determine how to properly place and use commonly used splints and braces in patients with orthopedic traumatic injuries. Collaborate with other healthcare professionals to implement evidence-based prehospital immobilization protocols. Access free multiple choice questions on this topic.

Traumatic musculoskeletal injuries represent a major global and national public health burden and are a leading cause of emergency department utilization. Results from large epidemiologic studies from the United States and worldwide demonstrate that traumatic injuries account for tens of millions of emergency department visits annually, with musculoskeletal trauma contributing substantially to disability, cost, and loss of function across age groups.[1][2] Within this broad category, joint injuries are among the most frequently encountered patterns and are a core focus of both emergency medical services (EMS) and hospital-based trauma systems.[1][3] In the prehospital environment, joint injuries are often challenging to characterize and appropriately stabilize because of limited diagnostic resources, variable patient factors, and the presence of distracting injuries. Nevertheless, early recognition and structured assessment of suspected joint injuries are essential to guide immobilization decisions and prevent secondary harm during transport.[3][4] These injuries arise from a wide range of mechanisms, including high-energy motor vehicle collisions, pedestrian and motorcycle crashes, sports trauma, and falls from height, and even seemingly minor events such as ground-level falls or low-energy torsional injuries in susceptible individuals. These diverse mechanisms produce patterns ranging from simple sprains to unstable complex fracture-dislocations and periarticular fractures. Because of this spectrum of severity, all suspected joint and extremity injuries in the field should be managed using a standardized strategy that prioritizes hemorrhage control, pain management, anatomic realignment, and immobilization spanning the joints above and below the injury.[2][3]

In the prehospital environment, joint injuries are often challenging to characterize and appropriately stabilize because of limited diagnostic resources, variable patient factors, and the presence of distracting injuries. Nevertheless, early recognition and structured assessment of suspected joint injuries are essential to guide immobilization decisions and prevent secondary harm during transport.[3][4] These injuries arise from a wide range of mechanisms, including high-energy motor vehicle collisions, pedestrian and motorcycle crashes, sports trauma, and falls from height, and even seemingly minor events such as ground-level falls or low-energy torsional injuries in susceptible individuals. These diverse mechanisms produce patterns ranging from simple sprains to unstable complex fracture-dislocations and periarticular fractures. Because of this spectrum of severity, all suspected joint and extremity injuries in the field should be managed using a standardized strategy that prioritizes hemorrhage control, pain management, anatomic realignment, and immobilization spanning the joints above and below the injury.[2][3] Timely and well-performed immobilization in the prehospital setting reduces pain, limits further skeletal and soft-tissue damage, decreases blood loss, and protects adjacent neurovascular structures. This may lower the risk of complications such as compartment syndrome and the need for more complex operative reconstruction.[2][3] Observational data from multiple trauma systems have shown that immobilization is frequently performed suboptimally, with errors in splint selection, application, and documentation of distal perfusion and neurologic status. In a series, fewer than 10% of patients with limb injuries received immobilization that met predefined quality criteria, and overall immobilization quality was strongly associated with EMS personnel's education level.[4] These findings support the need for targeted education on injury assessment and immobilization techniques for EMS professionals and the broader interprofessional trauma team.

Joint immobilization is a critical component of prehospital musculoskeletal care, but improper application or prolonged immobilization can lead to significant complications. Neurovascular compromise is a primary concern, as splints that are excessively tight or improperly positioned can restrict blood flow and cause tissue ischemia, neurologic injury, or compartment syndrome. Excessive external compression, especially from circumferential devices, may contribute to pressure-related soft-tissue injury. Similarly, improper padding or splint contours can exacerbate pain, cause shear injury, or lead to blistering. Malalignment may occur when immobilization is performed without adequate realignment or when the device does not span the joints above and below the injury. This can cause further injury displacement, exacerbate soft-tissue trauma, or complicate later reduction attempts. Certain dislocation patterns are associated with increased skin tension and tissue necrosis when manipulation or attempts at forced reduction occur before immobilization. In these cases, immobilization in the found position is safer when resistance is encountered. Inadequate or improperly performed immobilization that allows motion at the injury site may worsen ligamentous or chondral injury, increase bleeding into the joint or surrounding tissues, and prolong pain and swelling. These risks underscore the importance of appropriate device selection, proper technique, and repeated reassessment during transport.[21][30][33][34]

Immobilization of joint injuries in the prehospital setting reduces the risk of secondary injury, facilitates safe transport, and prepares patients for definitive surgical or nonoperative care. Evidence from consensus guidelines and observational studies supports early stabilization and splinting of unstable extremity and joint injuries, including in multisystem trauma, as part of a coordinated strategy that prioritizes life-threatening conditions while still protecting limbs and managing pain.[18] Effective immobilization requires understanding the mechanism of injury, performing thorough neurovascular assessments before and after splinting, and selecting appropriately sized devices. The clinical impact of immobilization depends on coordinated interprofessional teamwork. Emergency medical service clinicians and other first responders conduct initial assessment and splinting; emergency medicine and orthopedic clinicians provide medical oversight, protocol development, and real-time consultation. Nurses perform continuous monitoring, reassessment, and handoffs in the emergency department, and pharmacists design and evaluate safe, evidence-based pain management protocols.[36] Clear, standardized communication of injury patterns, neurovascular status, splint type, and medications administered enhances patient-centered care, reduces errors, and allows trauma and orthopedic teams to plan timely definitive management. Data from low- and middle-income settings underscore the value of integrating prehospital healthcare professionals into the overall care system, demonstrating reductions in preventable disability and improved limb outcomes.[37]