Incorrect Use of Splints Causes Poor Healing in Children

A new study reveals that more than 90% of potential pediatric fractures are splinted improperly, which can lead to swelling and skin injuries.

Researchers at the University of Maryland School of Medicine (Baltimore, USA) reviewed 275 cases involving children up to the age of 18 who were initially treated in community hospital emergency rooms and urgent care facilities in Maryland (USA), and then later evaluated by pediatric orthopedic specialists. A standardized questionnaire was used for patient demographics, type of splint, facility type, practitioner type, and time from splint application to orthopedic evaluation. Clinical evaluation included functional position, appropriate length, and presence of an elastic bandage on the skin.

The results showed that the most common reason for improper placement of a splint was putting an elastic bandage directly onto the skin, which occurred in 77% of the cases. In 59% of the cases, the joints were not immobilized correctly, and in 52% the splint was not the appropriate length. Skin and soft-tissue complications were observed in 40% of the patients. The study was presented at the American Academy of Pediatrics (AAP) national conference and exhibition, held during October 2014 in San Diego (CA, USA).

“Splints are effective for immobilization of fractured extremities in children and adolescents when placed appropriately,” said senior author and study presenter Assistant Professor of Orthopedics Joshua Abzug, MD. “Unfortunately, many practitioners in emergency departments and urgent care settings incorrectly applied splints, potentially causing injury. Everything we do, no matter how minor it may seem needs to be done correctly.”

Broken bones are common in children and adolescents, with nearly half of all boys and a quarter of all girls experiencing a fracture at some point before the age of 16. Emergency departments (EDs) and urgent care centers use splints to temporarily stabilize a possible fracture; the splint is made of rigid strip placed on the extremity, which is then wrapped with a soft padding followed by an elastic bandage to hold it in place. Once splinted, the patients are referred to an orthopedic surgeon, who removes the splint for further evaluation.

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University of Maryland School of Medicine