Doc Crusades to Correct Poor Splinting

More than 90% of potential pediatric fractures are splinted improperly in emergency rooms and urgent care centers, according to a study by researchers at the University of Maryland School of Medicine. They are presenting their findings at the American Academy of Pediatrics National Conference in San Diego. Improper splinting can lead to swelling and skin injuries.

The study, which was reported in Medical Press, examined 275 children and teenagers who had initially been treated at emergency rooms or urgent care facilities in the state of Maryland. They were all later evaluated by University of Maryland pediatric orthopedic specialists.

“Splints are effective for immobilization of fractured extremities in children and adolescents when placed appropriately, ” said the presenting and senior author, Joshua M. Abzug, M.D., assistant professor of orthopedics at the University of Maryland School of Medicine. “Unfortunately, many practitioners in emergency departments and urgent care settings incorrectly applied splints, potentially causing injury, ” he said.

As reported by Medical Press, “the researchers found that the most common reason for improper placement of a splint was putting an elastic bandage directly on 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.”

As a result of the findings, Abzug believes that health care professionals need more extensive education and training on proper splinting techniques. He plans to conduct a follow-up study working with providers in emergency departments and urgent care centers on how to correctly apply sprints.

He said that he became aware of the problem when patients came into his office with improperly placed splints. He recalled, “I observed a lot of cases where a splint was placed incorrectly, so instead of just making note of it, I wanted to be more rigorous in coming up with a way to possibly fix the problem.” He advises parents to take it seriously when a child complains of pain from a splint. “If there is any question, get in to see an orthopaedist as quickly as possible. Any child complaining of pain away from the point of the fracture or experiencing swelling may have an improperly placed splint, ” he said.

Abzug is creating educational signs that he hopes will be placed around the emergency departments at community hospitals and in urgent care facilities. The signs will include photos of a correctly placed splint and instructions on how to apply a splint using all up-to-date guidelines.