Many childhood fractures are treated incorrectly

Children seen in an emergency department (ED) or urgent care center for fractures often receive incorrect treatment, which can lead to poor healing and other complications, according to a study presented at the recent American Academy of Pediatrics National Conference in San Diego. Improper splinting is the usual culprit.

To evaluate splint application and complications from incorrect splinting, pediatric orthopedists from the University of Maryland School of Medicine, Baltimore, prospectively enrolled 225 patients aged 0 to 18 years (mean age, 8 years) with a splint in place who were referred to the pediatric orthopedic clinic from EDs or urgent care centers.

Patients or parents filled out a standardized questionnaire about demographics, type of splint, where it was applied, who applied it, and time from application to orthopedic evaluation. Researchers took frontal and lateral photographs of each splint, removed it (except for 31 patients who had had fracture reduction), and examined the limb for soft-tissue complications.

AAP 2014: How much vitamin D is enough?

Two (blinded) orthopedists assessed each splint for position, appropriate length, and whether an elastic bandage touched the skin. They found improperly placed splints in 93% (210) of patients; improper joint immobilization in 56% (125); inappropriate length of splint in 50% (113); and an elastic bandage applied directly to the skin in 78% (176).

Of the 194 patients whose casts were removed, 41% (79) had soft-tissue complications, most often edema (58 patients). Thirty-six patients had pressure points on the skin and 6 had pressure points on bony prominences, which can result from inadequate padding. Eleven children had direct injury to skin and soft tissue.

In addition to skin and soft-tissue complications, improper splinting can result in misalignment and poor healing of the fracture. The researchers recommend more training in correct splinting techniques for healthcare personnel who treat children with fractures.

To get weekly clinical advice for today's pediatrician, subscribe to the Contemporary Pediatrics PediaMedia.