title: Serious infectious complications related to extremity cast/splint placement in children.
abstract: BACKGROUND
  Extremity injuries necessitating splinting or casting are commonly seen in the emergency department (ED) setting. Subsequently, it is not uncommon for patients to present to the ED with complaints related to an extremity cast or splint.
  
  
  OBJECTIVE
  To present a literature-based approach to the identification and initial management of patients with possible infectious cast/splint complications in the ED setting.
  
  
  METHODS
  We present two cases of serious infectious complications arising from extremity cast/splint placement seen in a single pediatric ED: a case of toxic shock syndrome in an 8-year-old child, and a case of necrotizing fasciitis resulting in upper extremity amputation in a 3-year-old child.
  
  
  CONCLUSIONS
  A wide spectrum of potential extremity cast/splint infectious complications may be seen, which include limb- or life-threatening infections such as toxic shock syndrome and necrotizing fasciitis. Simply considering these diagnoses, and removing the cast or splint to carefully inspect the affected extremity, are potential keys to early identification and optimal outcome of cast/splint complications. It is also prudent to maintain particular vigilance when treating a patient with a water-exposed cast, which may lead to moist padding, skin breakdown, and potential infection. In patients with suspected serious infections, aggressive fluid management and antibiotic therapy should be initiated and appropriate surgical consultation obtained without delay.
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center & Georgetown University Hospital, Washington, DC, USA.
authors.forename: B Elizabeth
authors.initials: BE
authors.lastname: Delasobera
authors.forename: Rick
authors.initials: R
authors.lastname: Place
authors.forename: John
authors.initials: J
authors.lastname: Howell
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Davis
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001133:Bones of Upper Extremity / Q000293:injuries* / Q000382:microbiology; D002370:Casts, Surgical / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000382:microbiology; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D012772:Shock, Septic / Q000209:etiology* / Q000382:microbiology; D013165:Splints / Q000009:adverse effects*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents