title: Assessment of Splints Applied for Pediatric Fractures in an Emergency Department/Urgent Care Environment.
abstract: BACKGROUND
  Fractures are common in the pediatric population. The initial evaluation is rarely by an orthopaedic surgeon, but commonly an emergency room or urgent care center physician/extender. This typically involves splint application by a nonorthopaedist to immobilize the extremity and provide stabilization. Iatrogenic injuries from inappropriate splint placement are a potential public health and legal concern that can lead to complications. The primary purpose of this study was to prospectively evaluate the adequacy of all splints placed on patients who presented to a pediatric orthopaedic office; secondary outcomes included assessing prevalence and types of complications that were associated with inadequate splints.
  
  
  METHODS
  Patients aged 0 to 18 years who presented with a splint were prospectively enrolled. Information was obtained regarding demographics of the patient and splint placement. Splints were evaluated for functional position, appropriate length, and presence of elastic bandage on the skin. Photographs were taken of each splint, and the extremity was examined for any soft tissue complications. Splints were not removed in 31 patients who had undergone fracture reduction.
  
  
  RESULTS
  In total, 275 patients were prospectively enrolled. Splints were improperly placed in 93%, with application of elastic bandage directly to the skin accounting for 77%. Improper positioning was observed in 59%, and inappropriate splint length was present in 52%. Skin and soft tissue complications were observed in 40%. The most common iatrogenic splint-related complication was excessive edema, seen in 28%. Direct injury to the skin and soft tissue was seen in 6%.
  
  
  CONCLUSIONS
  Many practitioners incorrectly apply splints, potentially leading to suboptimal results or causing injury. Complications of poor splint placement include excessive swelling, skin breakdown, and poor immobilization. Health care workers who treat pediatric fractures may benefit from more extensive education regarding proper splinting techniques.
  
  
  METHODS
  Level 2-therapeutic study.
authors.affiliation: Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Abzug
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Schwartz
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods*; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D058128:Compression Bandages; D004636:Emergency Service, Hospital; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013165:Splints