Rate Of Misapplied Splints In Children Extremely High
About The Study
On October 11th, the study was presented at this year’s American Academy of Pediatrics (AAP) National Conference and Exhibition by Dr. Joshua Abzug, director of pediatric orthopedics and assistant professor of orthopedics at the University of Maryland School of Medicine.
The elastic bandages associated with the splints often have insufficient mobilization and are applied directly to the skin, therefore causing complications. Although usually minor, these complications can sometimes lead to surgery and longer recovery times.
Other studies have been done regarding the complications of misapplied splints and related topics; however, “rather than just having anecdotal evidence, we wanted to have real data to show the people providing the splints and say, 'We need to make a change,' ” said Dr Abzug.
There were 225 children involved in the study, ranging from ages 0 to 18. These patients had splints administered by emergency departments or urgent care facilities. The patients were brought to the pediatric orthopedic clinic where a orthopedic surgeon examined the splint and removed it in order to evaluate the injury along with possible soft tissue complications.
Patients, or the parents of the patients in some cases, were asked to fill out a detailed questionnaire regarding the splint. Questions asked included the name of the type of splint, which healthcare provider and facility placed the splint, and how long had the splint been on the child.
Dr. Abzug noted that the results were much more troubling than anticipated. Furthermore, while no major complications were seen, the minor complications should not be overlooked, especially because of the high incidence rate of misapplication.
- 93% of splints were put on incorrectly.
- 78% had elastic bandages placed against skin.
- 50% of the splints were not the correct length.
Of the 225 patients, 31 had undergone fracture reduction, but the splint was not removed.
Of the 194 patients that had the splint removed:
- 41% had skin and soft tissue complications
- 30% had excessive edema.
- 19% were on pressure points of the skin
- 2% were on pressure points overlying bony prominences.
- 6% caused direct injury to the skin and soft tissue.
Efforts to Reduce Misapplication of Splints
Dr. Abzug has proposed creating a do’s and don’ts chart and instructional cards of proper splint application.
Dr. Theodore Ganley, sports medicine director at Children's Hospital Philadelphia and an associate professor of orthopedic surgery at the University of Pennsylvania School of Medicine, also agrees that posters would be helpful, but he also suggests videos and direct training would benefit the medical community: “Fortunately, kids are resilient. They tolerate splints that aren't perfectly placed, and overall, they respond well to minor skin irritations. If there is a positive, it's that with instruction, those splint placement errors are correctable issues.”