A lot of parents with active kids are familiar with the emergency department of their local hospitals, thanks to the common incidence of broken bones and sprained ligaments. According to a new study by researchers at the University of Maryland School of Medicine, mom and dad should pay careful attention to how their child’s injury is treated initially.
More than 9 in 10 potential pediatric fractures, the researchers found, are splinted improperly in ERs and urgent care centers. Such errors can cause swelling and skin injuries, and can lead to long-term structural and mobility problems.
These mistakes are significant, given the frequency of broken bones among children and adolescents — nearly half of all boys and one-quarter of all girls experience a fracture before they’re 16. The patients in the UM study had a range of fractures affecting all extremities, including fingers, arms, ankles and knees.
The results were drawn from reviewing 275 cases of children as old as 18 who were treated initially at community hospital emergency rooms and urgent care facilities in Maryland, and evaluated later by pediatric orthopedic specialists at UM.
A splint is created from at least one strip of rigid material placed against the injured extremity, which is then wrapped with padding and an elastic bandage to hold it in place and immobilize the joint. ERs and urgent care centers use splints as temporary stabilizers for possible fractures, and to reduce pain.
After being splinted, patients are referred to an orthopedic specialist, who removes the splint and evaluates the problem completely.
Dr. Joshua M. Abzug, an orthopedic specialist at the UM School of Medicine and the study’s lead author, said in a news release, “Unfortunately, many practitioners in emergency departments and urgent care settings incorrectly applied splints, potentially causing injury.”
The most common mistake in splinting kids, according to the study, was wrapping the elastic bandage directly onto the skin. That happened in more than 3 in 4 patients. In nearly 6 in 10, the joints were not immobilized correctly, and in more than half, the splint was not the proper length. Skin and soft-tissue complications were observed in 4 in 10 patients.
According to a report on NPR, the study showed that in some cases, the elastic bandage had been wound too tightly, which impedes blood circulation.
Sometimes, the bandage placement opened a wound. And one patient’s foot was immobilized at the wrong angle to her leg, which complicates her ability to walk she’s ready a few weeks later.
Abzug told NPR that broken bone treatment has changed in the last decade or two. Before, when parents and kids landed in the emergency room after an injury, the same person who diagnosed the break probably would fix it. But today, with increasing medical specialization and a proliferation of urgent care centers, it's more common for the emergency caretaker who splints the break to instruct the parent to follow up with an orthopedist for more treatment the next day.
"For whatever reason, many parents don't follow up right away," Abzug told NPR. "Sometimes it's a problem with health insurance, or they can't take time off work, or they just didn't understand the instructions."
But if the splinting wasn’t correct, waiting too long can cause devastating complications, including permanent loss of motion or a need for skin grafts. If the bandage was applied too tight, waiting even one night can produce lasting damage.
If your child’s injury has been splinted, observe the process to ensure only the rigid piece and the padding, not the bandage, make contact with the skin. Don’t ignore your child’s complaints about comfort or pain. Major swelling or discoloration in the area around the splint is sign that something’s wrong.
See an orthopedist as soon as possible if the treating emergency practitioner did not completely diagnose and treat the injury.