October 31, 2014

Improper Splinting of Kids' Fractures Is Common, and Can Cause Serious Complications

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.

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November 22, 2013

Vitamin D, Calcium and Building Good Bones

For many parents, the years between 9 and 14 are particularly difficult ages for rearing children. Puberty poses a lot of challenges, but one most people don’t consider is that it defines the narrow window in which humans build the bulk of their skeletons.

A story on NPR recently explained that a lot of kids that age aren’t getting what they need to build strong bones. And it’s not just a matter of nutrition, of sufficient amounts of calcium and vitamin D. They are essential for bone health, but so is physical stress.

In short, kids need to run and jump and make their bones work.

One of NPR’s sources, an orthopedic surgeon, said that when children jumped up and down between classes, for a total of about 15 minutes a day, they added mass to their leg bones.

For bones, bigger is better — the bigger they are, the harder they are to break.

"We think the bounce probably sends an electrical or other signal right up the skeleton, saying, 'OK, time to give more, time to build more bone.' " the doctor told NPR.

Any impact activity is good — jogging, tennis, basketball, dancing… Whatever your kid is happy doing. Federal health officials say that kids should get at least one hour of exercise every day, but it doesn’t have to be all at once. And it’s most important to get during the bone-building window.

On the nutrition front, children of all ages, including teenagers, often have a diet with too little calcium and vitamin D to build the best bones.

Children from 9 to 18 should get 1,300 milligrams of calcium every day. That’s about four or five glasses of milk, or the equivalent.

Most teens don’t come close. Only about 15 in 100 high school students drink milk, and only about 9 in 100 girls do, often because they perceive it as fattening. But that's not true — one glass of skim milk contains no fat and approximately 80 calories, about the same caloric content as an apple.

Good sources of calcium other than milk are yogurt and cheese.

Vegetables can be a source of calcium, but you have to eat tons of them to get the recommended levels. A cup of broccoli, for example, has only 42 mg of calcium. But fortified orange juice, breakfast cereals and tofu are good sources.

It’s always better to get this mineral from food, not supplements, especially for kids. The body absorbs calcium better from food than it does from supplements.

Even if kids get sufficient calcium, it won’t make much difference if they’re not getting sufficient vitamin D, which enables calcium to be absorbed during digestion.

Children, and most adults, need 600 international units of vitamin D a day. It’s found in fatty fish (salmon and sardines), and like calcium, is added to milk and orange juice. And, of course, we absorb it through exposure to the sun.

Unlike calcium, vitamin D can be appropriate in supplement form for some teenagers, especially if they don’t drink milk or eat fish and other healthful foods. A reasonable supplement for them would be about 400 international units per day.

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