This comes from a NY Times article  Mistakes in Treating Childhood Fractures published late last week that references an abstract presented at the AAP Conference.  This abstract seems to be getting a good bit of press (second only to keynote speaker Hilary Clinton getting heckled by someone with a bullphone), so this may be brought up in our ED in the coming weeks. 

The study was performed in the orthopedic clinic at University of Maryland.  They enrolled children who presented to the ortho clinic for follow up.  They state that 91% of splints were applied incorrectly, with major faults being incorrect length and elastic wrapping applied directly to skin.  No child had a serious outcome from incorrect splint placement that required surgery, but the authors did note excessive swelling and skin breakdown in a number of patients.

There is no complete article to evaluate, only an abstract, but I do have some questions about this study.

1.  Where were these children coming from?  The paper describes both urgent cares and “pediatric emergency rooms” but it is unclear if these refer to pediatric tertiary care centers or community EDs. Do they have dedicated techs for splints like we do? I think this is important because it effects the applicability of this study to our patient population.

2. How does this prove that all the splints were applied incorrectly?  We’ve all had kids that leave our ED with beautiful splints and come back 2 days later a disaster of dangling ace wrap.  Just because the splint is not in place at follow up does not mean it was not in place at discharge.

3.  Where were these splints and for what fractures were they performed?  If a big number are for questionable need (i.e. concern for occult supracondylar fractures) then perhaps this implies we should be looking at placing less splints.

All in all, an interesting abstract and article.  I know I will be on the look out for when this paper gets printed!