Abzug Joshua M, Schwartz Brandon S, Johnson Aaron J
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
J Pediatr Orthop. 2019 Feb;39(2):76-84. doi: 10.1097/BPO.0000000000000932.
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.
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.
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%.
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.
Level 2-therapeutic study.
骨折在儿童群体中很常见。最初的评估很少由骨科医生进行，而通常是由急诊室或紧急护理中心的医生/助理进行。这通常包括由非骨科医生应用夹板来固定肢体并提供稳定。不当夹板放置导致的医源性损伤是一个潜在的公共卫生和法律问题，可能会引发并发症。本研究的主要目的是前瞻性评估在小儿骨科门诊为患者放置的所有夹板的适用性；次要结果包括评估与不适用夹板相关的并发症的发生率和类型。
前瞻性纳入0至18岁使用夹板的患者。获取有关患者人口统计学和夹板放置的信息。评估夹板的功能位置、合适长度以及皮肤上是否有弹性绷带。为每个夹板拍照，并检查肢体是否有任何软组织并发症。31例已接受骨折复位的患者未取下夹板。
总共前瞻性纳入了275例患者。93%的夹板放置不当，其中77%是将弹性绷带直接应用于皮肤。59%观察到位置不当，52%存在夹板长度不合适的情况。40%观察到皮肤和软组织并发症。最常见的与夹板相关的医源性并发症是过度水肿，占28%。皮肤和软组织直接损伤占6%。
许多从业者错误地应用夹板，可能导致效果不佳或造成损伤。夹板放置不当的并发症包括过度肿胀、皮肤破损和固定不佳。治疗小儿骨折的医护人员可能会从关于正确夹板技术的更广泛教育中受益。
2级——治疗性研究。
