Webb Tyler, Lynch Daniel, Lin James, Groth Adam, Ly Thuan, Martin Kevin D
The Ohio State University College of Medicine, Columbus, OH 43210, USA.
Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH 43202, USA.
Mil Med. 2021 Dec 4. doi: 10.1093/milmed/usab505.
Splinting is an essential component of treating many lower extremity musculoskeletal injuries; however, little development has been made in splinting technology. The purpose of this study is to evaluate the efficacy of current immobilization equipment for lower extremity fractures by testing a novel one-step spray-on foam splint (Fast Cast) against structural aluminum malleable (SAM) lower extremity musculoskeletal injuries and 6-inch ACE (3M Corp., Minneapolis, MN, USA) bandage splints.
Six orthopedic surgical residents and two medical students participated in a prospective analysis of austere splinting techniques and equipment that utilized a cadaveric model with a distal third tibia-fibula shaft fracture. Each participant was observed and scored by three fellowship trained attending orthopedic surgeons. All scoring was independent using a 5-point Likert scale based on 10 splinting criteria (50 total points possible), including quality of radiographic reduction, time to completion, safety, and sustain longitudinal traction. The Likert scale is a set of questions that reflects the respondent's degree of agreement or disagreement with a statement. Each of the 10 questions has a range of 1-5. A score of 50 means the splint performed perfectly. The lowest possible score is a 10. The participants utilized standard equipment that included SAM splints and 6-inch ACE wraps (3M Corp., Minneapolis, MN, USA) in their first attempt. A second immobilization attempt was done with a one-step spray-on foam splint (Fast Cast). After each splinting attempt, the reduction was verified with radiographic imaging. Data analysis was performed using standard descriptive statistics, Student's t-tests, and inter-rater reliability was calculated using Cronbach's alpha scores. This project is Institutional Review Board (IRB) exempt.
The one-step spray-on foam splinting technique was superior (P < .05) in all parameters of the Likert scale, yielding a mean overall score of 45.1 points (±3.8), safety 4.7 points, longitudinal traction 4.5 points, and time 136 seconds (±23). The SAM resulted in a mean overall score of 33.8 points (±7.3), safety 2.8 points, longitudinal traction 4.1 points, and time 170 seconds (±52). Radiographic rating was 4.1 points (±0.7) for the SAM splint and 4.5 (±0.6) for Fast Cast. The differences in time to completion and radiograph rating did not reach statistical significance (P = .12 and P = .07, respectively).
A one-step spray-on foam splinting technique demonstrated consistent superiority in reducing fracture motion, potential soft-tissue damage, and sustained longitudinal traction as compared to the standard technique.
夹板固定是治疗许多下肢肌肉骨骼损伤的重要组成部分；然而，夹板固定技术进展甚微。本研究的目的是通过测试一种新型的一步式喷涂泡沫夹板（快速铸型）与结构性可塑铝（SAM）下肢肌肉骨骼损伤夹板和6英寸ACE（美国明尼阿波利斯3M公司）绷带夹板，来评估当前下肢骨折固定设备的疗效。
六名骨科住院医师和两名医学生参与了一项关于简易夹板固定技术和设备的前瞻性分析，该分析使用了一个模拟胫骨 - 腓骨远端三分之一骨干骨折的尸体模型。每位参与者由三名接受过专科培训的骨科主治医师进行观察和评分。所有评分均独立进行，采用基于10项夹板固定标准的5分制李克特量表（满分50分），包括X线复位质量、完成时间、安全性和维持纵向牵引。李克特量表是一组反映受访者对某一陈述同意或不同意程度的问题。10个问题中的每个问题的评分范围为1 - 5分。50分表示夹板固定效果完美。最低可能得分为10分。参与者在首次尝试时使用了包括SAM夹板和6英寸ACE绷带（美国明尼阿波利斯3M公司）在内的标准设备。第二次固定尝试使用一步式喷涂泡沫夹板（快速铸型）。每次夹板固定尝试后，通过X线成像验证复位情况。使用标准描述性统计方法进行数据分析，采用学生t检验，并使用克朗巴赫α系数计算评分者间信度。本项目无需经过机构审查委员会（IRB）批准。
一步式喷涂泡沫夹板固定技术在李克特量表的所有参数上均表现更优（P < 0.05），平均总分为45.1分（±3.8），安全性4.7分，纵向牵引4.5分，时间136秒（±23）。SAM夹板的平均总分为33.8分（±7.3），安全性2.8分，纵向牵引4.1分，时间170秒（±52）。SAM夹板的X线评分是4.1分（±0.7），快速铸型夹板的X线评分为4.5分（±0.6）。完成时间和X线评分的差异未达到统计学意义（分别为P = 0.12和P = 0.07）。
与标准技术相比，一步式喷涂泡沫夹板固定技术在减少骨折移位、潜在软组织损伤和维持纵向牵引方面表现出持续的优越性。
