Assessment of Splinting Quality: A Prospective Study Comparing Different Practitioners.

Background: Splinting is routinely performed in the emergency department (ED), and follow-up visits of improperly placed splints are commonplace in orthopaedic clinics. As open reduction and internal fixation (ORIF) of fractures has become the preferred treatment for many injuries, orthopaedic surgeons and emergency physicians have received less instruction on splinting technique. Limited literature exists regarding error/complication rates of splint application. The purpose of this study is to determine: (1) Is there a difference in splinting complication rates between orthopaedic and non-orthopaedic services, and low versus high volume emergency room and urgent care centers? (2) What are the most common technical errors and complications in splint application?

Methods: Patients presenting to orthopaedic clinic with any extremity splint were enrolled in this IRB approved prospective study. Splint characteristics collected included: type of provider placing the splint, duration of wear, type of splint, and material used (i.e. plaster or fiberglass). Errors included inappropriate length, circumferential placement, and direct contact between the ACE bandage and the skin; while complications included swelling, blistering, ulceration, heat injury, and other issues on a case-by-case basis.

Results: 203 patients were enrolled in this study. 98 (48%) were splinted by the Orthopaedics service, 69 (34%) were splinted in the trauma hospital ED, and 36 (18%) were treated at an outside hospital. 123/203 (61%) had an error/ complication related to the splint. Error/complication rates for orthopaedics, the trauma hospital ED, and outside hospitals were 46% (45/98), 65% (45/69), and 92% (33/36) respectively. The most common errors were inappropriate length, present in 58/203 (29%) patients, and direct contact between the ACE bandage and skin, present in 50/203 (25%) patients.

Conclusion: The appropriateness and complication rates of splints applied in the ED differ based on the type of provider and the institution. Outside hospitals were found to have the highest complication rates, while the lowest rates were associated with splints placed by Orthopaedics. These findings support the importance of education of proper splinting technique in non-trauma hospitals..