Hundreds of thousands of times each year in the United States, children go to emergency rooms with bone fractures. But new research from the University of Maryland School of Medicine shows the injuries are almost never splinted properly.

Ninety-three percent of splints used to immobilize fractured limbs temporarily are not put on correctly, according to the study of Baltimore-area pediatric patients. That can lead to swelling, skin injuries and other problems, some long-term.

“I did the study because I see a lot of splints on wrong, but I didn’t think it would be that high,” said Dr. Joshua M. Abzug, director of pediatric orthopedics at the University of Maryland Medical Center. “The next step is education.”

Abzug, also an assistant professor in Maryland’s School of Medicine, studied 275 children and teenagers who came to a Maryland pediatric orthopedist from a community hospital emergency department or urgent care center in the region.

Splints used to stabilize broken bones usually include a strip of rigid material, wrapping of soft padding and an elastic bandage to hold them in place. Most of the time, Abzug said, the application is good enough for a patient who will see an orthopedist within a few days. The orthopedist can evaluate and put on a cast.

But if that visit is delayed, he said, serious problems can develop. They include wounds that require skin grafts or even surgery to reset a bone.

In 77 percent of the cases Abzug studied, elastic bandages were incorrectly put directly on skin. In 59 percent, joints were not immobilized correctly. In 52 percent, splints were the wrong length. About 40 percent of the kids had skin and soft-tissue complications.

Children and parents also need to be warned not to remove splints, because they could reapply them improperly.

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