Childhood Fractures are Common
It is estimated that approximately 27 percent of girls and 42 percent of boys will have a fractured (broken) bone by the time they reach the age of 16, and some doctors believe that figure is higher. Even though fractures are very common, many pediatricians do not know how to place a splint correctly, and they usually refer their pediatric patients to orthopedic (bone) doctors for splinting. Doctors in the Emergency Department have more experience with splinting, but a recent study shows that patients are receiving inadequately applied or incorrectly applied splints in the ER in most cases.
Treatment of Fractures in the Emergency Department
Doctors are usually able to recognize a fracture by the deformity of a bone or by an X-ray, although fractures sometimes do not show up on X-rays until a few days have passed. In these cases, other tests, like a CT scan or a bone scan are useful. Treatment for a fracture should include an evaluation of the blood vessels and nerves around the fracture. This can be as simple as checking for a pulse and sensation, or it may require more extensive testing. Doctors in the Emergency Department will usually reduce (set) the fracture and splint it, and if it cannot be reduced (aligned properly) in the Emergency Department, an orthopedist should promptly be notified to see the patient.
When a person has a fracture, it is important to stop movement of the broken part, by using a splint made of a rigid material, which may be casting material, wood, metal, or plastic, applied to the patient’s extremity and secured with roller gauze or an elastic bandage. If the bone cannot be reduced without surgery, an orthopedist should be called to see the patient.
Fractures Treated Incorrectly in the Emergency Department
A study performed by pediatric orthopedic surgeons at the University of Maryland School of Medicine revealed that childhood fractures had been treated improperly in 93% of the 275 pediatric patients studied. Factors that contributed to injuries from improper splinting included use of an inadequate amount of padding in the splint, application of elastic bandages directly to the skin, failure to immobilize the fracture properly, and failure to use the correct length splint.
Complications From Improper Splint Placement
Some of the complications seen by researchers investigating improper application of pediatric splints included swelling, skin breakdown, and delayed healing as a result of a failure to immobilize the fracture. A splint must immobilize the joint above and the joint below the fracture site, to keep the broken bone from moving. If the broken bone is not kept immobile, it can’t heal properly.
Swelling was seen in 30% of the patients, and 19% of patients developed pressure points, with direct injury to skin and soft tissue seen in 6% of patients in this study. Pressure points result in pressure ulcers, and in this study, the swelling noted was more than would have occurred as a result of the fracture alone. Some children suffered additional pain, because the splint applied pressure to their nerves.
None of the cases in this study resulted in the need for surgery, but these patients were all seen promptly after their visit to the Emergency Department, which may have prevented serious complications. The children in the study often had splints that were too long and resulted in excessive swelling in their fingers and decreased movement.
Compartment Syndrome Is A Serious Complication
Compartment syndrome occurs when swelling in an arm or a leg around a fracture (or a burn) presses down and damages nerves and blood vessels in the compartments of the arm or leg. If you have a fracture and your pain gets worse, or if you begin to have numbness or paralysis, then you may be developing compartment syndrome and should see your doctor immediately. People who have compartment syndrome must be treated to prevent serious damage to the tissues of the compartment that is affected.
If Your Fracture Was Improperly Treated
If you were treated for a fracture in your emergency department or doctor’s office and experienced unexpected complications, you may have been the victim of negligence. Consult one of our top-rated Chicago medical malpractice lawyers today for a Free Consultation at 312-527-4500.
