Example of a poorly fitting splint from the ER
Most parents just trust and take the doctor’s word for it that the right kind of splint has been put on their child when they have a broken arm. The fact is that splints put on by clinics, ERs, and other health professionals often do more harm than good. Fortunately the harm is minor and temporary in almost every case, but these tips will help you avoid unnecessary discomfort for your child.
Broken arms need splints, but as a parent you should maintain some healthy skepticism and paranoia about how your child’s arm is immobilized, especially coming straight from the emergency room
The following are clues to a bad splint you can use if your child just had one put on in the ER or other clinic. Most orthopaedic surgeons should know better, but sometimes the office staff puts the splint on, so keep these in mind regardless of who put the splint on your child.
Clues to a bad splint – check the fingers!
Look at the fingers – are they swollen, purple? Can your child feel them and move them? For most casts and splints, the fingers should be completely free.
The cast material should stop in the middle of the palm on the palm side, and just shy of the big knuckles on the back side of the hand.
Most casts and splints are put on to stop the wrist or forearm from moving. Sometimes a special splint is made to stop the thumb from moving, but the other fingers should be free.
Even in a bad wrist fracture the fingers should remain free. It only takes a few hours for the fingers to stiffen up and get worse. This makes pain, swelling, and discomfort worse.
Another clue to a bad splint – check for tightness!
The splint should not be tight.
It may feel snug, but not tight to the point of being uncomfortable.
This is why casts (hard, fiberglass or plaster ones that go all the way around the arm) are never put on in the emergency room. The arm will swell a few days after the injury, making the cast tighter.
Tightness in a splint or cast is dangerous because as the swelling increases, this puts pressure on the blood flow to the arm, which can cause pain, nerve damage, and in the worst cases, gangrene.
Even worse, most kids are not complainers when they get a cast – they figure whatever they feel must be normal. This is a recipe for disaster if parents aren’t paying close attention.
Usually the tightness of a splint is fixed easily by either cutting or unwrapping the ace wrap on the outside. Ask your doctor before you do this.
Final clue to a bad splint – watch for pain!
Pain is never normal in a cast or splint.
Pain could be coming from any one or all of the following:
- skin rubbing on the hard material of the splint
- wet skin getting irritated
- too much pressure on the muscles, blood flow, and nerves from a tight cast
- cast is so tight that blood can’t drain as well from the hand
- pieces of the fractured bone are shifting and moving
If your child has pain in a cast or splint that’s uncontrolled by mild oral medicines and elevating the hand and arm above his heart, call your doctor right away.
It’s always worth it to get the splint removed and check for any problems rather than let something get worse, with potentially irreversible consequences later.
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