Radiographs ‘unnecessary’ after splinting

By Lynda Williams, Senior medwireNews Reporter

US researchers question the need for an X-ray after splinting, finding that most fracture patients do not benefit from this service.

The team from NYU Langone Medical Center, Hospital for Joint Disease report that the 204 patients who underwent postsplinting radiography for minimally or nondisplaced fractures had a significantly longer stay in the emergency room than the 138 patients who did not, at 8.5 vs 7.5 hours.

On average, imaging after splinting accounted for three of the 10 radiographs taken per patient, but analysis of the 82 postsplinting radiographs available found no evidence of malalignment after treatment.

"While certain circumstances call for additional imaging, routine performance of post-splinting radiography of non-displaced or minimally displaced fractures should be discouraged," say Sonia Chaudhry and team from NYU Hospital for Joint Diseases in New York, USA.

The researchers note that, despite the study being performed in a single center with residents on the same training program, use of postsplinting radiographs was inconsistently applied in 40% of cases, perhaps due to the lack of standardized protocols.

"The dearth of definitive evidence on the utility of post-splinting radiographs causes practitioners to base decisions solely on the opinions of their attendings and themselves, which may account for the non-uniformity in several aspects of fracture management," Chaudhry et al comment.

The study included 95 patients with open physes (average age 9.5 years) and 109 patients with mature skeletons (average age of 43.7 years).

The most common fractures were to the radius and ulna (n=67), metacarpals and phalanges (n=55), and the foot or ankle (n=44). Slab splints were positioned in 72 patients and sugar-tong splints in 61 patients, with the remainder receiving posterior long arm, short leg, or long leg splints.

Noting that splint materials are radiolucent and position is best examined at time of application, the team concludes in the Journal of Bone and Joint Surgery: "We recommend increased attention to detail with manual inspection of applied splints and education on proper splinting techniques."

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