Pediatrics

Colles Who?

Let’s face it, you went into Emergency Medicine for the glory, not for the twisted ankles/FOOSHes.  But you went into medicine to help people, so let’s start (and finish) there.  Even for the bread and butter EM / Urgent Care ankle/wrist sprains (and straight forward, uncomplicated, non-displaced distal fibula/radius fractures!) you can help people!

Simply by *NOT* placing a splint.

Ability to bear weight at 48 hrs? 56.6% vs 42%, Aircast vs splint for ankles.

Normal activity at 2 weeks for wrist buckle fractures? 95% vs 67% in favor for Aircast.

Function at 1, 2, 3, & 4 months? All better in Aircast.

Comfort at 24 hrs? Swelling? Better with Aircast.

Return to work sooner? Go Aircast.

The high school athlete wants nothing more than to get back on the field sooner. Why not help them by not placing them in a splint? You’ll increase comfort, ability to bear weight at 48 hours, and improve their chances at normal function at 1, 2, 3, and 4 months.

For what its worth, there is somewhat less data, but a similar trend for pediatric wrists (ie, buckle fractures) to have less pain and a sooner resumption to normal function.

For fractures, I’d make sure ortho is on the same page, but for the number of ankle/wrist sprains/breaks you see in a day in an ED, you can probably make a measurable difference for the better every single day by not splinting.

 

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PMID: 20400414

PMID: 8682822

PMID: 17545357

PMID: 2516838

PMID: 8164860

PMID: 8129116

PMID: 20457737

PMID: 16510648

PMID: 18277840

PMID: 12562669

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2 thoughts on “Colles Who?

  1. Pingback: Paging Dr Buckle, Part Two. | EM in Focus

  2. Pingback: Should you MRI Salter Harris 1’s? | EM in Focus

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