Improvement in the emergency splinting of fractures after a simple educational exercise

Splinting long bone fractures in the early stages of their management reduces pain, facilitates transport and helps prevent further soft tissue injury; but experience suggests that the rate of splinting is low. This study set out to quantify this rate and determine whether it could be improved with simple educational intervention.

Radiographs ordered in the emergency department over an 8-week control period were examined for fractures and presence of splints. The junior doctors responsible for these patients completed a questionnaire to assess how highly they rated early splinting. At the beginning of the next emergency term new junior doctors were given the same questionnaire followed by an information sheet relating to fracture management. The questionnaire was repeated after reading the information sheet to confirm comprehension. Radiographs performed over the following 8 weeks were examined.

Ninety-six long bone fractures amenable to splinting were X-rayed in the control period, and of these 15 were splinted (16%). After the intervention this rose to 28 out of 98 fractures (29%, P < 0.05). The intervention group prior to reading the information sheet ranked splinting in a similar manner to the control group (P > 0.20) but significantly higher afterwards (P < 0.01).

The rate of splinting of long bone fractures in the early stages of their management is low, and junior doctors do not regard this as a priority. We have shown that a simple teaching session significantly improves this rate and suggest that similar training should be provided to all emergency staff.