VIABILITY OF CARDBOARD SPLINTS IN THE EMERGENCY MANAGEMENT OF LOWER LIMB FRACTURES
Main Article Content
Abstract
At Mbarara Regional Referral Hospital Uganda, 60% of all admissions are due to severe trauma, 30-35% of which are from tibia/fibular fractures. Emergency splinting of these fractures can be lifesaving and ideally, Plaster of Paris (P.O.P) is the gold standard. Improvised cardboard splints have replaced P.O.P, since they were more readily available and thought to be less expensive to apply especially during the covid 19 pandemic supply chain crisis. While anecdotal evidence exists dating since the First World War, scarce published works exist in measuring the clinical effectiveness of cardboard splints in comparison to P.O.P. The aim of this study was to find out if cardboard can be an effective and cheaper emergency alternative splint to P.O.P especially during the supply chain crises frequent in low resource environments.
A prospective, experimental, cadaveric study was done where 44 open tibia-fibular fractures were splinted with both cardboard and P.O.P. The clinical effectiveness of cardboard and P.O.P splints was found through the measurement of immobilization at a fracture site via the use of 5 angular and 9 linear measurements. Cost comparisons of the splint were also done. Cardboard proved to be the non-inferior splint in 9 of the 14 measures of effectiveness. In the other 4 measures, no statistically significant differences were seen, while P.O.P was superior in 1 measurement. Cardboard proved to be the least expensive splint. During extreme shortages, cardboard could be considered as an emergency material for adequate splinting of lower limb fractures.
Keywords:
Cardboard splints, Emergency management, Lower limb fractures, Tibia fractures, Fibula fractures, Plaster of Paris (P.O.P), Trauma care, Low-resource environments
Article Details
How to Cite
WAHOME, R.; HARBORNE, D.; ELLIS, R..
VIABILITY OF CARDBOARD SPLINTS IN THE EMERGENCY MANAGEMENT OF LOWER LIMB FRACTURES.
Medical Research Archives, [S.l.], v. 12, n. 8, aug. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5606>. Date accessed: 06 sep. 2024.
doi: https://doi.org/10.18103/mra.v12i8.5606.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
Anne S. Boyd, H. J. B., Chad Asplund. (2009). Splints and Casts Indications and Methods.pdf. American Academy of Family Physicians, Am Fam Physician. 2009;80(5):491499.
Austin Smith, a. W. D. (2019). SplintER Series: Complications & Discharge Care Plans | Splint Principles 103. academic life in emergency medicine.
Biryabarema, E. (2018). Ugandan hospitals hit by shortages of drugs, other suplies. Reuter's. Retrieved from
https://www.reuters.com/article/us-uganda-healthcare-idUSKBN1KM4PC
Boyd, A. S., Benjamin, H. J., & Asplund, C. (2009). Principles of casting and splinting. Am Fam Physician, 79(1), 16-22.
Brouhard, R., & Menna, M. (2019). How to Splint a Broken Arm With Cardboard. Retrieved from https://www.verywellhealth.com/splinting-a-broken-arm-4020293
Brown, H. A., Skaggs, J., Brady, C., Tumusiime, V., & White, A. S. (2020). Injury patterns of patients presenting to a non-governmental hospital in Western Uganda. African Journal of Emergency Medicine, 10(3), 118-122. doi:https://doi.org/10.1016/j.afjem.2020.02.001
Burrows, H. J. (1966). Joint Motion: Method of Measuring and Recording. Published by the American Academy of Orthopaedic Surgeons, 1965. Reprinted by the British Orthopaedic Association, 1966. 7¼x4¾ in. Pp. 88, with numerous line drawings. Paper cover. 1966. Edinburgh and London: E. & S. Livingstone Ltd. Price 5s., plus 6d. postage. The Journal of Bone and Joint Surgery. British volume, 48-B(4), 857-857. doi:10.1302/0301-620x.48b4.857
Carl R. Chudnofsky, S. E. B. Roberts: Clinical Procedures in Emergency Medicine, 5th ed, Chapter 50 Splinting.pdf. In Roberts: Clinical Procedures in Emergency Medicine, 5th ed.
CDC. (2018). National Hospital Ambulatory Medical Care Survey 2018. C.D.C. GOV.
Chalya, P. L., Mabula, J. B., Dass, R. M., Mbelenge, N., Ngayomela, I. H., Chandika, A. B., & Gilyoma, J. M. (2012). Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania. Journal of Trauma Management & Outcomes, 6(1), 1. doi:10.1186/1752-2897-6-1
Chigblo, P., Lawson, E., Tidjani, F., Padonou, A., Nezien, C., Goukodadja, O., . . . Akue, A. (2017). Epidemiology of Fractures in a Tropical Country. European Scientific Journal, 13. doi:10.19044/esj .2017.v13n24p416
Chowdhury, P., Paul, S. K., Kaisar, S., & Moktadir, M. A. (2021). COVID-19 pandemic related supply chain studies: A systematic review. Transp Res E Logist Transp Rev, 148, 102271. doi:10.1016/j.tre. 2021.102271
Clelland, S. J., Chauhan, P., & Mandari, F. N. ( 2016). The epidemiology and management of tibia and fibula fractures at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The Pan African Medical Journal, 25(51). Retrieved from http://www.panafrican-med-journal.com/content/
Colditz, J. (2002). Plaster of Paris: The forgotten hand splinting material. Journal of hand therapy : official journal of the American Society of Hand Therapists, 15, 144-157. doi:10.1053/hanthe.2002. v15.015014
core, U. m. (2000). Manage musculoskeletal injuries, US MARINE corps field medical training battalion student matterial.
Gocke, T., Tintinalli, J. E., Cline, D., Ma, O. J., & McGraw-Hill Education (Firm). (2015). Posterior Leg Splint [two-dimensional moving image]McGraw-Hill's AccessMedicine (pp. 1 online resource (1 streaming video file, approximately 2 min. 19 sec). Retrieved from https://ezproxy.lib.monash.edu.au/login?url=https://accessmedicine.mhmedical.com/MultimediaPlayer.aspx?MultimediaID=5481074
Hao, B. C., & Xie, K. B. (2014). [Manipulative reduction and external fixation with cardboard splint for the treatment of calcaneal fractures: a 60-case report]. Zhongguo Gu Shang, 27(7), 545-550.
Heckman, J. D., & Sarasohn-Kahn, J. (1997). The economics of treating tibia fractures. The cost of delayed unions. Bull Hosp Jt Dis, 56(1), 63-72.
Hsia, R. Y., Ozgediz, D., Mutto, M., Jayaraman, S., Kyamanywa, P., & Kobusingye, O. C. (2010). Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy. International journal of emergency medicine, 3(3), 165-172. doi:10.1007/ s12245-010-0200-1
Hu, Q. D., Jiao, P. Y., Shao, C. S., Zhang, W. G., Zhang, K., & Li, Q. (2011). [Manipulative reduction and external fixation with cardboard for the treatment of distal radial fracture]. Zhongguo Gu Shang, 24(11), 907-909. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22295483
Hunt, D. R., & Albanese, J. (2005). History and demographic composition of the Robert J. Terry anatomical collection. American Journal of Physical Anthropology, 127(4), 406-417. doi:https://doi.org/10.1002/ajpa.20135
Independent, T. (2020). 500 bodies unclaimed from KCCA mortuary annually. The Independent. Retrieved from https://www.independent.co.ug/500-bodies-unclaimed-from-kcca-mortuary-annually/
Kisitu, D. K., Eyler, L. E., Kajja, I., Waiswa, G., Beyeza, T., Feldhaus, I., . . . Dicker, R. A. (2016). A pilot orthopedic trauma registry in Ugandan district hospitals. J Surg Res, 202(2), 481-488. doi:10.1016 /j.jss.2015.12.028
Kramer, B., Hutchinson, E. F., Brits, D. M., & Billings, B. K. (2019). Making the Ethical Transition in South Africa: Acquiring Human Bodies for Training in Anatomy. Anatomical Sciences Education, 12(3), 264-271. doi:https://doi.org/10.1002/ase.1814
Langley-Hobbs, S., Abercromby, R., & Pead, M. (1996). Comparison and assessment of casting materials for use in small animals. The Veterinary record, 139, 258-262. doi:10.1136/vr.139.11.258
Louis solomon, D. w., Selvadurai Nayagam. (2010). Apley's System of Orthopaedics and Fractures.pdf.
Lugada, E., Komakech, H., Ochola, I., Mwebaze, S., Olowo Oteba, M., & Okidi Ladwar, D. (2022). Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening. J Pharm Policy Pract, 15(1), 14. doi:10.1186/s40545-022-00412-4
Malanga, G. A. M., & Mautner, K. M. (2017). Musculoskeletal physical examination: An Evidence-Based Approach (Vol. Second edition): Elsevier, Inc.
Mawa, M. (2018). Report on the state of regional referral hospitals in Uganda. Retrieved from Uganda:
Noriki, S., Iino, S., Kinoshita, K., Fukazawa, Y., Inai, K., Sakai, T., & Kimura, H. (2019). Pathological analysis of cadavers for educational dissection by using postmortem imaging. Pathol Int, 69(10), 580-600. doi:10.1111/pin.12857
Oporia, F., Kisakye, A. N., Nuwematsiko, R., Bachani, A. M., Isunju, J. B., Halage, A. A., . . . Kobusingye, O. (2018). An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study. Pan Afr Med J, 31, 1. doi:10.11604/pamj.2018.31.1.15223
Parmar, A., Tyagi, S. K., Dabas, V., Mistry, J., Jhala, S., Suthar, D., . . . Bhatti, M. (2014). Assessment of the physical and mechanical properties of plaster of Paris bandage cast used as a splinting and casting materials. Veterinary World, 7, 1123-1126. doi:10.14202/vetworld.2014.1123-1126
Ranganadham, m., patel, a. A., srivastava, d. A. K., & solanki, d. M. J. (2024). Characteristics of paper, corrugated paper, fiber board and wood. In D. M. J. S. (ed.) (Ed.). Retrieved from http://ecoursesonline.iasri.res.in/mod/page/view.php?id=6199
Sheldon, D. B., & Sebastian, C. F. (1959). The emergency splinting of fractures with cardboard. West J Surg Obstet Gynecol, 67, 300-302. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14445766
Shikaro, S., Harborne, D., & Deus, T. (2018). Incidence,patterns of injury and short term outcomes of polytrauma patients admitted in Mbarara regional referral Hospital. pending publication, local research.
Srimani, P., Mazumdar, A., & Majumdar, S. (2017). ANALYSIS OF CADAVER POPULATION: A RETROSPECTIVE STUDY IN A MEDICAL TEACHING INSTITUTION IN WEST BENGAL. International Journal of Anatomy and Research, 5, 3530-3534. doi:10.16965/ijar.2017.106
Statistics, U. B. o. (2018). Uganda National Household Survey 2016-2017. Kampala, Uganda: Government of Uganda
Surgeons, A. C. o. (2018). Advanced trauma and life support (ATLS). In C. o. Trauma (Ed.), (10TH ed., Vol. 10TH EDITION, pp. Chapter 8).
Vieira, G., Barbosa, R., Marcolino, A., Shimano, A., Elui, V., & Fonseca, M. (2011). Influence of the number of layers of paris bandage plasters on the mechanical properties speciments used on orthopedic splints. Revista brasileira de fisioterapia (São Carlos (São Paulo, Brazil)), 15, 380-385. doi:10.1590/S1413-35552011005000018
W.H.O. (2020). Casts and Splints. World Health Organisation.INTERNATIONAL, https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/surgical-care/imeesc-toolkit/best-practice-safety-protocols/casts-and-splints.pdf?sfvrsn=c18eb740_5(Kajiwara Maki, ). Retrieved from https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/surgical-care/imeesc-toolkit/best-practice-safety-protocols/casts-and-splints.pdf?sfvrsn=c18eb740_5
Wandera, S. O., Kwagala, B., & Ntozi, J. (2015). Determinants of access to healthcare by older persons in Uganda: a cross-sectional study. International Journal for Equity in Health, 14(1), 26. doi:10.1186/s12939-015-0157-z
Austin Smith, a. W. D. (2019). SplintER Series: Complications & Discharge Care Plans | Splint Principles 103. academic life in emergency medicine.
Biryabarema, E. (2018). Ugandan hospitals hit by shortages of drugs, other suplies. Reuter's. Retrieved from
https://www.reuters.com/article/us-uganda-healthcare-idUSKBN1KM4PC
Boyd, A. S., Benjamin, H. J., & Asplund, C. (2009). Principles of casting and splinting. Am Fam Physician, 79(1), 16-22.
Brouhard, R., & Menna, M. (2019). How to Splint a Broken Arm With Cardboard. Retrieved from https://www.verywellhealth.com/splinting-a-broken-arm-4020293
Brown, H. A., Skaggs, J., Brady, C., Tumusiime, V., & White, A. S. (2020). Injury patterns of patients presenting to a non-governmental hospital in Western Uganda. African Journal of Emergency Medicine, 10(3), 118-122. doi:https://doi.org/10.1016/j.afjem.2020.02.001
Burrows, H. J. (1966). Joint Motion: Method of Measuring and Recording. Published by the American Academy of Orthopaedic Surgeons, 1965. Reprinted by the British Orthopaedic Association, 1966. 7¼x4¾ in. Pp. 88, with numerous line drawings. Paper cover. 1966. Edinburgh and London: E. & S. Livingstone Ltd. Price 5s., plus 6d. postage. The Journal of Bone and Joint Surgery. British volume, 48-B(4), 857-857. doi:10.1302/0301-620x.48b4.857
Carl R. Chudnofsky, S. E. B. Roberts: Clinical Procedures in Emergency Medicine, 5th ed, Chapter 50 Splinting.pdf. In Roberts: Clinical Procedures in Emergency Medicine, 5th ed.
CDC. (2018). National Hospital Ambulatory Medical Care Survey 2018. C.D.C. GOV.
Chalya, P. L., Mabula, J. B., Dass, R. M., Mbelenge, N., Ngayomela, I. H., Chandika, A. B., & Gilyoma, J. M. (2012). Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania. Journal of Trauma Management & Outcomes, 6(1), 1. doi:10.1186/1752-2897-6-1
Chigblo, P., Lawson, E., Tidjani, F., Padonou, A., Nezien, C., Goukodadja, O., . . . Akue, A. (2017). Epidemiology of Fractures in a Tropical Country. European Scientific Journal, 13. doi:10.19044/esj .2017.v13n24p416
Chowdhury, P., Paul, S. K., Kaisar, S., & Moktadir, M. A. (2021). COVID-19 pandemic related supply chain studies: A systematic review. Transp Res E Logist Transp Rev, 148, 102271. doi:10.1016/j.tre. 2021.102271
Clelland, S. J., Chauhan, P., & Mandari, F. N. ( 2016). The epidemiology and management of tibia and fibula fractures at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The Pan African Medical Journal, 25(51). Retrieved from http://www.panafrican-med-journal.com/content/
Colditz, J. (2002). Plaster of Paris: The forgotten hand splinting material. Journal of hand therapy : official journal of the American Society of Hand Therapists, 15, 144-157. doi:10.1053/hanthe.2002. v15.015014
core, U. m. (2000). Manage musculoskeletal injuries, US MARINE corps field medical training battalion student matterial.
Gocke, T., Tintinalli, J. E., Cline, D., Ma, O. J., & McGraw-Hill Education (Firm). (2015). Posterior Leg Splint [two-dimensional moving image]McGraw-Hill's AccessMedicine (pp. 1 online resource (1 streaming video file, approximately 2 min. 19 sec). Retrieved from https://ezproxy.lib.monash.edu.au/login?url=https://accessmedicine.mhmedical.com/MultimediaPlayer.aspx?MultimediaID=5481074
Hao, B. C., & Xie, K. B. (2014). [Manipulative reduction and external fixation with cardboard splint for the treatment of calcaneal fractures: a 60-case report]. Zhongguo Gu Shang, 27(7), 545-550.
Heckman, J. D., & Sarasohn-Kahn, J. (1997). The economics of treating tibia fractures. The cost of delayed unions. Bull Hosp Jt Dis, 56(1), 63-72.
Hsia, R. Y., Ozgediz, D., Mutto, M., Jayaraman, S., Kyamanywa, P., & Kobusingye, O. C. (2010). Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy. International journal of emergency medicine, 3(3), 165-172. doi:10.1007/ s12245-010-0200-1
Hu, Q. D., Jiao, P. Y., Shao, C. S., Zhang, W. G., Zhang, K., & Li, Q. (2011). [Manipulative reduction and external fixation with cardboard for the treatment of distal radial fracture]. Zhongguo Gu Shang, 24(11), 907-909. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22295483
Hunt, D. R., & Albanese, J. (2005). History and demographic composition of the Robert J. Terry anatomical collection. American Journal of Physical Anthropology, 127(4), 406-417. doi:https://doi.org/10.1002/ajpa.20135
Independent, T. (2020). 500 bodies unclaimed from KCCA mortuary annually. The Independent. Retrieved from https://www.independent.co.ug/500-bodies-unclaimed-from-kcca-mortuary-annually/
Kisitu, D. K., Eyler, L. E., Kajja, I., Waiswa, G., Beyeza, T., Feldhaus, I., . . . Dicker, R. A. (2016). A pilot orthopedic trauma registry in Ugandan district hospitals. J Surg Res, 202(2), 481-488. doi:10.1016 /j.jss.2015.12.028
Kramer, B., Hutchinson, E. F., Brits, D. M., & Billings, B. K. (2019). Making the Ethical Transition in South Africa: Acquiring Human Bodies for Training in Anatomy. Anatomical Sciences Education, 12(3), 264-271. doi:https://doi.org/10.1002/ase.1814
Langley-Hobbs, S., Abercromby, R., & Pead, M. (1996). Comparison and assessment of casting materials for use in small animals. The Veterinary record, 139, 258-262. doi:10.1136/vr.139.11.258
Louis solomon, D. w., Selvadurai Nayagam. (2010). Apley's System of Orthopaedics and Fractures.pdf.
Lugada, E., Komakech, H., Ochola, I., Mwebaze, S., Olowo Oteba, M., & Okidi Ladwar, D. (2022). Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening. J Pharm Policy Pract, 15(1), 14. doi:10.1186/s40545-022-00412-4
Malanga, G. A. M., & Mautner, K. M. (2017). Musculoskeletal physical examination: An Evidence-Based Approach (Vol. Second edition): Elsevier, Inc.
Mawa, M. (2018). Report on the state of regional referral hospitals in Uganda. Retrieved from Uganda:
Noriki, S., Iino, S., Kinoshita, K., Fukazawa, Y., Inai, K., Sakai, T., & Kimura, H. (2019). Pathological analysis of cadavers for educational dissection by using postmortem imaging. Pathol Int, 69(10), 580-600. doi:10.1111/pin.12857
Oporia, F., Kisakye, A. N., Nuwematsiko, R., Bachani, A. M., Isunju, J. B., Halage, A. A., . . . Kobusingye, O. (2018). An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study. Pan Afr Med J, 31, 1. doi:10.11604/pamj.2018.31.1.15223
Parmar, A., Tyagi, S. K., Dabas, V., Mistry, J., Jhala, S., Suthar, D., . . . Bhatti, M. (2014). Assessment of the physical and mechanical properties of plaster of Paris bandage cast used as a splinting and casting materials. Veterinary World, 7, 1123-1126. doi:10.14202/vetworld.2014.1123-1126
Ranganadham, m., patel, a. A., srivastava, d. A. K., & solanki, d. M. J. (2024). Characteristics of paper, corrugated paper, fiber board and wood. In D. M. J. S. (ed.) (Ed.). Retrieved from http://ecoursesonline.iasri.res.in/mod/page/view.php?id=6199
Sheldon, D. B., & Sebastian, C. F. (1959). The emergency splinting of fractures with cardboard. West J Surg Obstet Gynecol, 67, 300-302. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14445766
Shikaro, S., Harborne, D., & Deus, T. (2018). Incidence,patterns of injury and short term outcomes of polytrauma patients admitted in Mbarara regional referral Hospital. pending publication, local research.
Srimani, P., Mazumdar, A., & Majumdar, S. (2017). ANALYSIS OF CADAVER POPULATION: A RETROSPECTIVE STUDY IN A MEDICAL TEACHING INSTITUTION IN WEST BENGAL. International Journal of Anatomy and Research, 5, 3530-3534. doi:10.16965/ijar.2017.106
Statistics, U. B. o. (2018). Uganda National Household Survey 2016-2017. Kampala, Uganda: Government of Uganda
Surgeons, A. C. o. (2018). Advanced trauma and life support (ATLS). In C. o. Trauma (Ed.), (10TH ed., Vol. 10TH EDITION, pp. Chapter 8).
Vieira, G., Barbosa, R., Marcolino, A., Shimano, A., Elui, V., & Fonseca, M. (2011). Influence of the number of layers of paris bandage plasters on the mechanical properties speciments used on orthopedic splints. Revista brasileira de fisioterapia (São Carlos (São Paulo, Brazil)), 15, 380-385. doi:10.1590/S1413-35552011005000018
W.H.O. (2020). Casts and Splints. World Health Organisation.INTERNATIONAL, https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/surgical-care/imeesc-toolkit/best-practice-safety-protocols/casts-and-splints.pdf?sfvrsn=c18eb740_5(Kajiwara Maki, ). Retrieved from https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/surgical-care/imeesc-toolkit/best-practice-safety-protocols/casts-and-splints.pdf?sfvrsn=c18eb740_5
Wandera, S. O., Kwagala, B., & Ntozi, J. (2015). Determinants of access to healthcare by older persons in Uganda: a cross-sectional study. International Journal for Equity in Health, 14(1), 26. doi:10.1186/s12939-015-0157-z