Break Repairs: Casting vs. Splinting

Most cases of arm or leg fractures require splinting before a cast is molded.

But splints for broken bones seem to have gotten a bit of a bad reputation, especially when parents expect the traditional cast to be molded on their child’s bone fracture almost immediately after an injury.

Splinting serves an important function, allowing the body’s natural protective mechanism – swelling — to occur before a cast is custom-made.

Up to a third of all children will experience an arm or leg bone fracture of some type, with the rate increasing significantly during puberty, and to a greater degree for boys. Arm fractures are most common.

Splints – also known as “half-casts” – provide less support than casts, but are easier to use and can be adjusted. They also can be tightened or loosened easily if the swelling in the arm or leg increases or decreases. Velcro straps make it easier for the patient or health care provider to put the splint on or take it off.

“Splints give us a chance to re-evaluate a patient in 5 to 7 days,” said Pooya Hosseinzadeh, M.D., a pediatric orthopedic surgeon with Baptist Children’s Hospital, whose specialties include fractures, spine care and sports-related injuries.

So the debate is not as much about “casting vs. splinting” as it is about “when to splint and when to cast.”

Casts provide more support and protection for a limb that is injured or broken. They are normally made from plaster or fiberglass and can be easily molded to the shape of the injured arm or leg. The plaster or fiberglass form a hard layer that protects the injured limb and keeps it immobilized.

“A lot of parents feel more comfortable with casts,” Dr. Hosseinzadeh said. “It’s a good precaution especially because school can be an unpredictable environment. And it prevents minor injuries from becoming serious injuries.”

The biggest risk is “compartment syndrome” if a cast is fitted too early and swelling develops.

Compartment syndrome occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

“If we put on a cast initially, we are increasing the chance of developing compartment syndrome,” Dr. Hosseinzadeh said. Fractures that can be casted soon after injury are mostly minor “hairline” or of the “non-displaced” type. A non-displaced fracture is a break in which the bone remains aligned properly, despite being broken.

Besides hairline fractures with minimal swelling, splinting is the preferred method for initial stabilization of the fracture.

Sometimes prevention and easing parents’ concern play a part in deciding whether to apply a cast mold immediately. With minor or hairline fractures, a cast gives parents more peace of mind than a splint.

Signs and symptoms of a fracture in children:

  • Pain or swelling.
  • Obvious deformity or displacement.
  • Difficulty using or moving the injured area
  • Warmth, bruising or redness in the injured area
  • Seek medical care immediately if your child displays any of the symptoms of a fracture.

    What should parents do if their child suffers an obvious limb fracture?

    “If a parent sees a deformity or injury, they should immediately immobilize the limb,” said Dr. Hosseinzadeh. “That will help with the pain and decrease the chance of more displacement before they get medical attention.”

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