What type of splint is recommended for a distal femoral metaphysis compacted fracture in a 2-year-old?

Splinting for Distal Femoral Metaphysis Compacted Fracture in a 2-Year-Old

A long leg posterior splint with the knee in 15-20° of flexion is the recommended immobilization method for a distal femoral metaphysis compacted fracture in a 2-year-old child.

Fracture Characteristics and Considerations

Distal femoral metaphyseal fractures in young children require careful assessment and management due to several important factors:

• The distal femoral physis contributes to 70% of femoral growth and 37% of total limb growth 1
• Compacted (or torus/buckle) fractures result from compression from axial loading along the length of the bone 2
• In children aged 2 years, these fractures are typically from accidental trauma, unlike in non-ambulatory infants where abuse should be considered 2, 3

Recommended Splinting Technique

Primary Immobilization Method

• Long leg posterior splint extending from the gluteal fold to the toes
• Position the knee in 15-20° of flexion
• Ensure the ankle is in neutral position (90°)

Application Technique

1. Apply stockinette from toes to upper thigh
2. Use cotton padding with extra padding at bony prominences
3. Apply plaster or fiberglass splint material posteriorly
4. Never apply elastic bandage directly to the skin (a common error seen in 77% of improperly placed splints) 4
5. Secure with elastic bandage over the padding

Critical Aspects of Proper Splinting

Proper splint application is essential to prevent complications. Research shows 93% of splints are improperly placed in pediatric fracture care 4. Key elements include:

• Appropriate length: Must extend from gluteal fold to toes
• Functional position: Knee in slight flexion (15-20°)
• Proper padding: Especially over bony prominences
• No direct skin contact with elastic bandage
• Appropriate tension: Tight enough for stability but not restricting circulation

Monitoring and Follow-up

• Assess neurovascular status immediately after splint application
• Instruct parents to monitor for:
  • Excessive swelling
  • Color changes in toes
  • Inability to move toes
  • Increasing pain not controlled with prescribed analgesics
• Schedule orthopedic follow-up within 5-7 days

Special Considerations

While child abuse should be considered with distal femoral metaphyseal fractures in non-ambulatory children 3, in a 2-year-old ambulatory child, these fractures are more commonly associated with accidental trauma 2. Several studies have demonstrated that short falls to the knee may produce torus or impacted transverse fractures of the distal femoral metaphysis 2.

Timely and effective analgesia is more critical to outcomes than the exact timing of splint application 5, but proper immobilization helps with pain control and prevents further displacement.

Potential Complications of Improper Splinting

Common complications from improper splinting include:

• Excessive edema (seen in 28% of cases) 4
• Skin breakdown (6% of cases) 4
• Poor immobilization leading to fracture displacement
• Neurovascular compromise

Proper splinting technique is essential to minimize these risks while providing adequate stabilization until definitive treatment.