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Straightening an Angulated Fracture

Question Type:
Full Question:
Among adults and children who receive First Aid for an angulated long bone fracture (P), does realignment of the fracture prior to splinting (I), compared with splinting as found (C), change neurological injury, vascular injury, splinting, pain, Time to medical transportation (O)?
Consensus on Science:
For the question of straightening an angulated fracture, compared with splinting as found, the literature search initially returned 458 citations. After application of inclusion and exclusion criteria by title and abstract (inclusion: care provided before definitive treatment; exclusion: hospital settings, use of analgesics), 9 studies were identified for full review. Upon full review, all 9 studies were excluded because they did not completely meet criteria for inclusion; thus, no evidence was found to address the critical outcomes of neurologic injury, vascular injury, or splinting, nor was there evidence for the important outcome of pain.There is no published evidence for or against the realignment of angulated long bone fractures as a first aid procedure in terms of neurologic or vascular injury, pain, or time to medical transportation outcomes.
Treatment Recommendation:
No recommendation; we found no evidence regarding the risks and benefits of straightening an angulated fracture by first aid providers.Values, Preferences, and Task Force InsightsConsistent with the first aid principle of preventing further harm, and based on training and circumstance, providers may need to move an injured limb or person. In such situations, first aid providers should protect the victim, which includes splinting in a way that limits pain, reduces the chance for further injury, and facilitates safe and prompt transport.
CoSTR Attachments:
Summary of Findings Table - none_n.docx    

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