Environmentally friendly splints for limb immobilisation: a systematic review.

Introduction: Climate change is estimated to be the biggest global health threat of the 21^st century, and has prompted calls to move away from processes in healthcare associated with high energy consumption and greenhouse gas emission. In musculoskeletal medicine, splints are widely used for limb immobilisation. These have typically been made from single-use materials such as gypsum, although in recent years purportedly environmentally friendly splints have been designed. In this systematic review, we set out to assess the clinical effectiveness of all commercially available environmentally friendly splinting materials, including Woodcast^®.

Methods: The AMED (Allied and Complementary Medicine Database), CINAHL^® (Cumulative Index to Nursing and Allied Health Literature), Cochrane Central Register of Controlled Trials, Embase^®, Emcare^® and MEDLINE^® databases were searched to identify studies assessing the clinical effectiveness of biodegradable and environmentally friendly splints prior to paper review and data extraction. Formal quantitative synthesis was not possible owing to the substantial heterogeneity in the study designs and outcome measures.

Results: Six papers met the inclusion criteria, all investigating one particular splint material (Woodcast^®). One was a case series, two were cohort studies and three were randomised controlled trials. Primary outcome measures were heterogeneous but the environmentally friendly splints were generally equivalent to traditional splint materials. Studies were mostly at a high risk of bias.

Conclusions: There is limited research assessing 'green' splints in practice although the data suggest similarity with existing materials and no substantial safety concerns. Further scrutiny of the clinical effectiveness and environmental credentials of such splints is also required.