Prehosp Emerg Care. The device is also popular because it is simple to use and relieves pain well. The mean . You can immobilize a limb using your hands if you are untrained by placing your fingers around the bone at the ends of the fractures and pulling it up. If the patient is to be transferred to another hospital, the leg should be immobilised in a Thomas type splint (if available) or a backslab. Femoral Traction Splint. The Hare traction splint is a device used to immobilize and stabilize a patients lower leg and foot. Traction to the fractured femur is applied with a heel strap that is anchored off of the distal frame. Helicopter service may prefer the Sager because it is slightly shorter than the Hare and may fit better in the helicopter, especially if a patient is tall. When covering a football game on artificial turf, you should have enough supplies to cover numerous skin scrape. 2009 Winter;10(4):337-42 [. femur fracture, HEMS, traction splint Share Resuscitation of Penetrating Trauma . It is critical to understand how traction is generated by a mobilized splints in order to create the splints. Ensure that the stretcher or table is long enough to support the distal end of the device (eg, 20 cm [8 inches] beyond the ipsilateral foot). splints. Prehosp Emerg Care 2003;7:241-3. Use the contralateral, uninjured leg as a landmark if the injured leg is shortened. One of the most painful of all injuries that one can suffer is a fractured femur. It involves inserting a pin or wire directly into the bone, then attaching weights through pulleys or ropes to it that control the amount of pressure applied. A traction splint is used to immobilize a bone or joint that has been injured. As soon as the femur reaches 11 years old, a rigid rod can be used to attach the inner portion of the sac. After applying a splint to the leg, it is common to reexamine the neurovascular function of the leg. Hare uses bipolar traction to move his limb with bilateral steel rods that flank it. The femur is the most durable and powerful bone in the body. These cookies do not store any personal information. Adequate fracture stabilization reduces the risk of further soft tissue damage, relieves pain, and aids in wound healing. 4. When you have an open reduction, orthopedic surgeons reposition your bone pieces to return them to their proper alignment. Of those articles, they also found that splints were often applied to patients with contraindications, are rarely used, take up space, and dont have much evidence for their benefit. Traction splints should be worn for all mid-shaft femur fractures to ensure patient comfort and better fractures alignment. Traction splinting is a useful tool for femur fracture alignment, increasing arterial blood flow, decreasing pain, and reducing the risk of further injury from fractured bone fragments. In my mind, this is a bit too simplistic. Based on a work athttps://litfl.com. Irajpour A, Kaji NS, Nazari F, Azizkhani R, Zadeh AH. If a cardboard splints is not available, they can be used as a substitute. It is strongly advised that vaccinations be carried with the traveler on any trip, and that proper documentation be provided. @article{Runcie2015FemoralTS, title={Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or Not to Use? Application of traction splints to the femur can be a bit tricky, mostly because of the various indications and contraindications. [, Wood SP, Vrahas M, Wedel SK. When a patient has a fractured femur, he or she requires 10% of their body weight to be recovered. In some cases, traction may also be used to realign bones that have been displaced by a fracture. As an overview of the Prehospital Immobilization process, this article includes a Prehospital Traction Splint. A femoral shaft fracture treated with an early operative procedure has a good chance of recovery. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada)dedicated to using leading-edge science to save and improve lives around the world. Constriction. Femoral neck fractures can be occult: if patient has significant pain or cannot ambulate, do advanced imaging. When muscles spasm less and leg lengths increase, both static and dynamic traction mechanisms may lose traction. 2022 Emergency Trauma Management Pty Ltd. Post was not sent - check your email addresses! It is critical that medical personnel keep an eye on patients with suspected femur fractures in order to keep them stable. There are limited data available on the benefit of traction splint use for femur fracture in the prehospital or transport environment. . It is critical to consider the type of fracture and the extent of the soft tissue injury when selecting a traction splint. To construct this splints, two pieces of cloth are sewn together. There is a chance of receiving a neural injury, but these occurrences must be documented. When the femur fractures and the thigh begins to fill with blood, it becomes more spherical in shape. And of those 5 (see Traction splints may also reduce and/or decrease pain and bleeding due to femur fractures, particularly those that are shortened. It may be possible to adjust the magnitude of force more finely and control it with elastic traction. Learn how your comment data is processed. When applying weight or traction to the skin, it should never result in wounds or soft tissue damage. Disadvantages of prolonged skin traction are: Loosening. This also helps maintain the normal length of your leg while you await surgical repair. Medical Director of the Texas State Aquarium, Padre Island National Seashore, Robstown EMS, and Code 3 ER | EBM gone Wild | @EBMGoneWild |. In the pre-hospital or austere setting, these benefits are much smaller and have a higher risk associated as well. The most common type of fracture in infants is a femoral fracture, which is usually stable and can be successfully treated with a Pavlik harness, splints, or spica casting. I was unable to find any useful references that provide an accurate evidence base for the oft-quoted figure of 1500ml (or 4units producing class III shock from the ATLS manual 8th edition which has no obvious reference for this figure) for the potential amount of blood that can be lost from a fractured femur. When the area is being splinted, it is critical that it be kept clean and dry. Measure the splint on the unaffected leg. A patented pulley system makes traction application easier than other devices, and a unique hitch allows use despite a foot amputation. While other traction splints are contraindicated with lower leg injury or amputation, the STS's unique design allows the ankle strap to be alternately positioned proximal to the calf. The most common way to treat an injured femur in the field is with traction splints. Immobilize the leg: either with a posterior splint or simply a pillow under the thigh. Traction splinting for fractured shaft of femur why do we do it? It consists of a padded board that is attached to the limb, and a pulley system that is used to apply the traction. completely nonexistent data, and even fewer premanufactured devices are Hare and Sager are two of the markets most popular traction splints. One Size Fits All The STS works with both adults and peds. Devices supposed to only be used for Femur fx. In case of sale of your personal information, you may opt out by using the link. 2001 Mar;19(2):137-40. Do you have a reference that more accurately describes blood loss from femoral shaft fractures? Lightweight and Compact - The STS weighs only 0.60kg and is 58.5cm W x 7.7cm H in size. Whilst none of the available traction splints support the thigh fully, application of traction will allow less movement than would occur with an unsupported leg. Femoral traction splints are designed to apply traction to the lower portion of the leg, distal to the fracture, usually by pulling the ankle away from a stabilized pelvis. Product description: The Curaplex Traction Splint effectively realigns a fractured femur to proper position, reducing pain, restoring profusion and inhibiting vascular, nerve, bone and muscle damage. Even for bilateral femur fractures, a great deal of rotational stability may be accomplished simply by wrapping both . The most common method of fracture correction is intramedullary nail therapy. Fully 68% reported that they used a traction splint for every suspected femur fracture, and the other 32% said they selectively used them. % of people told us that this article helped them. Friar's balsam may be used to improve adhesion. Sager's traction is quantifiable and gentle and will not disrupt or move Pelvic bones immobilized by MAST Trousers. If an ambulance were equipped with a Sager and two Hares, the field would be able to select which ambulance best met the needs of each trauma patient. Elastic traction must be adjusted as joints remodel and move more freely, whereas inelastic traction must be maintained. We havent touched on the best method or device for applying traction, complications of traction splinting, other methods of analgesia for femoral shaft fractures or other related issues but hopefully we can cover thesein future posts. Prehospital midthigh trauma and traction splint use: recommendations for treatment protocols. 8-22). Use for phrases Skeletal traction is used for fractures of the femur (thighbone), pelvis, hip, and certain upper arm fractures. Adjust the length of the splints on the injured leg as needed. The femur is the longest bone in the body and a highly vascularised bone, due to its role in haematopoesis . Then they attach the pin to weights that keep your femur straight. H Frowde, Hodder and Stoughton, London; 1919) that argues a reduction of death from 80% to 15% for femoral gunshot injuries, but this cant be used realistically today as evidence.There is a teaser at the end of the article though. For femur fractures, using a splint that applies consistent traction has several benefits. The main problem in prehospital or wilderness care is that the person with the femur fracture also needs extraction. The Fare-Tec CT-6 splint. This is the reason why it is vitally important to make a traction splint for a fractured femur as quickly as possible. Knowing that absence of data does not equal absence of benefit, we all left likely doing the same thing we were doing before. To prevent fragments of bone from damaging these structures, and to prevent the bone from moving out of place, a splint is applied to the femur. D. humerus. Slishman Traction Splint (STS) The innovative STS design has the traction mechanism positioned at the patient's hip. But creating a make-shift splint needs to stop being taught as the best or only way to treat femur injuries. Rather than steel rods on either side of the fractured limb, the Sager applies traction from the ankle with counter pressure directed at the ischial tuberosity. By signing up you are agreeing to receive emails according to our privacy policy. A Thomas Traction Splint is a bandage that is applied around the leg to aid in its holding. Specifically, the often theorized benefits of pain reduction, bleeding, and nerve injury are not shown in any recent literature. Simple, adjustable, wrap-around ankle hitch designed to allow EMTs to check pedal pulses. To keep your pins in good condition, apply a half-strength hydrogen peroxide solution and sterile dressings twice daily. For geometric shapes of equivalent upper radius dimensions, a sphere has 2/3 the volume of cylinder and a cone (or frustum) has 1/3 the volume of a cylinder. Thomas splint: Thomas splint with a Pearson knee piece attached to the splint. I think the old myths of major blood loss in a femur fracture is likely to be confounded by the fact that the forces involved in fracturing a femur also is likely to lead to a number of other major blunt traumatic injuries. It also prevents the inevitable thigh muscle spasm from further displacing or moving the fracture (sometimes jamming the injured bone ends together) which can be very painful. It is typically used when there is a risk of the bone or joint being displaced or when there is already an existing injury that needs to be stabilized. The patients body weight should be between 10% and 15% of the optimal traction point. Femoral traction splints are made of carbon tubing which snaps together via an internal bungee and fixes to the leg via velcro straps. This allows femur traction to still be applied and leaves the lower leg accessible for other splinting or bandaging. Traction splints interfere with many litters, are by design only useable for 1 type of injury, and require a significant amount of highly specific training. A traction splint is a device worn on the leg to keep a fracture from moving. Because V-shaped traction splints are the most common type of traction splints used for fractures in the femur, this type of traction splints is commonly used. Learn more about the Merck Manuals and our commitment to. 8-22) or elastic traction to generate joint motion and tissue remodeling of primary stiff joints (Fig. It is not recommended for patients who have sustained a fracture of the patiline, kneecap, or shinbone. It is best to refer orthopedic surgeons to treat patients who have diabetes or a condition that is not well understood. When should you not use a traction splint? Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. This website uses cookies to improve your experience while you navigate through the website. By drawing the thigh back into its more anatomical, frustum (or inverted cone) shape, traction splints prevent blood loss from occurring. The traction splint includes a pair of spaced adjustably extensible side members, a traction mechanism coupled to first ends of the side members for exerting a pulling force on the limb, and a cross member traversing second ends of the side members and adapted to abut a portion of the patient. traction splints can be made from a variety of materials, including metal, plastic, and even cloth. Stabilize the device against the pelvis and the ankle as directed by the product instructions, including the proper sequence of these steps. Furthermore, it keeps the fracture from further displacing or moving the thigh muscles. It has been designed for pre hospital and patient transport. Donway traction splints are half-ring traction splints that are intended to be used by people who cannot use standard traction splints due to limited range of motion. This helps reduce bleeding. Traction splints interfere with many litters, are by design only useable for 1 type of injury, and require a significant amount of highly specific training. 2004 Aug;29(8):64-9. The most common traction splints you'll see in the field are the Hare (bipolar) and the Sager (unipolar). A knife and a multitool can be useful depending on the circumstances, as well as depending on where the event is taking place. That Is the Question. Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on Tumblr (Opens in new window), Click to share on Pinterest (Opens in new window), Click to email this to a friend (Opens in new window), FACEM/GP/Advanced Trainee Critical ED Procedures Course, a sphere has 2/3 the volume of cylinder and a cone (or frustum) has 1/3 the volume of a cylinder, ETM Podcast Episode 11: Trauma Short Open pneumothorax, ETM Podcast Episode 12 Bruce Paix & Andrew Perry Approach to the surgical airway. Skin traction rarely reduces a fracture, but reduces pain and maintains length in fractures. Hare Traction Splint (Bipolar Traction Splint) Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. In children, definitive stabilization can be accomplished through splints, casting, skeletal traction, external fixation, pinning, flexible intramedullary nailing, and plating. When a person falls off a high stool or from a significant height, MVA causes a quarter of femoral shaft fractures. The traction splint is used to secure the leg in a better, near-reduced position. The thigh is generally in the shape of an inverted conical frustum (a cone with the pointy end cut off). Do a fascia iliaca or femoral nerve block: this is a safe and effective way . 2009 Sep;19(9):295-8. Traction splints may also be used in ankle and knee injuries. These cookies will be stored in your browser only with your consent. Remove the traction splint: this can often result in worsening injury. Image source The term rimp refers to a type of splints made of a rigid object such as a board or a wooden frame. You also have the option to opt-out of these cookies. DOI: 10.1016/j.wem.2015.01.006 Corpus ID: 34716314; Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or Not to Use? To investigate the attitudes of rescuers toward the use of femoral traction splints. Choosing the appropriate traction splints should take into account the type of fracture and the extent of the soft tissue damage. Place the ischial pad against the bony prominence of the buttocks until the ischial pad rests against the injury. It usually takes a few weeks to completely heal from splending, but it is critical to keep the area as comfortable as possible while it is healing. Official Recommendations of the International Commission for Mountain Emergency Medicine, ICAR MEDCOM, Intended for Mountain Rescue First Responders, Physicians, and Rescue Organizations. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. It is possible that traction devices with half-ring designs (such as Thomas or Hare splints) can cause hip flexion of up to 30 degrees. The trusted provider of medical information since 1899, Medically Reviewed Apr 2021 | Modified Sep 2022. An isolated fracture of the midshaft femur is one of the signs of traction. since the creation of the modern emergency medical services (ems) systems in the later-half of the 20th century, the traction splint (ts) has been standard equipment on ambulances to treat both adult and pediatric femur fractures. review. The skin is prepared and shaved -it must be dry. Wilderness Environ Med. This is achieved by applying a pulling force to the affected limb, which stretches the tissues and relieves pressure on the injured area. From field to hospital: When applied, Sager Splint model SX404 is radiolucent to all areas of a femoral fracture. Posing a complication of periosteum tears, particularly those with a complete tear, may make cast immobilization impossible. In wilderness medicine, the situation is even worse. Thus, forgive me for not remembering all the finer details of everyones points of view. Both are good splints. 5. In the end, I'm not saying that traction splinting isn't without benefits. Mechanical traction reduces the possibility of vascular and nerve damage; Wide elastic support straps maintain the injured leg within the frame of the splint, helping to provide in-line traction; Heel stand instantly locks into place for support but folds flat for storage; Available in adult and pediatric sizes, or as a kit A traction Vary should be installed at a distance of between 6.4 and 29.8 miles. Enter search terms to find related medical topics, multimedia and more. In the pre-hospital or austere setting, these benefits are much smaller and have a higher risk associated as well. The STS applies traction from the hip and is infinitely adjustable. Preference cookies are used to store user preferences to provide content that is customized and convenient for the users, like the language of the website or the location of the visitor. Traction Splint effectively realigns a fractured femur to a proper position, reducing pain, restoring profusion and inhibiting vascular, nerve, bone and muscle damage. But do we need to be doing them at all, and more importantly, should we be teaching the next generation of wilderness medical professionals to do it ad infinitum? They can also be used for certain types of dislocations and other injuries to the extremities. Dr. We do not control or have responsibility for the content of any third-party site. The diaphysis of the femur has a normal anatomic alignment that is 5 to 7 degrees from the physiologic axis of the femur, which can be drawn from the center of the femoral head to the center of the knee. Fractures in the femoral shaft in children are quite common, with the majority of them healing quickly and without serious complications. In the field, open femur fractures are contraindications to traction splint application Significant injuries to the knee Use about 10% of the patient's body weight or up to about 7 kg (15 pounds). The Sager Traction splints are available in the following sizes: *BR The Sager traction splint, a unipolar split, can be used to treat fractures in the femur. There are other splints on the market, such as the Thomas, Kendrick, Donway, Slishman, and CT-6 splints, but they are less common. To review the literature for evidence on the use of traction splints in prehospital medicine and test the hypothesis that femoral traction splints reduce morbidity and mortality in patients with a fractured femur. There are many femur traction splint devices, and all are based on the same principle: a rigid frame that anchors at the proximal pelvis and extends traction beyond the distal heel. In order to pull the thighbone (femur) towards the mid-thigh, a V-shaped splint is formed on the arm. found using Boolean operators, only 5 were ultimately included in the A femoral diaphysis fracture in the neurological system is uncommon, but it is critical to carefully assess your motor and sensory abilities. Friction. There is a book from 1919 (Gray, H. The Early Treatment of War Wounds. Of the 141 they The company that makes the Hare traction splint gives the sole indication as a suspected femur fracture, and the sole contraindication as an open femur fracture. Transverse fractures occur as a result of bending forces or direct trauma. It is commonly used in emergency situations to prevent further injury to the leg or foot, and to provide pain relief. This allows femur traction to still be applied and leaves the lower leg accessible for other splinting or bandaging. An incomplete fracture realignment can occur due to an elevation of the leg when the angle is not in line with the patients hip. Lie the patient supine with the injured lower extremity supported. It is beneficial to use traction splints on both the open and closed fractures of the femoral diaphysis. The light, compact splint is designed to apply femoral traction to relieve pain and reduce hemorrhage and the possibility of further neurovascular injury. 2003 Apr-Jun;7(2):241-3. Am J Emerg Med 2001;19:137-40. When a femur fracture occurs as a result of high-energy trauma, it is necessary to conduct a comprehensive evaluation. Traction is controlled by a 4 to 1 purchase system using a small line to apply tension. Traction splint is, in most cases, used in the stabilization of the mid shaft femur structure. Traction splints are typically used for fractures of the femur (thighbone), tibia (shinbone), and humerus (upper arm bone). All rights reserved. To create this article, volunteer authors worked to edit and improve it over time. Femoral traction splints are designed to apply traction to the lower portion of the leg, distal to the fracture, usually by pulling the ankle away from a stabilized pelvis. A microadjustment system allows for precise traction application and adjustment. Traction splints may not be as effective on proximal femur fractures. The Thomas Traction Snopes are simple and effective, and they are used in a variety of situations. Traction splints provide a counter-pull to reduce the size of the thigh and realign the fractured femur. traction splints have not been shown to worsen blood loss), it is probably OK to continue using them for the purpose of haemorrhage control whilst remaining nascent of the limitations of the science behind the technique. The Thomas half-ring group includes both the modified Thomas splints and the Thomas splint, whereas the non-half-ring group includes the Sager splints and the CT-EMS traction system, both of which are made of carbon fibers. Please confirm that you are a health care professional. Necessary cookies are absolutely essential for the website to function properly. The most common types of injuries are those to the knee, hip, and pelvis. Furthermore, it is more comfortable to wear than a Thomas splints, and it is generally more effective at relieving pain. This half-ring traction splints is ideal for people with limited mobility and is designed for those who require it. Special Considerations: NAI -Child abuse occurs in 50-80% of children <2years and in up to 30% of children <4years with femoral fractures Femoral shaft fractures are among the most common diaphyseal fractures in children with an estimated annual incidence of 19 fractures per 100,000 children in the . It is critical, however, to consult with a doctor before beginning traction splints. First, a traction splint stretches out the powerful muscles of the thigh (and the surrounding fascia), which compresses blood vessels embedded in the muscles and holds the bone ends in place. It is primarily used on patients with mid-line femur fractures. This category only includes cookies that ensures basic functionalities and security features of the website. The Thomas Traction Splint can be applied to either the left or right leg. It is mandatory to procure user consent prior to running these cookies on your website. A large compartment in the thigh can hold up to three liters of bleeding blood. The proximal aspect is padded against the ischial tuberosity. Skin Traction - Lower Extremity. That Is the Question. My 2c. Traction . How much? We also use third-party cookies that help us analyze and understand how you use this website. They can also be used for certain types of dislocations and other injuries to the extremities. The light, compact splint is designed to apply femoral traction to relieve pain and reduce hemorrhage and the possibility of further neurovascular injury. 45. If diabetic athletes are covered by a medical team, a glucometer should be used. Traction splints are typically used for fractures of the femur (thighbone), tibia (shinbone), and humerus (upper arm bone). Use OR to account for alternate terms A fracture in the newborn or infant can heal within a few days, but a fracture in the adolescent can heal for 10 to 14 days. And that discussion was mostly directed at commercial devices used in inter-facility transport or in-hospital use. Sager Traction Splints are indicated in 93% of all femoral fractures (treats mid-shaft and proximal third fractures).As such, they have a much broader range of application and use than other traction splints. J Perioper Pract. Here in NY State, whatever type or brand traction splint, CONTRA-Indicated to use for fx leg if possible tib-fib involvement. You should have a mouth-to-mouth resuscitation mask or other means of mouth-to-mouth compressions in your possession. Its a simple matter of geometry. Heel stand folds flat for storage and . We use traction splints on open femur fractures, wash out with 2L of saline first. This site complies with the HONcode standard for trustworthy health information: verify here. Femur fracture immobilization with traction splints in multisystem trauma patients. Not only that, but the usually involve some poor soul being left without a shirt, poles, a jacket, and maybe their backpack. If skin traction is likely to be used for more than 24 hours, greater patient comfort and better control of the femoral fracture can be achieved by using Hamilton-Russell . MeSH terms Adolescent Adult Aged Aged, 80 and over Air Ambulances* Child Child, Preschool Weighted traction splints: Healthcare providers will place a strap on your ankle and use weights attached to a frame and pulley. Theoretical benefit of traction splinting is reduction in bleeding and improved pain Sager and Hare splints are commonly used by EMS providers Buck's traction used by ortho Disposition Admit Typically requires ORIF See Also Femur fracture External Links Wheelers' Textbook - Femoral Shaft Fracture References Fractures and dislocations displaced by muscle forces that cannot be adequately controlled with simple splints can be stabilized with traction. This allows femur traction to still be applied and leaves the lower leg accessible for other splinting or bandaging. This article investigated the use of femoral traction splints by The splints are lightweight and simple to adjust, making them ideal for most people. Commercially available femoral traction splint kit (eg, Hare, Sager, Ferno-tracTM, KendrickTM), Drugs for analgesia/sedation (eg, fentanyl, morphine, propofol). Am J Emerg Med. wikiHow is a wiki, similar to Wikipedia, which means that many of our articles are co-written by multiple authors. B. pelvis. [, Bledsoe B, Barnes D. Traction splint. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It seems no-one really knows and weve all been quoting a guesstimate. Christian Micallef. . Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. The initial treatment is usually skin traction, later converted to skeletal traction. Buck's skin traction is widely used in the lower limb for femoral fractures, lower backache, acetabular and hip fractures. But if there isnt, is it time to stop? Yes you can use on open fracture (only unilateral). In more complex splints, it is possible to align the fracture with a series of straps and supports. A traction splint is a device that is used to stabilize a bone or joint in order to prevent further injury. This site uses Akismet to reduce spam. This splint features a telescoping design along with directions printed on the nylon leg straps to ensure quick application. These traction splints are the most commonly used, and they should be used when there is an isolated fracture of the femoral artery or gunshot wounds. The Thomas splint supports the leg and balanced traction is applied. Wood SP, Vrahas M, Wedel SK. If you suspect a limb injury with a possible fracture, apply a traction splint. This innovative design change provides a number of outstanding benefits over conventional traction splints: Does not . Ensure adequate traction is applied by using the traction scale if available on the specific device. Reference. Assess distal pulses both before and after splint application. Long leg splints. One of the most common types of traction splints is the Hare splint, which features metal rods with a series of adjustable straps for security. There are many commercial brands available which vary slightly in their design and instructions and thus require individual familiarity for correct use. Dr. Anthony Borshneck and Joseph Sager developed a splints for the Sager family in the 1970s. This likely overestimates actual fractures by a decent margin as well. A traction splints is typically triggered by a suspected or obvious fracture of the midshaft femur. In comparison to an unsupported leg, traction allows less movement. A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod (s) to mimic normal bone stability and limb length, and a mechanical device to apply traction (used in an attempt to reduce pain, realign the limb, and minimize vascular and neurological complication) to the limb. The traction splints can be used to treat both closed and open fractures of the femoral diaphysis. This bandage is applied to the ankle, knee, and ankle in varying degrees. Femoral traction splints are used to temporarily stabilize and possibly reduce femoral shaft fractures. Hi Andy, I think one of the main misconceptions on splinting of femurs and the pelvis is the idea that it limits blood loss by reducing the size of the cavity. Traction Splinting. A traction splint for applying traction to an injured limb of a patient. It is also not recommended that patients who are critically injured receive traction splints. There are several types of traction splints, including the Hare and Sager splints. The CT6 Femoral Traction Leg Splint is a compact, powerful, reliable device that helps relieve pain and prevents further damage to surrounding muscle and tissue while reducing the risk of death caused from severed arteries. This California EMT program introduces an additional bone fracture management skill with equipment provided by many BLS ambulance companies as part of the Sager Traction Stabilizing Application. Traction splintsare external devices primarily used in the pre-hospital acute management for the reduction and immobilization of femoral shaft fractures. Because of proper splinting, blood flow to the heart increases, pain and spasms decrease, and bone fragments are less likely to be injured. We use cookies to make wikiHow great. The frame and pulley put gentle pressure on your femur. Traction splints are used to keep a bone in a nearly-reduced position in a fracture. The act of traction splinting itself can be divided into two parts, traction and splinting. In this type of bandage, a broken arm or leg is treated with a pin. The Sager traction splint is a unipolar split that can be used to align femur fractures. Children who have only isolated fractures of the femur exhibit no significant haematocrit or haemodynamic changes. In the absence of haemodynamics instability in children, blood loss could cause moderate to large blood loss, but this is unlikely to cause problems in adults. Lets face it, the devices we concoct out of ski poles, webbing, carabiners, and the like, often arent very good at providing traction to begin with. By clicking Accept, you consent to the use of ALL the cookies. The primary function of these devices is to provide stabilization at the scene for the transport of patients to the hospital. With the appropriate application of traction, the broken ends of the bone have limited movements, and this will aid in decreasing patient's pain (Nackenson, Baez, & Meizoso, 2017). This could be a stretcher, a rod, or a piece of wood. There are several contraindications to the use of traction splints: -The patient has an open fracture -The patient has a suspected spinal injury -The patient has a suspected pelvic fracture -The patient has a suspected hip fracture -The patient has a suspected femur fracture -The patient has a suspected knee fracture -The patient has a suspected ankle fracture -The patient has a suspected lower leg fracture -The patient has a suspected foot fracture. Use to remove results with certain terms These cookies track visitors across websites and collect information to provide customized ads. The main role is to maintain anatomical alignment, allow clot stabilization and prevent ongoing vessel disruption. The broken femur bone is dangerously close to the femoral artery and can easily sever it. To splint the bone, a hard object is tied to the edge of the leg. that are macgyvered out of available materials. The Slishman Traction Splint (STS) is an innovative traction device that solves many of the current problems with other tactical traction splints. In this situation, Sager Splints may be applied over MAST Trousers if treatment of the fractured Femur is indicated or desired. Not only is this an excruciatingly painful injury, it is inherently dangerous. Admit I keep hearing debate if contra-indicated when "open" femur fx, due to possibility of infection, other side of the coin is to use, and have antibiotics for possible . There are some precautions to be taken before using traction splints. The frame has two adjustable straps that are used to secure the splint to the leg. The broken femur bone is dangerously close to the femoral artery and can easily sever it. Only in cases of fracture or injury involving the elderly or children requires skin traction, such as those caused by hip fracture or pediatric injury. One can lose a moderate to large amount of blood which may potentially contribute to haemodynamic instability in adults, but probably not in children. Analytical cookies are used to understand how visitors interact with the website. For a supine patient, Hare Splints are worn with a strap in the thigh. ETM Course is a comprehensive, 3-day, face-to-face trauma course specifically designed to meet the needs of Australasian Emergency Medicine practitioners. In most cases, this type of surgery is required to repair a ruptured femoral vein. Allergy. What did the literature say about traction splinting? The modified Thomas splint is a modification of the Thomas splint that was designed to fit people of all body types. Prehospital Midthigh Trauma and Traction Splint Use: A Retrospective Review of a Trauma Registry, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, Runcie H, Greene M. Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or Not to Use? Complications such as bleeding, fat embolism, and infection are possible in patients who have a fractured femur. Ipsilateral fracture(s) of the ankle, foot, and/or lower leg. One of the main initial treatments for this injury is application of some sort of traction splint, designed to apply distracting force between the lower leg and the relatively "fixed" base of the pelvis, which pulls the displaced and shortened femur back into a more anatomical position. The femur is then braced against this object, being tied down with ropes or straps. The use of traction splints should not be performed unless there is a fracture-dislocation of the knee, as well as a rupture of the ankle joint. All traction splints performed similarly with regard to the primary outcome measure of mean pounds of traction created at the end of 30 minutes of application, with results ranging from 10.4 to 13.3 pounds. If youre in the heat, a rectal thermometer should be available to measure core temperatures. Includes: Carrying case [, Abarbanell NR. [, Ellerton J et al. In the end, Im not saying that traction splinting isnt without benefits. The femoral shaft excludes commonly fractured parts of the femur such as hip and supracondylar fractures. Although traction is beneficial to femur fractures, it can be harmful to fractures or ligament injury distal to the femur fracture. A small, retrospective chart review that relied on changes in hematrocrit and several estimates/assumptions (for example: estimated total blood volume based on weight, assumed ml of blood loss per percent drop in hematocrit, requirement for transfusion based on symptomatology) showed an average estimated blood loss of 1,276 ml, with a wide range of 740ml-2,620 ml. Reference. The authors also surveyed rescue teams to assess their use and Ensure that the patient has been made comfortable by allowing the fracture site to heal naturally. Femur fractures in remote settings also can require significant resources to stabilize, package, and evacuate the patient. When a foot, ankle, or joint injury occurs, a type of splints called a grafting is used. Proper splinting increases arterial blood flow, decreases pain and spasm, and lowers the risk of further injury from bone fragments. To determine the incidence of femur fractures in mountain rescue in England and Wales. They simply arent robust enough compared to commercial products. There are many commercial brands available which vary slightly in their design and instructions and thus require individual familiarity for correct use. Low-profile ischial pad permits splint to be applied with minimum movement of the patient's leg. 44. Femur fracture immobilization with traction splints in multisystem trauma patients. The #EM3 team demonstrates the steps required to apply the Kendrick traction device (KTD) for immobilising femur fractures, along with additional advice for . Of these, only 13% were treated with traction splints, 17% with non-traction splints, and a whopping 70%(!) Because of its flexibility, a splints can be worn at the bedside and is frequently combined with conservative measures such as crutches or walkers. This article has been viewed 16,412 times. As a result of traction splints, such as the Hare or Sager, patients experience less pain. Include your email address to get a message when this question is answered. traction splints may be appropriate in a patient who has a femoral fracture, but there is no evidence to suggest they will improve their quality of life. Skeletal traction: Your provider will do surgery to place a pin in your femur or tibia. Therefore, many traction splints are make-shift devices 2015 Sep;26(3):305-11 [, Agrawal Y, Karwa J, Shah N, Clayson A. Traction splint: to use or not to use. This could easily cause the victim to bleed to death. In CA, we were taught to reduce the fracture and splint it. Traction splints are recommended for patients who have mid- femur fractures in order for them to be more comfortable and fracture alignment to be improved. The gist of that discussion was similar tomany other twitter-basedmedical discussion. see if there is any definitive data for or against the use of traction One of the main initial treatments for this injury is application of some sort of traction splint, designed to apply distracting force between the lower leg and the relatively fixed base of the pelvis, which pulls the displaced and shortened femur back into a more anatomical position. It is where the sickest of the sick patients are found in our ED. The splint consists of two parts: an inner sleeve that is placed over the leg, and an outer frame that is attached to the inner sleeve. Ensure adequate traction by frequently assessing pain relief and length of extremity compared to uninjured side. This splint features a telescoping design along with directions printed on the nylon leg straps to ensure quick application. Stabilize fracture that require repair in neurovascular injuries as soon as possible. If the injury is close to the knee, traction splints should not be used. Its possible that traction is ineffective if theres still a fracture in the foot or an ankle. To create this article, volunteer authors worked to edit and improve it over time. You may be placed in a long leg cast or splint before surgery to help keep the broken femur aligned properly. Femoral traction splints are designed to apply traction to the lower portion of the leg, distal to the fracture, usually by pulling the ankle away from a stabilized pelvis. This video demonstrates one correct way to perform Hare Traction Splint to help prepare you for the New York State EMT Practical Skills Examination Children aged 12 months to 6 years are more likely to require hip spica cast treatment. It is possible to insert these instruments into the femoral and bifurcated shafts of the femur and tibia. Closed treatment with traction, splinting, and casting may be temporary treatment or definitive treatment . A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. o [ abdominal pain pediatric ] Femoral traction splints are designed to apply traction to the lower portion of the leg, distal to the fracture, usually by pulling the ankle away from a stabilized pelvis. Furthermore, it is one of the most advanced traction splints because it is made of high-quality materials and is easily adaptable to suit the majority of people. Apply longitudinal traction on the ankle to straighten and lengthen the shortened leg to the length of the contralateral leg. When there is movement, it is the most common cause of fracture-related pain. JEMS. A paediatric study showed no significant haematocrit or haemodynamic change in children with isolated femur fractures, prompting the comment that even in cases of diagnosed femur fracture in children, dropping haematocrit or haemodynamic instability should prompt a search for bleeding elsewhere. Femoral shaft fractures should be put into skin traction (10% of body weight) to help with pain management. Its been awhile since the FOAM twitter community got together and discussed the utility of femoral traction splints. Then why arent they using them? Thanks to all authors for creating a page that has been read 16,412 times. without any splinting at all. After this, it is sewn together between the two pieces of cloth. Position any leg support straps as directed (eg, 2 above the knee and 2 below). Half-ring traction splints, such as those used by the Thomas family, are popular in the United States. This could easily cause the victim to bleed to death. Pressure sores can develop as a result of repeated use of traction splints, which is why traction splints are used as a temporary immobilization. This helps to prevent further injury and allows the area to heal. Indications EMR: Open or closed mid-shaft fractures of the femur in patients who are otherwise clinically stable Abarbanell NR. 4 despite being the standard of care treatment for midshaft femur fractures, little is known about their utilization The STS weighs only 21 ounces and is 23" W x 3" H in size. An EMS relic? Lesson Summary. Their main aim is to limit movement of fracture fragments, thus reducing the risk of vessel injury, pain, and nerve damage 1. o [teenager OR adolescent ]. A properly healed fracture will allow for less infection and a more successful healing process. Most femoral shaft fractures occur in the third of the bone, which is the hip. This provides a very precise and delicate form of traction that can be used for adult and pediatric patients. Children under the age of 18 are not allowed to adjust their adult beds. As always, you'll hear about the hot topics covered in CDEM's regular features, including moyamoya disease-induced stroke in Clinical Pediatrics, recurrent prosthetic hip dislocation in Critical Cases in Orthopedics and Trauma, traction splinting a midshaft femur fracture in The Critical Procedure, moderate temperature management after . Traction splinting, such as a Kendrick traction splint, are used in suspected or isolated . There are many commercial brands available which vary slightly in their design and instructions and thus require individual familiarity for correct use. This isnt answered by this survey, but I bet a few medical directors out there would like to know why their medics are saying one thing, and doing another. How does traction splinting reduce blood loss? We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. How does traction splints reduce blood loss (stab marks)? Radiolucent design enables X-Rays and Catscans to be taken without . Prehospital midthigh trauma and traction splint use: recommendations for treatment protocols. Why do we do traction splints on the shaft of a fractured femur? Two femur fracture splints are commonly used: Hare and Sager. Traction splints are used primarily to immobilize and secure fractures of the: A. hip. Sorry, your blog cannot share posts by email. However the anatomy of the femur makes application of the flexible aluminium/foam-padded splints, inflatable splints or plaster backslabs impractical and ineffective. This technique allows for unipolar traction by using only one steel rod and placing it between the patients legs rather than the entire leg. In a bimodal distribution, the first peak occurs during early childhood, and the second occurs during adolescent adolescence. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the . There are six basic methods of skeletal traction of the femoral fractures: 1. , MD, University of California San Francisco - Fresno. But its a nice theory and given the other main benefit of stabilisation and analgesia and the lack of apparent serious harm (i.e. The Hare and Sager traction splints are the most commonly used traction splints, and they are also recommended for fractures in the femoral and gunshot wounds. The splint can be adjusted to different lengths, depending on the size of the patients leg. A femur fracture in the hips right leg occurs in close proximity to the popliteal artery and vein. Dr. James R. Roberts MD FACEP, FAAEM, FACMT, is the editor-in-chief of Roberts and Hedges Clinical Procedures in Emergency Medicine and Acute Care, a book published in 2019. Femoral shaft fractures are common, especially in high-energy trauma, with an incidence of around 4 per 10000 person-years. Raise your heel stand after the splint has been placed. Steel rods sit between a patients legs and apply traction from the ankle with counter pressure to the tuberosity of the ischial region. It takes up little space in vehicles or aircraft and can easily be strapped to jump bags and backpacks. In California, no skill verification is required for registration. Many anecdotal accounts of benefits ofan intervention (in this case, traction splints), vs the utter lack of data showing benefit. Using a traction splint, you can measure how far the gauge has traveled. This product can be applied on the spot and in a matter of minutes. To expedite the transportation of the injured leg, wrap it in a piece of string against the uninjured leg. Susanne Spano at UCSF-Fresno presented a poster at SAEM with some good data that showed no statistical difference in mortality or complications of actual femur fractures treated with either traction splinting or no traction splinting. 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