# Backboarding a Hip fx



## jaksasquatch (Sep 11, 2013)

Say you have a pt with a hip fx with noted pn with an obviously shortened limb. This patient shows NO MOI for a C-spine injury, say its an elderly woman who fell in the shower. Would you then backboard the pt since it acts as a big "splint" or would you use the scoop stretcher or maybe a sheet? Also how can I tell the difference between a hip fx and a pelvic fx in the field? I'm assuming by the crepitis and discoloration in the pelvic area but you never know until you take pictures


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## Onceamedic (Sep 11, 2013)

The only way I would backboard this patient is if I planned to take her sledding before going to the ED.


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## medichopeful (Sep 11, 2013)

Kaisu said:


> The only way I would backboard this patient is if I planned to take her sledding before going to the ED.



I think the OP meant use the backboard as a splint, but not necessarily apply it all the way (so no head blocks/immobilization).


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## Mariemt (Sep 11, 2013)

If you feel the need to backboard the patient to avoid moving and jostling , then yes, but I would prefer not to if possible. This is where the traction splint is appropriate and I would use that.


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## rmabrey (Sep 11, 2013)

Mariemt said:


> If you feel the need to backboard the patient to avoid moving and jostling , then yes, but I would prefer not to if possible. This is where the traction splint is appropriate and I would use that.



Isnt A hip Fx a contraindication for a traction splint?

ETA, yes I would use a board as a splint and to facilitate movement. And this is one of few occasions that I pad the voids


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## Roby777 (Sep 11, 2013)

rmabrey said:


> Isnt A hip Fx a contraindication for a traction splint?
> 
> ETA, yes I would use a board as a splint and to facilitate movement. And this is one of few occasions that I pad the voids




Only mid femur fracture for traction


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## phideux (Sep 11, 2013)

I like the scoop stretcher for hips. 
No to the traction splint on hips.


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## Yarbo (Sep 11, 2013)

I like to use scoop stretchers to get patients with hip fractures off the floor. Also, another thing you can use is a KED upside down. I've heard great things about this method and intend on trying it.


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## DesertMedic66 (Sep 11, 2013)

Sheet wrapped tightly over both hips + breakaway flat + pain medication.


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## CALEMT (Sep 11, 2013)

The two (2) times that I have had a pt with a hip fx we back boarded both. For me and my partner it was quick and fairly easy.


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## TheLocalMedic (Sep 12, 2013)

NO!  Why would you subject a patient who is already in pain to the added discomfort of a backboard???  Have you ever had to lay on one for any length of time?  It's super uncomfortable!  

Do a sheet around the hips and then possibly a breakaway flat of you need to move them, once on the gurney you can make the flat fold a bit so they can have their head elevated.  

DON'T BACKBOARD PEOPLE UNLESS IT IS TRULY WARRANTED!  Especially older folks!


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## TheLocalMedic (Sep 12, 2013)

Oh, and copious pain meds...  We carry morphine and I generally do a first dose of 5 mg before moving them followed by another 5 after the move.  Aim for them to be feeling good by the time you roll in.


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## DesertMedic66 (Sep 12, 2013)

TheLocalMedic said:


> Oh, and copious pain meds...  We carry morphine and I generally do a first dose of 5 mg before moving them followed by another 5 after the move.  Aim for them to be feeling good by the time you roll in.



Every hip fracture/dislocation that I have had 5mg-10mg had little to no pain relief :/


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## Medic Tim (Sep 12, 2013)

Pain management prn then move them to the stretcher with a scoop.

 One of the services I used to work for never had scoops so we would use a draw sheet/blanket or a board( for extrication only)


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## MSDeltaFlt (Sep 12, 2013)

jaksasquatch said:


> Say you have a pt with a hip fx with noted pn with an obviously shortened limb. This patient shows NO MOI for a C-spine injury, say its an elderly woman who fell in the shower. Would you then backboard the pt since it acts as a big "splint" or would you use the scoop stretcher or maybe a sheet? Also how can I tell the difference between a hip fx and a pelvic fx in the field? I'm assuming by the crepitis and discoloration in the pelvic area but you never know until you take pictures



Elderly female (especially those who have bore children) = osteoporosis until proven otherwise.  Falling in the slippery confined space of a shower that has fractured the hip is always MOI for other injuries up to and including spinal.  Do not get caught by distracting injuries.  Rule out all other injuries by invading their personal space and placing your hands on each and everything that might get injured before not treating it.

I don't like treating mechanisms of injury.  I like to treat clinical assessments.


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## rmabrey (Sep 12, 2013)

DesertEMT66 said:


> Every hip fracture/dislocation that I have had 5mg-10mg had little to no pain relief :/



Dilaudid FTW!


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## Handsome Robb (Sep 12, 2013)

jaksasquatch said:


> Say you have a pt with a hip fx with noted pn with an obviously shortened limb. This patient shows NO MOI for a C-spine injury, say its an elderly woman who fell in the shower. Would you then backboard the pt since it acts as a big "splint" or would you use the scoop stretcher or maybe a sheet? Also how can I tell the difference between a hip fx and a pelvic fx in the field? I'm assuming by the crepitis and discoloration in the pelvic area but you never know until you take pictures



One way to differentiate from a pelvic injury and a acetabular/femur injury is that a pelvic injury that requires a pelvic sling (sheet wrapped around the heps) is if the pubis symphysis is widened. A pelvice sling is indicated for an "open book" pelvic fracture. the pubic symphysis is generally the width of your thumb, maybe two fingers. Any wider than that without femoral/acetabular involvement (shortening and/or rotation) a sling should be placed. With shortening and rotation you can assume an acetabular injury or hip dislocation and a pelvic sling should not be applied as you can actually cause more damage. Same goes for a pelvis that's extremely unstable (read: suspected multiple pelvic ring fractures). 

I'll add my ALS twist to this call but I know it's in the BLS section. I'd give the pt a fentanyl and midazolam cocktail, wait for it to take effect and then remove the patient from the shower and place them on a *scoop stretcher*. the concave of the scoop is much more comfortable for the patient. Also, it's easy to use to move them and then remove once they're on the gurney then place it again if you want to move them from the gurney to the ED bed. A scoop stretcher is not meant to stay in place during transport. If you don't have a scoop using a LSB to move the patient is appropriate but I'd remove it as soon as they were on the gurney if at all possible. 

Also, another great splint for a femoral neck/dislocated hip is a large vacuum splint. Doesn't compress the injured site but will help stabilize it. I'll usually apply one prior to placing the scoop stretcher. 

The caveat to this is if the patient is in so much pain that they cannot properly follow your assessment to use NEXUS or the Canadian C-Spine Rule to clear their c-spine in the field you're going to have to board them unfortunately. If this is the case you need to pad the hell out of them.


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## Mariemt (Sep 12, 2013)

rmabrey said:


> Isnt A hip Fx a contraindication for a traction splint?
> 
> ETA, yes I would use a board as a splint and to facilitate movement. And this is one of few occasions that I pad the voids


It has a shortened limb. Most hip fractures are actually an upper femur.  With the shortened limb this sounds like an actual femur.


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## jaksasquatch (Sep 12, 2013)

So when your talking about backboarding you would still use the headblocks and pad the voids if c-spine couldn't be cleared? Also I've read that the traction splint shouldn't be used on hip fx (proximal femur fx) or pelvic fx. How can I tell a midshaft femur from a hip fx? I assume a midshaft would shorten more so then a proximal.


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## Christopher (Sep 12, 2013)

jaksasquatch said:


> So when your talking about backboarding you would still use the headblocks and pad the voids if c-spine couldn't be cleared? Also I've read that the traction splint shouldn't be used on hip fx (proximal femur fx) or pelvic fx. How can I tell a midshaft femur from a hip fx? I assume a midshaft would shorten more so then a proximal.



Backboards are not spinal immobilization devices, they're extrication devices. You can choose to add head blocks, tape, towel rolls, a C-collar, spider straps, 9 foot straps, perhaps even a head bed...but it still has nothing to do with immobilization.

Once you separate your terminology to remove this confusion, the answer becomes obvious.

Rolling your hip Fx patient is going to be awful, sliding your hip Fx patient is going to be awful. Whatever you choose, you must limit both of these actions.

If you had some indication for spinal motion restriction, you should continue through whatever your procedures are for SMR.

If you have no indication for spinal motion restriction, you should continue through whatever your procedures are for moving a patient with a hip Fx.

You probably have a device which can satisfy both the Brothers Grimm and your patient's hip Fx: the scoop stretcher!


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## jaksasquatch (Sep 12, 2013)

Christopher said:


> Backboards are not spinal immobilization devices, they're extrication devices. You can choose to add head blocks, tape, towel rolls, a C-collar, spider straps, 9 foot straps, perhaps even a head bed...but it still has nothing to do with immobilization.
> 
> Once you separate your terminology to remove this confusion, the answer becomes obvious.
> 
> ...



   Got ya, using it as an extrication device on a hip fx (saying you don't have a scoop stretcher) what strapping technique (hi/low, pchute etc...) would one want to use?


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## Christopher (Sep 12, 2013)

jaksasquatch said:


> Got ya, using it as an extrication device on a hip fx (saying you don't have a scoop stretcher) what strapping technique (hi/low, pchute etc...) would one want to use?



Not a fun prospect if that is all you have. Perhaps if you carry a KED you can slide that upside-down, underneath the hip first.

If you lack the KED, my suggestion would be what most of the others have echo'd. Blanket wrap first, pad the mess out of your backboard, then do a lift-and-slide technique to inch the backboard under them; such that they're not moving but the backboard is.

This is my go-to guide for illustrations of the many different ways you can successfully lift/move patients.


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## Tigger (Sep 12, 2013)

Mariemt said:


> It has a shortened limb. Most hip fractures are actually an upper femur.  With the shortened limb this sounds like an actual femur.



That alone should not be reason to apply a traction splint. Placing a Hare type splint a patient with proximal femur fracture, especially on the femoral neck, can be extremely painful for the patient. The anchoring ischial strap can cross the fracture site so when you pull traction the patient is going to be in even more pain. 

Other traction splints (Sager, etc) can also have these issues.

Also most hip fractures are not just an upper femur fracture, I'd check your sources on that one.


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## Mariemt (Sep 12, 2013)

Tigger said:


> That alone should not be reason to apply a traction splint. Placing a Hare type splint a patient with proximal femur fracture, especially on the femoral neck, can be extremely painful for the patient. The anchoring ischial strap can cross the fracture site so when you pull traction the patient is going to be in even more pain.
> 
> Other traction splints (Sager, etc) can also have these issues.
> 
> Also most hip fractures are not just an upper femur fracture, I'd check your sources on that one.



Without being there and seeing I have no way of knowing. The hip fractures thus far have so far resulting in feet turnung and limb elongation. 

Applying the traction splint on my pts with the upper femur fracture has provided much relief.


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## mycrofft (Sep 12, 2013)

Christopher said:


> Backboards are not spinal immobilization devices, they're extrication devices. You can choose to add head blocks, tape, towel rolls, a C-collar, spider straps, 9 foot straps, perhaps even a head bed...but it still has nothing to do with immobilization.
> 
> Once you separate your terminology to remove this confusion, the answer becomes obvious.
> 
> ...



Lemme hear the choir repeat, "extrication device"!
Amen!

Then, once out, how to minimize leg movement and motion to hips?
Scoop is much like a LSB but not as effective as immobilization. 
Don't logroll pt onto the board; use clothing or weasel a bedsheet or whatever (thin transfer plastic board?) under to raise her as LSB or KED is slid under.


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## jaksasquatch (Sep 12, 2013)

Christopher said:


> Not a fun prospect if that is all you have. Perhaps if you carry a KED you can slide that upside-down, underneath the hip first.
> 
> If you lack the KED, my suggestion would be what most of the others have echo'd. Blanket wrap first, pad the mess out of your backboard, then do a lift-and-slide technique to inch the backboard under them; such that they're not moving but the backboard is.
> 
> This is my go-to guide for illustrations of the many different ways you can successfully lift/move patients.



Love that book, makes it pretty obvious. Do you have any other resources like that on basically any topic EMS? I'm like a 3 yr old, I love picture books


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## unleashedfury (Sep 12, 2013)

I've used the scoop a few times to accommodate the patient with an hip fracture. I've heard of the KED vest method. But I have yet the opportunity to try it..


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## mycrofft (Sep 12, 2013)

Christopher said:


> Not a fun prospect if that is all you have. Perhaps if you carry a KED you can slide that upside-down, underneath the hip first.
> 
> If you lack the KED, my suggestion would be what most of the others have echo'd. Blanket wrap first, pad the mess out of your backboard, then do a lift-and-slide technique to inch the backboard under them; such that they're not moving but the backboard is.
> 
> This is my go-to guide for illustrations of the many different ways you can successfully lift/move patients.



I will grab a soda and go through that link's material. I smell pragmatism.


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## mycrofft (Sep 12, 2013)

Tigger said:


> That alone should not be reason to apply a traction splint. Placing a Hare type splint a patient with proximal femur fracture, especially on the femoral neck, can be extremely painful for the patient. The anchoring ischial strap can cross the fracture site so when you pull traction the patient is going to be in even more pain.
> 
> Other traction splints (Sager, etc) can also have these issues.
> 
> Also most hip fractures are not just an upper femur fracture, I'd check your sources on that one.



Most cases called "hip fx" are femoral neck fx.


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## mycrofft (Sep 12, 2013)

*A hip is not a hipbone.*

I've heard the MAST helps with PELVIC fx but not HIP  (femoral neck) fx.
Femoral neck fracture ("hip fx").



VERSUS

Illiac fx  ("hipbone fx").​




OK, so what you are trying to mininmize are affected leg movement in relation to the pelvis, and jouncing.

This can be done on an ambulance litter mattress with sandbags and tying on sheets or blankets, then driving carefully. 

Getting the pt onto and off of it are the challenges.

I would think a traction splint might help with discomfort if there is no pelvic injury.


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