# traction splints



## billycorgi (Aug 11, 2013)

What circumstances would you apply a traction splint in the back of the ambulance rather than on scene?


----------



## NomadicMedic (Aug 11, 2013)

If you didn't notice the midshaft femur fracture until you got them in the truck.


----------



## unleashedfury (Aug 23, 2013)

DEmedic said:


> If you didn't notice the midshaft femur fracture until you got them in the truck.



+1, 

If you go by the "National Standard" you are given 10 minutes scene time for a trauma patient. I'd prefer to mobilize the fracture before moving the patient unless unforseen condtions permit.


----------



## rob the mexican medic (Aug 25, 2013)

billycorgi said:


> What circumstances would you apply a traction splint in the back of the ambulance rather than on scene?



still have never done this in 6 years. not even sure where it is on the unit lol. Hopefully my partner does.


----------



## unleashedfury (Aug 25, 2013)

rob the mexican medic said:


> still have never done this in 6 years. not even sure where it is on the unit lol. Hopefully my partner does.



I used one twice in 13 years. We usually bust them out for annual skills review which is nice cause I know I would've forgotten how to use it by now. 

But in the same way be a little aggressive know your unit


----------



## dreadpiraterobby (Aug 26, 2013)

unleashedfury said:


> I used one twice in 13 years. We usually bust them out for annual skills review which is nice cause I know I would've forgotten how to use it by now.
> 
> But in the same way be a little aggressive know your unit



True know your unit but I honestly don't get the point. I mean I've been on lots of femur fractures we learned after the fact. It would have to be such an obvious open femur fracture for me to bust this out


----------



## chaz90 (Aug 26, 2013)

dreadpiraterobby said:


> True know your unit but I honestly don't get the point. I mean I've been on lots of femur fractures we learned after the fact. It would have to be such an obvious open femur fracture for me to bust this out



...Wait for it...












And why would we hopefully decide not to "bust out" the traction splint on the gnarly open fracture?


----------



## mycrofft (Aug 26, 2013)

chaz90 said:


> ...Wait for it...
> 
> 
> 
> ...



To reintroduce the exposed bone into the wound can cause sepsis. How about immobilize pt, sterile saline dressing with dry bulky cover, and lots of drugs?


----------



## randomfire (Sep 12, 2013)

mycrofft said:


> To reintroduce the exposed bone into the wound can cause sepsis. How about immobilize pt, sterile saline dressing with dry bulky cover, and lots of drugs?



God I love this forum. So much stuff from discussions I never would have thought of and never got told in basic class.

What would they end up doing in the ER, how do you sterilize a bone?


----------



## Tigger (Sep 12, 2013)

randomfire said:


> God I love this forum. So much stuff from discussions I never would have thought of and never got told in basic class.
> 
> What would they end up doing in the ER, how do you sterilize a bone?



With the help of some anesthesia. 

I know where mine is (the pedi and regular one), but I have also not had the occasion to use one. I had a patient we could have possibly used it on last month but there wasn't much in the way of limb shortening and the patient was "only" in 4/10 pain when she wasn't moving, which fentanyl kept under control. I figured further moving the patient to get her on the splint would not have made things better. 

The ED did not apply theirs either.


----------



## Household6 (Sep 12, 2013)

God star for mycroft! Traction splints only go on closed femur breaks when the break is proximal to the patella on the bottom 2/3 of the femur.


----------



## rmabrey (Sep 12, 2013)

Ive applied a traction splint exactly once. 

Im still not convinced it was a femur fracture, nor am I convinced that leaving mamaw lie on the hot concrete was the best idea


----------



## mycrofft (Sep 12, 2013)

billycorgi said:


> What circumstances would you apply a traction splint in the back of the ambulance rather than on scene?



This................


----------



## STXmedic (Sep 12, 2013)

In regards to applying a traction splint to an open femur fracture, I have not seen that as a contraindication except in old textbooks (it may be listed in some newer that I'm not aware of). 

I understand the thought process of not doing it. However, I decided to look around for some literature on it.* Most places I looked said withholding applying traction was old practice, and found unnecessary. For just a quick glance- a brief statement on it from ITLS can be found here.

So with that said, would like to hear some of the other guys' thoughts on it. Yes, you're reintroducing a contaminated bone into the body. However, the bone and wound are already contaminated, the entire wound will get thoroughly irrigated and cleaned, and the patient will likely be started on antibiotics anyway. Considering all of that will be covered, it seems like the benefit would lean more toward stabilizing the mid-shaft fracture, eliminating potential further damage, and alleviating pain (especially if you're in a system without fairly progressive pain management abilities).

*The brief looking I did was on my phone with limited access to full articles. I'll try and look more into it when I get a chance.


----------



## rob the mexican medic (Sep 13, 2013)

chaz90 said:


> ...Wait for it...
> 
> 
> 
> ...



I don't get it. Maybe i'm retarded


----------



## STXmedic (Sep 13, 2013)

rob the mexican medic said:


> I don't get it. Maybe i'm retarded



I'm pretty sure he's referring to what mycrofft addressed; introducing contaminated bone and tissue back into the body- potentially putting the patient at risk for infection.


----------



## chaz90 (Sep 13, 2013)

STXmedic said:


> I'm pretty sure he's referring to what mycrofft addressed; introducing contaminated bone and tissue back into the body- potentially putting the patient at risk for infection.



It was. I was going off of what may have been an old adage. Admittedly, this is something I've done zero research on since my initial exposure in EMT school years ago. My entire adversion to traction on open femur fractures comes from my EMT instructor telling me that it was a "bad thing" and multiple protocols that don't allow it. Keep in mind, these same instructions would still have me backboarding everyone I see with 15 LPM O2, so take it with a grain (or bucket full) of salt. Honestly, these patients are going to be placed on an antibiotic regimen anyway with thorough irrigation of the site and surgical repair.


----------



## CFal (Sep 13, 2013)

We had a patient with bilateral femur fractures last winter, the guys on scene pulled traction on both legs.  We ended up calling in a DHART helicopter for him, the traction provided so much pain relief he was euphoric and on the phone with his mom "hey mom! I got hurt but I feel great and they're taking me out in a helicopter!"


----------



## TheLocalMedic (Sep 13, 2013)

The handful of times I've applied one it was pretty obvious that they had a femur fracture.  I doubt that you'd "miss" seeing that until you were en route.  

Open fractures are no longer considered a contraindication for applying traction.  I also hears rumors that "they" are considering a trial for pre-hospital antibiotics for open fractures...


----------



## TechYourself (Sep 13, 2013)

randomfire said:


> God I love this forum. So much stuff from
> 
> What would they end up doing in the ER, how do you sterilize a bone?



Nothing, that's a job for the OR.  

We'd manage pain, dress, and splint in place.  Open femur fx usually have a surgical consult within minutes of arrival.


----------



## Household6 (Sep 13, 2013)

STXmedic said:


> In regards to applying a traction splint to an open femur fracture, I have not seen that as a contraindication except in old textbooks (it may be listed in some newer that I'm not aware of).
> 
> I understand the thought process of not doing it. However, I decided to look around for some literature on it.* Most places I looked said withholding applying traction was old practice, and found unnecessary. For just a quick glance- a brief statement on it from ITLS can be found here.
> 
> ...



I uh.. If I was a patient with an open fracture, I would prefer my responding medics not push my bone back in. Wouldn't that be a sure way to sever a femoral artery? With a nice sharp bone being shoved blindly back into the thigh muscle? Severing a sciatic nerve maybe? No. No thank you. I'll just sit in pain for a while.


----------



## STXmedic (Sep 13, 2013)

Except nobody is forcibly pushing anything back in.

What do you think the difference is between open and closed. When you apply traction to a closed fracture, it doesn't just magically appear in place.

What do you think the hospital is going to do? Magically pop it into place, too? Granted, they will likely pull traction slower.

But if you want to bear the pain and request me to not do anything about it, it's your right to refuse  Hell, I'll gladly throw you on a backboard and tape you down, too. Maybe throw a NRB to you while I call the chopper.


----------



## EMT B (Sep 13, 2013)

fresh fresh out of class i had a motor cycle accident where one pt had a midshaft femur fracture. i was told to hold traction and i just held the leg there like we did in class cause i thought that was what you were supposed to do. nobody told me you had to pull :blush:


----------



## CFal (Sep 13, 2013)

EMT B said:


> fresh fresh out of class i had a motor cycle accident where one pt had a midshaft femur fracture. i was told to hold traction and i just held the leg there like we did in class cause i thought that was what you were supposed to do. nobody told me you had to pull :blush:



I blame your EMT instructor


----------



## EMT B (Sep 13, 2013)

we can blame lots of things on my instructor


----------



## mycrofft (Sep 14, 2013)

From the ITLS: 
AND I QUOTE: and add red accents
" Given that ALL OPEN FRACTURES are contaminated and subject to infection and
will need to undergo wash-out and / or debridement by an orthopedic surgeon, we
believe that application of a traction splint in the austere environment to either
open or closed fractures benefits the patient. Copious irrigation, preferably in route,
should be performed prior to reduction to reduce foreign material in the wound. If
available, appropriate antibiotic therapy should be initiated and the fact that the
fracture was open and reduced by EMS personnel must be conveyed to the receiving
facility.
Recommendation:
For patients in isolated or austere environments, where transport to definitive care
is substantially delayed, application of a traction splint after stabilization of life
threatening injuries can improve patient comfort and reduce possibility of
neurovascular injury."

Also at the start, they cite lack of published material, citing only one "consensus document": whatever that means:

AND I QUOTE:

"In response a literature review on the topic was performed. No Class 1 evidence was found to support the use or non use of this device in the above mentioned clinical situation. Only one consensus document from the wilderness rescue literature was located."

My interpretation: they reviewed the literature, found insufficient material, so they winged it. They also say do it after everything else is stabilized, enroute, in austere or isolated settings only, with irrigation and antibiotics before reduction (which can occur fully or partially when tactin is applied; if it is sticks out out 2 inches and you tract it to a 1/2 inch protrusion, you have introduced 1.5 inches of potentially dirty bone into the tract.
I also argue their proposition that only/so much force is required that the wound is already contaminated (I differ, having seen two incidents where the clothing was not breached; one was car versus pedestrian, the other was jogger versus pipe in the dark) so reintroducing the contaminated bone into the tract and potentially into intimate contact with the nonexposed bone end is not a concern versus the assumed contamination (so we don't need sterile dressings and trache tubes now, also?).

The document smells like a preliminary and is not for people working in urban and suburban settings, or rural ones where transport/treatment times to receiving facility is prompt.


----------



## DesertMedic66 (Sep 14, 2013)

As Chaz said this is something that I have not done any research on at all. The reasoning I was given in EMT class as to not apply traction to an open fender fracture was a mix of contaminating the wound more when/if the bone enters the skin and the possibility of lacerating the artery when/if the bone enters the skin. 

We are still teaching not to use traction on open fractures.


----------



## Jim37F (Sep 27, 2013)

I bombed a skills test the other day, and traction splints were a big chunk of why. Basically they said I tried to pull traction on a hip fx instead of a femur fx. At what point on the leg does it stop being the femur and start being the hip?

They also said I didn't know how to use their splint, which is true. My service uses the Hare, which I'm comfortable with, but the company i tested at had the other one (sager? I think) which I haven't seen since EMT school nearly a year ago now. 

Also, I know any sort of fracture, sprain, strain etc anywhere else on the leg is a contraindication to traction, but what about soft tissue injuries? If I had to take a test right now I'd say an open injury (I.e. one that required bandaging and bleeding control) would be a no go for traction, but what about a closed soft tissue injury, such as bruising?


----------



## NomadicMedic (Sep 27, 2013)

Jim37F said:


> I bombed a skills test the other day, and traction splints were a big chunk of why. Basically they said I tried to pull traction on a hip fx instead of a femur fx. At what point on the leg does it stop being the femur and start being the hip?



A traction splint is ONLY indicated in a a MID SHAFT femur fracture.







It's stops being the femur and becomes the hip when it's the femoral head and NOT the mid shaft.


----------



## Javaman (Sep 29, 2013)

DesertEMT66 said:


> As Chaz said this is something that I have not done any research on at all. The reasoning I was given in EMT class as to not apply traction to an open fender fracture was a mix of contaminating the wound more when/if the bone enters the skin and the possibility of lacerating the artery when/if the bone enters the skin.
> 
> We are still teaching not to use traction on open fractures.



Would having no distal pulse change the decision not to apply traction on an open fracture?


----------



## DesertMedic66 (Sep 29, 2013)

Javaman said:


> Would having no distal pulse change the decision not to apply traction on an open fracture?



For my area and what I have to teach, no it wouldn't change anything. Open fractures = bleeding control and splinting in place. We are taught to realign extremities one time if there are no distal functions only on closed fractures.


----------



## kaisardog (Sep 30, 2013)

*midshat  femur: think thigh  cantalopes...*

boarders working  ski  patrol  at  a  major   resort,  we  see  2  dozen femur  fx  per  season. most  victims  are  young  wild  skiers or riders.  a  hare  splint gives  amazing and  immediate   relief.  in  15  years  we've  never  seen  an  open  fx.  all  of  the  ones  we've seen  have looked  like  cantaloupes in  the  middle  of  the frontal  :rofl: thigh...


----------



## CFal (Sep 30, 2013)

Last year on my patrol we had a bilateral femur fracture in one of our terrain parks


----------



## mycrofft (Sep 30, 2013)

kaisardog said:


> boarders working  ski  patrol  at  a  major   resort,  we  see  2  dozen femur  fx  per  season. most  victims  are  young  wild  skiers or riders.  a  hare  splint gives  amazing and  immediate   relief.  in  15  years  we've  never  seen  an  open  fx.  all  of  the  ones  we've seen  have looked  like  cantaloupes in  the  middle  of  the frontal  :rofl: thigh...



There. Direct experience.


----------



## the_negro_puppy (Sep 30, 2013)

[YOUTUBE]http://www.youtube.com/watch?v=L1-hWv6yYpY&feature=youtu.be[/YOUTUBE]

Here's an interesting vid of our service adopting the CT-6


----------



## Handsome Robb (Sep 30, 2013)

Javaman said:


> Would having no distal pulse change the decision not to apply traction on an open fracture?



How far are we from the hospital?

The further away the more I'd consider pulling. With that said, there's no guarantee it'd help either.


----------



## Miscusi (Sep 30, 2013)

billycorgi said:


> What circumstances would you apply a traction splint in the back of the ambulance rather than on scene?




If the patient is not stable, getting to the hospital becomes priority.


----------



## NBFFD2433 (Oct 18, 2013)

I can honestly say that I have never used a traction splint yet.


----------



## Horse Feathers (Oct 21, 2013)

Has anyone here ever used a Slishman Traction Splint?

I would think that it would be a lot easier to apply in a rig than any other device, since it does not stick out past the foot, and traction can be pulled from the proximal (hip) end. It is also not contraindicated in cases of concurrent lower leg injuries...  <$.02>

Can't post live links - but you can google it...


----------



## Tigger (Oct 21, 2013)

Recently purchased one with their buy back deal for Hare splints, but no use yet.


----------



## Horse Feathers (Oct 23, 2013)

Tigger said:


> Recently purchased one with their buy back deal for Hare splints, but no use yet.



I was thinking that because the lower hitch can be applied proximal to the calf, it might be do-able to actually apply in the rig... not that I would ever try it...


----------



## Tigger (Oct 23, 2013)

Why not? We bought it primarily because it offers more options than other traction splints, it's smaller, and the price was right.


----------



## Fire51 (Oct 23, 2013)

I live where it snows a lot during winter, so we get the elderly people who slip on ice or people who have fallen off ladders trying to clear snow off the satellite. So I have used it about three time, they work good but it's only for a closed mid shaft femur fracture, like everyone else has said, and a lot of the time the hip is associated  with the femur fracture.


----------



## teedubbyaw (Oct 23, 2013)

DEmedic said:


> A traction splint is ONLY indicated in a a MID SHAFT femur fracture.
> 
> 
> 
> ...



And there is a issue with traction splints; You can never be certain it is an isolated femur fx.


----------



## Christopher (Oct 24, 2013)

As a small "by the way," the literature (weakly) supports the use of traction splints for either closed or open fractures.

The important part, which EMS likely never does, is irrigation and taking a pre-traction/bandaging photo.


----------

