# Tib/fib fractures...



## dreamergirl32 (Feb 23, 2009)

I am currently writing an assignment on the management of tib/fib fractures after a job involving this.
On the job in question the paramedics used a hare traction splint to immobilise the fracture.
I was just wondering what other EMT's/Paramedics views are on using this and what alternatives others may have used...

Any advice/knowledge much appreciated ^_^

x


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## DT4EMS (Feb 23, 2009)

dreamergirl32 said:


> I am currently writing an assignment on the management of tib/fib fractures after a job involving this.
> On the job in question the paramedics used a hare traction splint to immobilise the fracture.
> I was just wondering what other EMT's/Paramedics views are on using this and what alternatives others may have used...
> 
> ...



I have never used the HARE for a tib/fib fx. A vacuum splint or SAM splint have worked well for me over the years.


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## medicdan (Feb 23, 2009)

A Traction splint is indicated and not ever used for tib/fib fractures, rather more proximal, the femur when fractured. 
According to the textbook, Tib/fib fractures are usually immobilized with a hard (padded board splint), although you will find most field practitioners use a pillow splint (or just a pillow tied around the leg to immobilize and minimize pain on movement). If there is ALS (paramedics) on scene, they would consider giving Morphine for pain, and Zofran to avoid nausea and vomiting. 

Is this what you were looking for? Welcome to EMTLife, and let us know if you have other questions.


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## Epi-do (Feb 23, 2009)

Traction splints are to be used on midshaft femur fractures.  For a Tib/fib fx, it should have been imobilized with padded board splints, ladder splints, SAM splint, vacuum splint, or some other similar splinting device.


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## dreamergirl32 (Feb 23, 2009)

Thanks!
Thats more than helpful!
I had been told previously that the hare splint wasnt really suitable but just thought id see if everyone else thought that!!

Morphine was given as analgesic which seemed to work well!Although no anti emetic was given.

x


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## karaya (Feb 23, 2009)

emt.dan said:


> If there is ALS (paramedics) on scene, they would consider giving Morphine for pain, and Zofran to avoid nausea and vomiting.


 
Or, if your protocols allow, FENTANYL could be used for pain management.


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## medic417 (Feb 23, 2009)

Were distal pulses present?  If not perhaps they were hoping to restore pulses by using traction to realign and relieve pressure etc.  Not sure if it would work but maybe they were trying to think outside the box to solve a limb and possibly life threatening problem.  

And pain management is vital.  Never allow a patient to suffer needlessly.


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## dreamergirl32 (Feb 23, 2009)

Distal pulses were present throughout.
We dont give any pain relief except entonox and morphine in my service, 
Another quick question, does anyone know the likeihood of compartment syndrome in these kind of fractures??
xx


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## Summit (Feb 23, 2009)

*You CAN use a HARE to help SPLINT a tib-fib, but DO NOT APPLY TRACTION.* You are using it purely as part of a splint in this case.

That said, I'd much rather use a vacuum splint or even multiple SAMs. I might try to use a HARE before an air splint, but that's just cuz air splints suck when dealing with decreasing altitude during transport (and even otherwise, I don't like airsplints). Then again, I don't carry a Hare.

If you don't have the awesomeness that is a vacuum AND a happy injury that fits it, *splinting is more of an art form. Use what you have and build and pad a splint that works and is "comfortable."*


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## EMT007 (Feb 23, 2009)

medic417 said:


> Were distal pulses present?  If not perhaps they were hoping to restore pulses by using traction to realign and relieve pressure etc.  Not sure if it would work but maybe they were trying to think outside the box to solve a limb and possibly life threatening problem.
> 
> And pain management is vital.  Never allow a patient to suffer needlessly.



Unless their transport time was greater than 4 hours, it wasn't a limb or life threatening problem. I can see repositioning to attempt to reestablish a distal pulse (and my protocols allowed for that), but traction just seems useless and possibly detrimental.


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## medic417 (Feb 23, 2009)

EMT007 said:


> Unless their transport time was greater than 4 hours, it wasn't a limb or life threatening problem. I can see repositioning to attempt to reestablish a distal pulse (and my protocols allowed for that), but traction just seems useless and possibly detrimental.



Yes we reposition by realigning as best possible by feel as well.  And thats why I asked about pulses as thought maybe they were attempting repositioning using the traction.  Actually even repositioning you would be manually creating traction as you would pull so you could manipulate bones into alignment so really not much difference.  

Not sure I completely agree with your four hour statement but I'm to tired to think it out right now.


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## BossyCow (Feb 23, 2009)

Where exactly was the break?


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## reaper (Feb 23, 2009)

dreamergirl32 said:


> Distal pulses were present throughout.
> We dont give any pain relief except entonox and morphine in my service,
> Another quick question, does anyone know the likeihood of compartment syndrome in these kind of fractures??
> xx



Compartment syndrome is not common in these fractures, but it does happen. When I had my last Tib/Fib fx, I spent 4 days in the hospital, due to compartment syndrome.

It is something that needs to be accessed for.


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## BossyCow (Feb 23, 2009)

My son's tib/fib fx last summer was way at the base of the leg. You couldn't use a traction device on it because of the location of the break. No place to pull for traction. He got surgery and some lovely titanium jewelry.


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