# Pulling traction on an open femur fracture...yes or no?



## EMT7137 (Jun 25, 2019)

Is pulling traction on an open femur fracture a critical fail during a trauma practical final?? I've been looking everywhere in my coursework for this but nowhere did I find that this was taught as a critical fail.


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## Jim37F (Jun 25, 2019)

When in doubt, ask your instructor.

In the real world local protocols vary.

There are some places where an open compound fx is a hard contraindication...

When I was in LA, the County skill sheet explicitly said we were allowed to apply traction to an open femur fx (assuming of course it was an otherwise isolated midline femur fx, but open vs closed didn't affect whether we could apply traction or not)...

FWIW I *think* (so don't quote me on this lol) NREMT frowns upon traction splinting open femur fractures


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## NPO (Jun 25, 2019)

Jim37F said:


> FWIW I *think* (so don't quote me on this lol) NREMT frowns upon traction splinting open femur fractures



Correct. Protocols will vary, but national standard is NO traction on an open fracture.


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## Bishop2047 (Jun 26, 2019)

Interesting. I know in my Primary care Paramedic (Canada 2010) schooling open fractures were a critical fail, though that quickly changed 

I work air amb, and in facility. I put traction on a fellow just a few days ago with an open fracture. Now I have the added benefit of x-rays and such that you don't get in the pre-hospital environment, but as a rule even for ground services open fractures are not a contraindication for traction anymore in Canada. ATLS also is somewhat indifferent towards traction, and does not care if the fracture is open or not. 

The science seems to find there is little benefit or harm done by traction overall, though I still like it for pain reduction on those long flights.

http://www.fresno.ucsf.edu/em/posters/Prehospital Midthigh Trauma and Traction Splint Use_Poster.pdf


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## wtferick (Jun 26, 2019)

Just go off based the National standards. You are going to get many varied answers.


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## Paul1961 (Oct 2, 2019)

NPO said:


> Correct. Protocols will vary, but national standard is NO traction on an open fracture.


Curious were the National standard guidelines are located? It is a common standard of care practice  to immobilize open and closed fractures of the femur based on current PHTLS and ITLS guidelines.


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## Emily Starton (Mar 4, 2020)

wtferick said:


> Just go off based the National standards. You are going to get many varied answers.


agree with you


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## joshrunkle35 (Sep 11, 2020)

I would pull traction on one if:

A) It was the only way to control blood flow
or
B) It was the only way to control pain

If you have good pain meds and they still have a pulse, splint in a position of comfort and transport.


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## Akulahawk (Sep 11, 2020)

For testing purposes, go with whatever the NREMT, or whatever your specific course (ITLS/PHTLS) indicates. Your EMT course should instruct you as far as the current national standard or current standard for your certifying exam. I know this sounds a bit, shall we say, vague, but it's really what you need to do. 

For real-world application, if you _must _pull traction on an open _mid-shaft_ femur fracture, remember to tell the receiving facility that the fracture was actually an _open_ fracture. The ED will probably consider that to be the case, but at least by letting the ED know, this actually might make the ED staff recall that we're going to want to start antibiotics. In some cases, that means we'll have to remember to start another IV line (or two) due to the fact that some antibiotics are incompatible with some crystalloid IV fluids, most often Lactated Ringer's. 

Otherwise, I'm with @joshrunkle35  above: If you have good pain meds and the patient meets parameters to get the meds, give them. Make sure that distal pulses are intact/present and splint in a position of comfort and transport.


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## LOLOLOLMedic (Sep 12, 2020)

In most states and the NREMT it is contraindicated unless you have an air traction splint.


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## Akulahawk (Sep 13, 2020)

NYNJCTMedicJD said:


> In most states and the NREMT it is contraindicated unless you have an air traction splint.


Generally speaking, unless you have a traction splint device of some sort, you aren't going to be easily able to pull traction on a broken femur... Also given that there are several kinds of traction devices, I suspect the NREMT and several states likely aren't specifying a very specific type of device and only care that you're applying the device correctly.


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## LOLOLOLMedic (Sep 13, 2020)

.


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## DrParasite (Sep 14, 2020)

LOLOLOLMedic said:


> In most states and the NREMT it is contraindicated unless you have an air traction splint.


I'm going to assume you meant HARE traction splint right?  Because there is also the Kendrick Traction Splint.  a traction splint is often a required item on an ambulance, so you should have one.

as for open or closed, if it's an open femur FX, that means the bone has popped through the skin, and once that happens, splint it as you find it.  once it's out of the skin, we don't pull it back into the body (to much risk or bad stuff happening).  Leave that to the doctor.


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