Closed mid shaft femur fracture

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Jacedc

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Would you put on the sager or hair traction splint on a patient before or after back boarding them?
 
Either or. As long as the patients legs aren't strapped to the board yet you are fine.
 
Sweet thank you for answering!
 
Debate over backboarding aside, I would say traction splint before (if, that is, the person lets you touch their leg!). Part of backboarding, remember, is securing the legs, which you would need the splint on to do correctly in a femur scenario. Also, the sooner you get the femur "realigned," the better.
 
medichopeful said:
Debate over backboarding aside, I would say traction splint before (if, that is, the person lets you touch their leg!). Part of backboarding, remember, is securing the legs, which you would need the splint on to do correctly in a femur scenario. Also, the sooner you get the femur "realigned," the better.
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This.

Your patient would probably be better with the leg splinted first, while it might hurt like hell while you're realigning it once it is secured with propper traction your patient will probably be much happier.
 
I would not use the splint.

I would put the leg in traction.

It can be done with Kling and not all the metal crap.
 
I was always taught to do it first.

In hopes it will releive some pain as you are rolling them around.
 
Veneficus said:
I would not use the splint.

I would put the leg in traction.

It can be done with Kling and not all the metal crap.
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I don't think improvising a traction splint is in most peoples standard of care. If you carry a traction splint and are trained to use it, why re-invent the wheel?
 
zmedic said:
I don't think improvising a traction splint is in most peoples standard of care. If you carry a traction splint and are trained to use it, why re-invent the wheel?
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So you don't have to take it off for an x-ray?

So the patient can fit in the truck the way they were intended to?

So you don't have to leave the device at the hospital? (more for the hospital that doesn't want to store EMS crap)

So the hospital staff can maintain traction without having to figure out the EMS specific device while waiting for ortho?

Just a couple of reasons I guess.

No need to buy, carry, maintain, or improvise making said gagets work.

Simple is better. I didn't realize specific commercial devices constituted a standard of care anywhere.

Afterall, what is the difference between a KED, An Oregon Vest, and short board? Other than the company you are giving your money to?

I am sure a company like physio control woul just love if somebody decided that a LP 15 was specified as the standard of care and not simply "EKG monitor." Probably a few other companies out there wouldn't mind either.
 
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But learn how to "improvise" so you don't have to learn how to when there's an injured pt at your side.

Also, fractured midshaft femur can bleed a lot (will traction improve bleeding from the femur itself? Veneficus?) and the bone ends can endanger some very major vessels. AS WELL as causing truly excruciating pain which can lead to or worsen shock.

By the way, it is Hare traction splint, not "hair". Sounds like a truly weird improvisation, using hair...;)
 
mycrofft said:
(will traction improve bleeding from the femur itself? Veneficus?)
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Theorhetically, yes, reducing the space it is bleeding from and into should permit faster clotting.

Realistically, I do not think it would be clinically significant.

Edit: significant for the purpose of controlling an existing hemorrhage from the bone.
 
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I've been a big fan of the sager and the KTD since i did ski patrol, just because they are both compact and you don't need to worry about them fitting in the helicopter. I think the Hare is an outdated device but since people don't like change we haven't switched. Sager and Hare are about the same price but sager is half the weight and size. KTD is a 1/3 of the cost and tiny piece of equipment at 20oz.

I've always splinted before back boarding but that's just how I was trained. Seems like less movement if you do it that way.
 
Anyone know how many lbs tension is required ?
(I know, it's sort of a trick question, as it will vary due to how long the muscle has been in spasm, how large the pt is, how muscular, etc). But generally, are we talking more than say fifteen lbs?*

NATO used to have, besides olive drab Hare splints, a long device shaved like a deep shallow "V" with the six inches of the "apex" turned down 90degrees and an underling ring to fit against the ischial tuberosity. The expectation was you would use triangular bandages or whatever to secure the splint at three or four points, then tie something around the booted foot to create a 'Spanish windlass" between the boot/foot and the bent"V". I think they also used to make a device to add to the traditional D ring stretcher (litter) but you needed to fasten the pt to the litter or it just dragged the pt towards the foot end eventually.




*QUOTE:

"The amount of traction applied is proportionate to the patient’s body weight. For a single-sided fracture, traction equal to 10 percent of the body weight up to 15 pounds is applied. For bilateral fractures, 10 percent of the body weight is applied per limb, up to a total of 30 pounds of traction."

(so I guessed pretty right, thinking about one leg.) ;)

SOURCE:
http://www.fireengineering.com/arti...ce-ems/back-to-basics-traction-splinting.html

Good article.
 
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I was taught 10% of body weight up to 15lbs.

As far as splinting before or after boarding I would say it depends. If there are other life threats going on then board and go and apply traction in the rig if able. This is what I was taught and it is what some LO's here prefer.
 
Veneficus said:
I would not use the splint.

I would put the leg in traction.

It can be done with Kling and not all the metal crap.
Click to expand...

Considering that transport to the hospital is likely going to be the most painful experience for the patient after the actual injury, I would like to do more for them than some kling. I can think of a few ways to improvise a traction devise, but none of them are nearly as effective as a purpose built splint. And if I can't get ALS in any reasonable amount of time, the splint is about it for pain control.

There are many more hands in the ED than on scene and while I understand that getting the splint off is a pain, it is certainly possible to do with relatively little pain if everyone communicates and works smoothly.
 
HOw about a ,long spine board with a leg traction device built in?
Ferno-Washington, you listening?
 
I trust most of my EMTs much more in their ability to put on a commercial traction splint than to rig up something.

Most splints fit in the ambulance. Otherwise how do those EMTs keep brining patients to my ER in traction splints.

We can see the fracture just fine even with a Sager or Hare on.

You can do whatever you want, but I think most rookie EMTs/medics reading this board are just going to get themselves into trouble if they start improvising traction splints rather than use what they are carrying.
 
...and need to be practicing with. Practice not only refreshes skills but it makes sure the splint is present and in good condition.
 
zmedic said:
I trust most of my EMTs much more in their ability to put on a commercial traction splint than to rig up something.

Most splints fit in the ambulance. Otherwise how do those EMTs keep brining patients to my ER in traction splints.

We can see the fracture just fine even with a Sager or Hare on.

You can do whatever you want, but I think most rookie EMTs/medics reading this board are just going to get themselves into trouble if they start improvising traction splints rather than use what they are carrying.
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It has been my experience that when using the Hare, that you have to put the pt in the ambulance "backwards" in order to get the door to close when using the Hare.

What is worse is when you get to x-ray and there is no traction and you can see overriding bone with the splint improperly applied in order to get it in the ambulance.

I don't think it is so much "rigging" as using normal body mechanics, but you are right, it is probably beyond the basic EMT training. I would be willing to bet though if I showed you how to do it, you would be sold.

Anatomy is a wonderful thing to understand.
 
Tigger said:
Considering that transport to the hospital is likely going to be the most painful experience for the patient after the actual injury, I would like to do more for them than some kling. I can think of a few ways to improvise a traction devise, but none of them are nearly as effective as a purpose built splint. And if I can't get ALS in any reasonable amount of time, the splint is about it for pain control.

There are many more hands in the ED than on scene and while I understand that getting the splint off is a pain, it is certainly possible to do with relatively little pain if everyone communicates and works smoothly.
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Do you hold manual traction before/during applying your splint?

The commercial devices just make it a hands free maneuver, so does the kling. You don't need any rods or other improvised stuff. JUst something to hold the traction to free your hands.

In fairness you do need something to tie the kling to, and I have found the backboard handles or the cot to work just fine.
 
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