Closed mid shaft femur fracture

Here an x-ray of a patient I had a little while ago. A donway traction splint was used, fitted correctly. Midshaft femur.

95vFe.jpg


What your opinion of this x-ray? Insufficient traction?
 
I'm no radiologist, but if it was immobilized and the pt experienced some relief, then it was sufficient. The field traction splints are not curative, as with all field splints they are for transport.

Are there protocols to overcome the spasm associated with such an injury? Benzo or a paralytic? I remember in the ER we wold hit them with a pretty good Valium dose before finally restoring a recalcitrant dislocated shoulder. Femoral fx must be much much harder.
 
Last edited by a moderator:
mycrofft said:
I'm no radiologist, but if it was immobilized and the pt experienced some relief, then it was sufficient. The field traction splints are not curative, as with all field splints they are for transport.

Are there protocols to overcome the spasm associated with such an injury? Benzo or a paralytic? I remember in the ER we wold hit them with a pretty good Valium dose before finally restoring a recalcitrant dislocated shoulder. Femoral fx must be much much harder.
Click to expand...

Agreed.

I can twist my protocol for versed to make it fit the situation. It's pretty open-ended.

I've never used traction splints. Not that I don't like them, just never had an isolated mid-shaft femur. Always had pelvic, hip or tib/fib involved as well.

Last one I came close to maxing out on my fentanyl protocol and also gave her a bit of versed. She was pretty happy by the time we got to the ER. 3 oblique fractures to the femur...ouch. This was the third time she ahd fractured that femur as well. Hip replacements and a poor diet did grandma wrong.
 
With this patient he was a young healthy male who failed to land a motorbike jump in a field. No other injuries. I believe we had given 2 x 5mg IV morphine before we started setting up for the splint, still in pain. I then gave him penthrane/methoxyflurane inhaler and the pain virtually 'went away' as he said lol. Traction was applied with pt receiving further IV morph enroute. Tx time approx 30 mins, we stopped on the way to pick up another medic who gave 2 x 1mg IV Midazolam, to assist with analgesia/controlling spasms. total of 25mg Morph was given.
 
The one we could save was due to running in the dark and colliding with a black-painted railing full tilt no hesitation and no guarding.

Another one fell almost sixteen stories feet first. Not, as you say, isolated.
 
mycrofft said:
The one we could save was due to running in the dark and colliding with a black-painted railing full tilt no hesitation and no guarding.
Click to expand...

Ouch.

Another one fell almost sixteen stories feet first. Not, as you say, isolated.
Click to expand...


Double ouch.

And still living? I hope not.
 
The fall victim stepped onto a counterweighted lift (parallel ropes with a board suspended between) not designed for people in a grain elevator. The counterweight was off. He tried to stop with his hands on the ropes (tore off skin), landed upright. Fx feet, ankles/tib fib, thighs, acetabular-femoral joints, T spine, and drove C spine into base of skull. Tough guy, lived another day in ICU.

Blackdog, USA toyed with nitrous oxide for field analgesia back in the late Seventies/nineteen eighty. Simultaneously and coincidentally, there was a wave of campus nitrous parties where I was working, a couple of kids went out dorm windows when they leaned back on window screens.
 
mycrofft said:
The fall victim stepped onto a counterweighted lift (parallel ropes with a board suspended between) not designed for people in a grain elevator. The counterweight was off. He tried to stop with his hands on the ropes (tore off skin), landed upright. Fx feet, ankles/tib fib, thighs, acetabular-femoral joints, T spine, and drove C spine into base of skull. Tough guy, lived another day in ICU.

Blackdog, USA toyed with nitrous oxide for field analgesia back in the late Seventies/nineteen eighty. Simultaneously and coincidentally, there was a wave of campus nitrous parties where I was working, a couple of kids went out dorm windows when they leaned back on window screens.
Click to expand...

Now that's impressive. Bummer for him, but impressive.


We have nitrous setups, they recently were just taken off the truck. ILS special events crews still use them and our ALS ski patrol uses it.

I love nitrous, it works brilliantly for getting someone out of a jacket without having to cut it off and they don't even notice the IV stick if we decide to use narcotics.
 
For those EMT students out there, better look at your practical exam sheets. For testing purposes, they usually like for you to immobilize before boarding.
 
wigwag said:
For those EMT students out there, better look at your practical exam sheets. For testing purposes, they usually like for you to immobilize before boarding.
Click to expand...

If the patient is reasonably stable and both the traction splint and spinal motion restriction are required I see no reason why you would not put the splint on first. The splint eases pain and limits further movement, both of which are going to occur during any sort of log roll.
 
Veneficus said:
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.
Click to expand...
Sure is! But social tact is also a wonderful thing to understand. As written, this post (and many others) have a condescending underlying tone to them. There's something that yells "ego". And this is coming from someone who doesn't always have the nicest sugar coated posts, either. That of course is a personal opinion.

Back to the topic, though. I've never had a problem closing the doors of the ambulance with a traction splint. We just move the backboard far enough up on the bench so a bit is hanging over the edge or resting on "captain's chair" or some put patient backwards on board. Also, locally trauma centers seem "decently" familiar with the Hare and Sager, and actually use both themselves from their own equipment room. I'm told it's an ATLS skill (?).
 
Ortho doc showed me a way to rig up traction using a giant ace bandage or two, after using manual traction and securing to the other leg. It turned out later to be pretty decent, but then again I didn't have a fancy traction splint (read: no way to get resupply from a UH-60) . Simple, and easy.

I've had good results with femoral nerve blocks for these types of tricky patients that didn't nessesarily need RSI yet pain meds were a slippery slope based on their cocominant injuries and overall condition. This of course, is out of the question in the states for most of us.

Works like a charm for tourniquet pain too.
 
AnthonyM83 said:
Sure is! But social tact is also a wonderful thing to understand. As written, this post (and many others) have a condescending underlying tone to them. There's something that yells "ego". And this is coming from someone who doesn't always have the nicest sugar coated posts, either. That of course is a personal opinion.
Click to expand...

It is probably best if I don't reply to this. :) I might say how I really feel.

AnthonyM83 said:
Back to the topic, though. I've never had a problem closing the doors of the ambulance with a traction splint. We just move the backboard far enough up on the bench so a bit is hanging over the edge or resting on "captain's chair" or some put patient backwards on board. Also, locally trauma centers seem "decently" familiar with the Hare and Sager, and actually use both themselves from their own equipment room. I'm told it's an ATLS skill (?).
Click to expand...

It is an ATLS skill. It is usually not given as much attention as the surgical skills though. More of a "by the way this is a teraction splint and this is how it works."
 
Oh yeah, forgot to mention good point on the bone bleeding. A lot of people don't factor that in.
 
wigwag said:
For those EMT students out there, better look at your practical exam sheets. For testing purposes, they usually like for you to immobilize before boarding.
Click to expand...

Goingn to be hard to put a traction splint on someone in the back seat of a rollovered Honda Fit or old (pre-198's) VW Bug.
 
Which exam sheet are you referring to?
Don't recall reference to backboarding or cspine on the NREMT traction splint sheet except for the final steps of securing to backboard...
 
mycrofft said:
Goingn to be hard to put a traction splint on someone in the back seat of a rollovered Honda Fit or old (pre-198's) VW Bug.
Click to expand...

The poster said "for testing purposes." In most testing scenarios the patient is just lying on the ground in front of you. They usually aren't inside of an actual car. So if the patient is just lying there with a femur fracture, put the traction splint on before backboarding.
 
Ooh, now that you poked your head in, Doc, have you ever tried a femoral block?
 
zmedic, agreed.
 
You must log in or register to reply here.
Back
Top