Midline femur fracture not a fracture, even with traction relief?

[emt6207]

I had this recently, so trying to understand, how is it possible for a trauma pt, with 8/10 midline femur pain, some swelling, no contusions, no deformities have pain relief on ktd traction down to 2/10, have an xray and find no fracture/break of any kind on the femur. As far as I and several other people around me know if there is pain relief on traction for mid-line femur pain its gotta be some kind of break/fracture causing the spasms and the pain.

Anyone got idea's?

 

[Handsome Robb]

If they have a midline femur fracture they should have relief with traction. With that said I'd never pull traction on someone without medicating them first. I've also never had a midshaft femur fracture requiring traction, all mine have been either hip dislocations or acetabular fractures so traction wasn't indicated.

You should only be pulling traction if you have indications of a midshaft femur fracture such as shortening of the limb. Swelling but no shortening or midshift deformity I wouldn't pull traction but that's just me.

 

[Medic Tim]

If they have a midline femur fracture they should have relief with traction. With that said I'd never pull traction on someone without medicating them first. I've also never had a midshaft femur fracture requiring traction, all mine have been either hip dislocations or acetabular fractures so traction wasn't indicated.

You should only be pulling traction if you have indications of a midshaft femur fracture such as shortening of the limb. Swelling but no shortening or midshift deformity I wouldn't pull traction but that's just me.

This^^^

 

[Veneficus]

I had this recently, so trying to understand, how is it possible for a trauma pt, with 8/10 midline femur pain, some swelling, no contusions, no deformities have pain relief on ktd traction down to 2/10, have an xray and find no fracture/break of any kind on the femur. As far as I and several other people around me know if there is pain relief on traction for mid-line femur pain its gotta be some kind of break/fracture causing the spasms and the pain.

Anyone got idea's?

That is a very limited view...

The proximal lower extremity has considerable anatomical structures. Injury or inflammation to any one of them could cause pain.

As for traction relief, if something is compressing a nerve or another structure causing local ischemia, repositioning (aka traction) could relieve the pressure in that area.

Less pressure would be less pain.

Additionally for muscular or tendonous injury, when you have local blood collection, the increase in pressure usually causes pain.

Reducing concentration of inflammatory mediators in a given area will reduce pain.

Did the pain return when traction was released?

What is to say that the change was not due to something other than the traction like time?

 

[WTEngel]

I'll be honest, the patients with femur fractures I have assisted have all reported rather nominal pain relief. This was on the patients that I did not administer analgesia to prior to reducing or pulling traction.

Analgesia is for pain relief, traction is for protection of neurovascular status...that's my opinion anyway.

 

[Veneficus]

Analgesia is for pain relief, traction is for protection of neurovascular status...that's my opinion anyway.

I absolutely agree without caviat or condition.

 

[AnthonyM83]

I'll be honest, the patients with femur fractures I have assisted have all reported rather nominal pain relief. This was on the patients that I did not administer analgesia to prior to reducing or pulling traction.

Analgesia is for pain relief, traction is for protection of neurovascular status...that's my opinion anyway.

I've had patients report IMMEDIATE and SIGNIFICANT pain relief from traction (though some momentary increase in pain from pulling the traction...which they didn't care about when they felt the relief of the other worse pain, letting out a loud sigh saying "OMG that's so much better")

Also, at the BLS level, there's limited options for pain relief...

 

[Veneficus]

I've had patients report IMMEDIATE and SIGNIFICANT pain relief from traction (though some momentary increase in pain from pulling the traction...which they didn't care about when they felt the relief of the other worse pain, letting out a loud sigh saying "OMG that's so much better")

I have also. But then I started working in the hospital.

Once at the hospital, the commercial traction slints are removed for radiology in most cases. No other form of traction is applied prior to fixation in my experience.

What is worse is when ortho cannot write orders in the ED and it is easer and faster to "fix it real quick" than wait for an ED doc to get around to writing an order and an available nurse to get around to carrying it out and not appropriately following up.

At that point it doesn't matter if it is a system failure or not, the practical result is a patient needlessly in pain. Pre ED analgesia is definately an easy fix to the problem.

Of course so is having doctors who can access meds and give them personally without a nurse. But the US will probably never see that again.

Also, at the BLS level, there's limited options for pain relief...

This is true. But just because the system that bills itself as the greatest medicine in the world won't pay for a provider who can manage pain or give that ability to ambulance drivers doesn't make applying traction a reasonable alternative solution.

Might as well tell them to "man up and walk it off."