New type of Traction Splint?

[Ghando14]

Hey, so I was working in the ER, and was talking to a doctor about a patient who had her right radius and ulna bones broken, and I was asked basically to "pull traction" on the arm while he wrapped the arm. This made me think of the traction splints for Femur bones. I was curious if there were tools used like traction splints for the upper extremities. The doc I was working with hadn't heard of anything like that, and no one else I've talked to has heard of anything.

If there isn't, and it's plausible, I think if would work great and do a lot of good for people in similar situations.

 

[zmedic]

Not really indicated for upper extremity. The reason to do it for the femur to keep the bone ends from lacerating the femoral artery or nerve. The manual traction while you were splinting was really just to keep the bone ends aligned, thereby maintaining the reduction the doc had done. Doing that mechanically in the field doesn't reduce mortality, hurts a lot. So why do it?

 

[Ghando14]

Well when you hold traction, for both the Femur and the upper extremities (when the situations are as I've stated before) it relieves a lot of the pain for the patient. It wasn't something that I thought could save lives, it was more a thought of making the patient more comfortable, and therefore easier to work with and such.

 

[Aidey]

Think about anatomically neutral positions. When the leg is extended out, it is relaxed. How would you apply traction to an upper extremity with it in a relaxed position while the patient is in an ambulance? The arm would need to be extended out, which is not a good position for transport.

 

[cmetalbend]

I can see both sides to this coin. Yes, for comfort, no for akwardness durin transport. But, if there was loss of distal pulse and traction recovered it, then I would want to maintain traction by some means. I did hear once of a PEDS hare trac. being used to immobilize an arm. No other info as to why. It was an example of "Thinking outside the box".

 

[mycrofft]

Anatomy issue versus potential benefit

What happens when someone keeps putting their weight on their armpit with a crutch? Axillary nerves get crushed, and potentially vessels and lymphatics. No structure comparable to the ischial tuberosity which the classic femoral traction splint uses to achieve traction. Just splint it to the torso and transport.

However...
If the pt is elevated above the floor far enough to drop the arm over the side and let it hang, attach weights to the forearm by extensive tape. Like is done to help relieve a dislocated shoulder, in conjunctin with muscle relaxant like valium.
Oh, someone has a patent on a humeral traction device:
http://www.patentstorm.us/patents/5788659.html

 

[8jimi8]

IV pole, metal chinese finger traps and weights.

already been thought of...

+1 for crushing axial nerves and lymph with a pediatric traction splint.

 

[Veneficus]

I am guessing that the only ways to stabilize a femur fx and why was not covered in class.

Such a shame...

The goal of splinting is to reduce mobility and as zmedic pointed out, the potentil complications of having sharp bone fragments moving around important structures as well as causing pain and psych trauma.

In order to properly splint something, you must immobilze the joints above and below the fx. The recess as well as the large muscle groups of the femur make that impossible.

As an experiment, sit in a chair and hold you leg out with your knee straight. Rotate your foot from the hip joint without moving your knee. How could you stop that motion with an external splint? You're welcome to get one and try, but according to the ortho practices, only exteranl fixation or traction will immobilize the femur short of surgical repair. (I myself like the rods, becase it looks really medieval and of course there are some medical benefits too.)

As for the large muscle groups, the only way to stop them from acting is to paralyze them or pull against them. The later is what a traction splint does.

 

[8jimi8]

I am guessing that the only ways to stabilize a femur fx and why was not covered in class.

As an experiment, sit in a chair and hold you leg out with your knee straight. Rotate your foot from the hip joint without moving your knee. How could you stop that motion with an external splint?

Just as an aside:

A short armboard stabilized underneath the leg, perpendicular to the long leg splints would reduce this motion. (think of the horizontal in a capital "A")

 

[Veneficus]

Just as an aside:

A short armboard stabilized underneath the leg, perpendicular to the long leg splints would reduce this motion. (think of the horizontal in a capital "A")

I am not seeing it, do you have a picture?

 

[8jimi8]

The concept is just a cross board to immobilize rotation. When you splint w/ a long board, you put one board lateral one medial and use kravats to secure the leg, if you have a short armboard underneath, perpendicular to both long leg splints, the long leg splints cannot rotate on the femur's axis. (maybe i'm just trying to explain something that doesn't need explaining? ) I may have gotten confused as to what you were originally describing.

 

[Veneficus]

The concept is just a cross board to immobilize rotation. When you splint w/ a long board, you put one board lateral one medial and use kravats to secure the leg, if you have a short armboard underneath, perpendicular to both long leg splints, the long leg splints cannot rotate on the femur's axis. (maybe i'm just trying to explain something that doesn't need explaining? ) I may have gotten confused as to what you were originally describing.

ok, I get it now.

I could see that working, but it seems like one nastly rig to try and set up.

It also doesn't address the shortening of the femur because of the muscle contraction.

 

[8jimi8]

ok, I get it now.

I could see that working, but it seems like one nastly rig to try and set up.

It also doesn't address the shortening of the femur because of the muscle contraction.

Agreed, a traction splint is the tool for the job. I don't know why i even posted that as a solution... lol

thanks for dragging that out of me hah.

 

[zmedic]

The reason a traction splint reduces pain in because it counteracts the strong thigh muscles from pulling the bone ends into the muscle and other tissue. In upper extremity fractures you don't have as much muscle. Most upper extremity fractures hurt more when you pull on it then when it is resting, not moving. When you watch those reductions the patients don't say "oh, that feels better" when they are pulling like with femurs. They are yelling to stop unless you sedate them.

 

[Ghando14]

When I was asked to pull traction on the arm with this patient, she reacted just as if it was a femur break, saying she felt some relief as I held her arm in traction. The doctor then went on to tell me that it was similar to the femur situation, where the larger muscles are pulling the arm in causing pain and discomfort. I see what you mean by cutting off circulation and nerve issues, I was just wondering, after talking with the doctor and working with the patient, if such a thing existed, and if not, how well would it work.

 

[Veneficus]

When I was asked to pull traction on the arm with this patient, she reacted just as if it was a femur break, saying she felt some relief as I held her arm in traction. The doctor then went on to tell me that it was similar to the femur situation, where the larger muscles are pulling the arm in causing pain and discomfort. I see what you mean by cutting off circulation and nerve issues, I was just wondering, after talking with the doctor and working with the patient, if such a thing existed, and if not, how well would it work.

Her feeling better may have been psychological or dependant on her specific injury.

Unfortunately there is a very strong push in modern medicine to only help "most patients" by attempting to remove all ambiguity from treatment decisions based on individual illness.

Would it work, probably sometimes. Would anyone buy it or have the capability to know when to apply it? Rarely.

 

[Ghando14]

Yeah I can see that. It just happened to be a thought I had while sitting there in the ER. But I'm sure there are a lot of things that could be considered in the same way, something that would help some people sometimes, but not enough or in a way to make it protocol.

I guess that's just how life goes.

 

[cmetalbend]

IV pole, metal chinese finger traps and weights.

already been thought of...

+1 for crushing axial nerves and lymph with a pediatric traction splint.

+1 for doing whatever it took to get the job done by creativity. -2 for making a poor stab at a 20yr vet. paramedic.

 

[8jimi8]

+1 for doing whatever it took to get the job done by creativity. -2 for making a poor stab at a 20yr vet. paramedic.

Sorry, I wasn't trying to make fun of anyone.