Pelvic fx with femur fx???

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Jn1232th

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What would you do for a patient who has left sided pelvic instability ( possible fx) along with possible femur fx with leg shortening???
I was told traction splint would not be used due to it contraindicated with the pelvic instability.

Will using a pelvic sheet wrap work for the instability and stabilizing the upper portion of the femur and a leg splint ( splinting above and below the knee) for stabilizing the lower portion?
 
Forget the indications and contraindications. You have a simple tool; it's basically one of those steering wheel locks. Traction splints need to push against something to work. Suspected pelvic fracture? Nuh uh, nope, not using that, wouldn't want that done to me.

What you suggested is fine. Although using a splint that is long enough to cover both sides of your femur fracture would be better. Sheet wrap is for helping to stabilize the pelvis only.
 
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Traction works by pulling i.e. applying force to move the femur distally.

I don't see any reason not to traction a fractured femur if there is a suspected pelvic fracture. The only exception that might exist would be if the femoral neck has been driven superomedially into the pelvic space through a fracture of the acetabulum socket. I suppose this would be most likely with force travelling superior or medially, however, I have never seen such a phenomenon and suspect it would be quite difficult to actually occur in reality.

Pelvic fractures can and do bleed, and they can be significant. Splinting the pelvis can be done with a scoop strap, strap from a femoral splint or using a specific pelvis binder such as the SAM splint. I guess you can also use a sheet but I am told it's hard to get the sheet tied tight enough.

Oh, and I am told it's no longer acceptable to "spring" the pelvis feeling for fracture.
 
Don't traction splints need to resist the ischium in order to maintain traction on the leg, resulting in displacement or some force being placed on the pelvis? I thought we wanted to avoid that if we could.
 
If the patient has a suspected femur fracture and a suspected pelvic fracture, you probably do not want to apply traction to the femur using the typical equipment found in a typical ambulance. Those devices depend upon an intact pelvis to be able to function correctly. In particular, when you are pulling traction on a femur there must be an equal and opposite force applied to the body. Both the Sager and Hare traction splints apply that opposite force to the pelvis through either the Ischium or the pubic rami. The Hare traction splint might split part of that applied force through the proxmial femur, but some force will still end up applied to the pelvis. With a fractured pelvis, you do NOT want to apply pressure to the pelvis unless it's a stablizing pressure, like a pelvic wrap to maintain the pelvic ring.

In this specific instance, I'd want to apply that pelvic wrap and use the longest split we have on an ambulance: the long spine board. Just make darned sure that there's no metal near the pelvis as this patient will likely need a CT scan and metal buckles cause much artifact.

That's my $0.02 on this.
 
Think about how the splint works and you'll see the answer depends on the splint.

Bipolar splints like Hare/Thomas or Sager need an intact pelvic ring to work. CONTRAINDICATED with a pelvic fx!

Unipolar splints like KTD, STS, and CT-6 do not work that way. You can use a KTD in the presence of a pelvic fx (unless your protocols say no).

Complex situations:
Of course unipolar splints have other contraindications (eg ankle fx, only useful on midshaft fx). As always, if you apply traction and it worsens the pain or hemodynamic instability, stop and splint the legs together... unless you have bilateral femur fx (and now it is a really bad day) then use your vacuum splint and improvise.

HEMS consideration:
Make sure that your solution will fit in the helo if you are calling one. One time we had to load a patient backwards in the helo to make the improvised splinting fit. If you resort to an air splint and use HEMS, give them the pump because they might need to air down at altitude and pump up on descent.

Wilderness consideration:
Also, for very long transports (>4hr) splinting the legs together is as good as or superior to traction due to inability to maintain constant traction, transport complications, positioning, muscle relaxation, traction compromising circulation, and potential pressure wounds.

Snow sports = a lot of fx femurs...
 
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This doesn't specifically address OP's question, but here's a great video about pelvic fractures in general:
 
Backboard is a long splint if you need to get on to the hospital quickly. We also have pelvic binders. Wouldn't worry much about the femur. Let the hospital take care of that one.

Even if the affected limb is not getting proper perfusion, it can still live for 3-5 hours.
 
Unless I am literally minutes from hospital I would apply traction to the femur.

A bipolar traction splint must be what is used locally because I've never been told it is contraindicated in femur fracture.

Guess you learn something new every day!
 
Lots of fentanyl + transport. Traction splints are for isolated, closed mid-shaft femur Fx only.
 
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