Pulling traction on an open femur fracture...yes or no?

Yessenia M

Forum Ride Along
Is pulling traction on an open femur fracture a critical fail during a trauma practical final?? I've been looking everywhere in my coursework for this but nowhere did I find that this was taught as a critical fail.


Forum Deputy Chief
When in doubt, ask your instructor.

In the real world local protocols vary.

There are some places where an open compound fx is a hard contraindication...

When I was in LA, the County skill sheet explicitly said we were allowed to apply traction to an open femur fx (assuming of course it was an otherwise isolated midline femur fx, but open vs closed didn't affect whether we could apply traction or not)...

FWIW I *think* (so don't quote me on this lol) NREMT frowns upon traction splinting open femur fractures


Forum Crew Member
Interesting. I know in my Primary care Paramedic (Canada 2010) schooling open fractures were a critical fail, though that quickly changed

I work air amb, and in facility. I put traction on a fellow just a few days ago with an open fracture. Now I have the added benefit of x-rays and such that you don't get in the pre-hospital environment, but as a rule even for ground services open fractures are not a contraindication for traction anymore in Canada. ATLS also is somewhat indifferent towards traction, and does not care if the fracture is open or not.

The science seems to find there is little benefit or harm done by traction overall, though I still like it for pain reduction on those long flights.

http://www.fresno.ucsf.edu/em/posters/Prehospital Midthigh Trauma and Traction Splint Use_Poster.pdf


Forum Ride Along
Correct. Protocols will vary, but national standard is NO traction on an open fracture.
Curious were the National standard guidelines are located? It is a common standard of care practice to immobilize open and closed fractures of the femur based on current PHTLS and ITLS guidelines.