Traction splint question

LucidResq

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Most resources I've checked say that a traction splint is to only be used on isolated midshaft femur fractures, but I've gotten conflicting information as to exactly what isolated means. One instructor told me that the patient can have no other injury whatsoever. Another told me that they should not have any other higher priority problems such as respiratory distress. Another told me they should have nothing wrong with their pelvis, tib/fib, foot etc.

So what exactly does isolated mean??

Like am I really not going to apply a traction splint just because someone has a broken wrist, as one instructor told me?
 

SC Bird

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Most resources I've checked say that a traction splint is to only be used on isolated midshaft femur fractures, but I've gotten conflicting information as to exactly what isolated means. One instructor told me that the patient can have no other injury whatsoever. Another told me that they should not have any other higher priority problems such as respiratory distress. Another told me they should have nothing wrong with their pelvis, tib/fib, foot etc.

So what exactly does isolated mean??

Like am I really not going to apply a traction splint just because someone has a broken wrist, as one instructor told me?
The reasoning behind not wanting to apply a traction splint to someone with a more critical injury or an immediate life threat, you don't want to spend the time stabilizing their leg when time is critical. So if you've got someone who's a multisystem trauma with an abdominal bleed and decreased breath sounds on one side....don't spend your time applying a traction splint for a femur fracture. Let the long backboard be their stabilization. Because they need surgery...not a perfectly splinted leg.

As far as making sure that the pelivs, ankle, and tibula/fibula are not fractured, think about what portions of the human body a traction split uses to pull traction. Those serve as "anchoring points" and are stressed when you pull traction. You don't want to attempt pulling traction on someone who's got a tib/fib fracture.:wacko:

As far as the "no other injury" or "never apply a traction splint to someone with a broken wrist"....use your judgement.B)

-Matt
 

MRE

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You would not apply a traction splint to a patient who had other injuries to the leg with the femur fracture or to the pelvis. If they did, the traction could cause more damage to these other areas.

Of course if your patient is unstable and/or has other more pressing issues like severe bleeding then you probably won't be worrying about the traction splint.

Edit: SC Bird beat me to it. Thats what I get for typing slow.
 
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Jimbean87

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traction

when using a traction splint you would not apply for several reasons. You may only use a traction splint if the patient doesn't have a more sever and life threatening condition that needs attention more so then the femur fracture. when applying traction the patient must not have a fracture any where else in the specified leg, pelvis or ankle/foot. the fracture must be a midline inclosed fracture. Remember when in doubt call medical control cover your azz thats what medical control is there for....
 

Ridryder911

EMS Guru
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Isolated femur fracture means that they have a mid-shaft femur fracture (non open or compound for us old farts). The whole intention of pulling traction is to reduce the likelihood of the crepitated ends lacerating the femoral artery and increasing damages. As well, the traction DOES not pull on the pelvis itself, you have three bones within the pelvic ring. (the ilium, ischium and subpubis) the traction is the pulled against itself. Technically, it pulls the gluteal folds and ischium, again not all the pelvis. Remember in all pelvic fractures, one will have a bi-lat fracture sites.

If your instructor told you that one should not apply a traction splint if they have another injury, then I would choose another school...now! Sorry, what an asinine statement. Yes, triage the injuries, and yes one may need to be treat others first, but this does not allow one to neglect splinting the femur. Again, remember how much blood loss in a isolated femur fracture (1000ml in a few minutes) as well as a source for fatty embolism, nerve damage and osteomyletitis.

Call my medical control about splinting.. expect not to have much of an arse left!
 

Jimbean87

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basic

You are a little more highly trained then I am I'm a emt-b so you would be much better at using your experiance and training in the field as for calling medical control I said in doubt call not just for splinting but for anything if you are doubting anything call and get there help
 

LucidResq

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Yeah I totally understand why you wouldn't want to spend time traction splinting when there are other serious injuries to attend to and why you wouldn't pull traction on a leg with a tib/fib fracture or anything like that, that one instructor that insisted the pt. cannot have anything else wrong tripped me up.

In my mock trauma assessment practical I had an auto vs. bike pt. with a flail chest and midshaft femur fracture. I obviously knew to manage the flail chest and associated respiratory distress first and complete my assessment, but due to what the instructor said I didn't know if it was "by the book" to mention that if I had time I would apply a traction splint.

Thanks for the input everyone. That instructor is pretty off.
 
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MRE

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As well, the traction DOES not pull on the pelvis itself, you have three bones within the pelvic ring. (the ilium, ischium and subpubis) the traction is the pulled against itself. Technically, it pulls the gluteal folds and ischium, again not all the pelvis. Remember in all pelvic fractures, one will have a bi-lat fracture sites.
Rid,

Can you talk a little more about pelvic fractures? specifically where in the pelvis a fracture typically would occur. When I mentioned not using a traction splint in the case of a pelvic injury, I was specifically thinking of a fracture of the ischial tuberosity on the side of the leg with the femur fracture. I realize that traction is not pulling on the pelvis itself, but pressure is still being placed on the tuberosity. In the field you may not be able to determine exactly what is inured, so with pain or other indications of an injury in the area of the hip/pelvis above the femur fracture, you would not apply a traction splint.

Please let me know what you think.
 
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