traction splints

[Household6]

In regards to applying a traction splint to an open femur fracture, I have not seen that as a contraindication except in old textbooks (it may be listed in some newer that I'm not aware of).

I understand the thought process of not doing it. However, I decided to look around for some literature on it.* Most places I looked said withholding applying traction was old practice, and found unnecessary. For just a quick glance- a brief statement on it from ITLS can be found here.

So with that said, would like to hear some of the other guys' thoughts on it. Yes, you're reintroducing a contaminated bone into the body. However, the bone and wound are already contaminated, the entire wound will get thoroughly irrigated and cleaned, and the patient will likely be started on antibiotics anyway. Considering all of that will be covered, it seems like the benefit would lean more toward stabilizing the mid-shaft fracture, eliminating potential further damage, and alleviating pain (especially if you're in a system without fairly progressive pain management abilities).

*The brief looking I did was on my phone with limited access to full articles. I'll try and look more into it when I get a chance.

I uh.. If I was a patient with an open fracture, I would prefer my responding medics not push my bone back in. Wouldn't that be a sure way to sever a femoral artery? With a nice sharp bone being shoved blindly back into the thigh muscle? Severing a sciatic nerve maybe? No. No thank you. I'll just sit in pain for a while.

 

[STXmedic]

Except nobody is forcibly pushing anything back in.

What do you think the difference is between open and closed. When you apply traction to a closed fracture, it doesn't just magically appear in place.

What do you think the hospital is going to do? Magically pop it into place, too? Granted, they will likely pull traction slower.

But if you want to bear the pain and request me to not do anything about it, it's your right to refuse Hell, I'll gladly throw you on a backboard and tape you down, too. Maybe throw a NRB to you while I call the chopper.

 

[EMT B]

fresh fresh out of class i had a motor cycle accident where one pt had a midshaft femur fracture. i was told to hold traction and i just held the leg there like we did in class cause i thought that was what you were supposed to do. nobody told me you had to pull :blush:

 

[CFal]

fresh fresh out of class i had a motor cycle accident where one pt had a midshaft femur fracture. i was told to hold traction and i just held the leg there like we did in class cause i thought that was what you were supposed to do. nobody told me you had to pull :blush:

I blame your EMT instructor

 

[EMT B]

we can blame lots of things on my instructor

 

[mycrofft]

From the ITLS:
AND I QUOTE: and add red accents
" Given that ALL OPEN FRACTURES are contaminated and subject to infection and
will need to undergo wash-out and / or debridement by an orthopedic surgeon, we
believe that application of a traction splint in the austere environment to either
open or closed fractures benefits the patient. Copious irrigation, preferably in route,
should be performed prior to reduction to reduce foreign material in the wound. If
available, appropriate antibiotic therapy should be initiated and the fact that the
fracture was open and reduced by EMS personnel must be conveyed to the receiving
facility.
Recommendation:
For patients in isolated or austere environments, where transport to definitive care
is substantially delayed, application of a traction splint after stabilization of life
threatening injuries can improve patient comfort and reduce possibility of
neurovascular injury."

Also at the start, they cite lack of published material, citing only one "consensus document": whatever that means:

AND I QUOTE:

"In response a literature review on the topic was performed. No Class 1 evidence was found to support the use or non use of this device in the above mentioned clinical situation. Only one consensus document from the wilderness rescue literature was located."

My interpretation: they reviewed the literature, found insufficient material, so they winged it. They also say do it after everything else is stabilized, enroute, in austere or isolated settings only, with irrigation and antibiotics before reduction (which can occur fully or partially when tactin is applied; if it is sticks out out 2 inches and you tract it to a 1/2 inch protrusion, you have introduced 1.5 inches of potentially dirty bone into the tract.
I also argue their proposition that only/so much force is required that the wound is already contaminated (I differ, having seen two incidents where the clothing was not breached; one was car versus pedestrian, the other was jogger versus pipe in the dark) so reintroducing the contaminated bone into the tract and potentially into intimate contact with the nonexposed bone end is not a concern versus the assumed contamination (so we don't need sterile dressings and trache tubes now, also?).

The document smells like a preliminary and is not for people working in urban and suburban settings, or rural ones where transport/treatment times to receiving facility is prompt.

 

[DesertMedic66]

As Chaz said this is something that I have not done any research on at all. The reasoning I was given in EMT class as to not apply traction to an open fender fracture was a mix of contaminating the wound more when/if the bone enters the skin and the possibility of lacerating the artery when/if the bone enters the skin.

We are still teaching not to use traction on open fractures.

 

[Jim37F]

I bombed a skills test the other day, and traction splints were a big chunk of why. Basically they said I tried to pull traction on a hip fx instead of a femur fx. At what point on the leg does it stop being the femur and start being the hip?

They also said I didn't know how to use their splint, which is true. My service uses the Hare, which I'm comfortable with, but the company i tested at had the other one (sager? I think) which I haven't seen since EMT school nearly a year ago now.

Also, I know any sort of fracture, sprain, strain etc anywhere else on the leg is a contraindication to traction, but what about soft tissue injuries? If I had to take a test right now I'd say an open injury (I.e. one that required bandaging and bleeding control) would be a no go for traction, but what about a closed soft tissue injury, such as bruising?

 

[NomadicMedic]

I bombed a skills test the other day, and traction splints were a big chunk of why. Basically they said I tried to pull traction on a hip fx instead of a femur fx. At what point on the leg does it stop being the femur and start being the hip?

A traction splint is ONLY indicated in a a MID SHAFT femur fracture.

It's stops being the femur and becomes the hip when it's the femoral head and NOT the mid shaft.

 

[Javaman]

As Chaz said this is something that I have not done any research on at all. The reasoning I was given in EMT class as to not apply traction to an open fender fracture was a mix of contaminating the wound more when/if the bone enters the skin and the possibility of lacerating the artery when/if the bone enters the skin.

We are still teaching not to use traction on open fractures.

Would having no distal pulse change the decision not to apply traction on an open fracture?

 

[DesertMedic66]

Would having no distal pulse change the decision not to apply traction on an open fracture?

For my area and what I have to teach, no it wouldn't change anything. Open fractures = bleeding control and splinting in place. We are taught to realign extremities one time if there are no distal functions only on closed fractures.

 

[kaisardog]

midshat femur: think thigh cantalopes...

boarders working ski patrol at a major resort, we see 2 dozen femur fx per season. most victims are young wild skiers or riders. a hare splint gives amazing and immediate relief. in 15 years we've never seen an open fx. all of the ones we've seen have looked like cantaloupes in the middle of the frontal :rofl: thigh...

 

[CFal]

Last year on my patrol we had a bilateral femur fracture in one of our terrain parks

 

[mycrofft]

boarders working ski patrol at a major resort, we see 2 dozen femur fx per season. most victims are young wild skiers or riders. a hare splint gives amazing and immediate relief. in 15 years we've never seen an open fx. all of the ones we've seen have looked like cantaloupes in the middle of the frontal :rofl: thigh...

There. Direct experience.

 

[the_negro_puppy]

[YOUTUBE]http://www.youtube.com/watch?v=L1-hWv6yYpY&feature=youtu.be[/YOUTUBE]

Here's an interesting vid of our service adopting the CT-6

 

[Handsome Robb]

Would having no distal pulse change the decision not to apply traction on an open fracture?

How far are we from the hospital?

The further away the more I'd consider pulling. With that said, there's no guarantee it'd help either.

 

[Miscusi]

What circumstances would you apply a traction splint in the back of the ambulance rather than on scene?

If the patient is not stable, getting to the hospital becomes priority.

 

[NBFFD2433]

I can honestly say that I have never used a traction splint yet.

 

[Horse Feathers]

Has anyone here ever used a Slishman Traction Splint?

I would think that it would be a lot easier to apply in a rig than any other device, since it does not stick out past the foot, and traction can be pulled from the proximal (hip) end. It is also not contraindicated in cases of concurrent lower leg injuries... <$.02>

Can't post live links - but you can google it...

 

[Tigger]

Recently purchased one with their buy back deal for Hare splints, but no use yet.