Traction Splint Relieving Pain

[JustKeepSwimming]

All through class, people kept saying, "Apply a traction splint to reduce patient discomfort". Now, having broken myself multiple times, I don't recall having a medical professional pull on something to reduce pain. The closest I've had to a femur fracture is a tib/fib, and when the ER doc pulled on that, everything went red and I passed out. I suppose not being conscious would reduce pain... Has anyone experienced a traction splint applied? Does it really reduce pain? Just curious :blush:

 

[medicdan]

Femur fractures are generally the result of considerable force or trauma (or more rarely, bone weakening/degenerative disease). Fractures cause limb shortening (and internal rotation), and considerable pain from muscle spasm (remember that femoral muscle surround the bone, shortening it, often overlapping the fractured segments). Traction to an isolated midshaft femur fracture generally relieves the muscle spasm, and decreases pain considerably.

edit: although this is a kid, femoral fractures usually look like this:

 

[Luno]

Gotta love EMT Class....

All through class, people kept saying, "Apply a traction splint to reduce patient discomfort". Now, having broken myself multiple times, I don't recall having a medical professional pull on something to reduce pain. The closest I've had to a femur fracture is a tib/fib, and when the ER doc pulled on that, everything went red and I passed out. I suppose not being conscious would reduce pain... Has anyone experienced a traction splint applied? Does it really reduce pain? Just curious :blush:

Here's an interesting thread we discussed about traction splinting...
http://www.emtlife.com/showthread.php?t=32916&highlight=traction+splint

 

[the_negro_puppy]

We have just started using these

Instead of the donway. Can be resized for paeds, can use 2 for bilateral femoral fractures.

Don't forget that traction allegedly reduces the chance of fat embolisms as well.

 

[Epi-do]

I personally can't answer your question, but I can tell you that the one isolated femur fracture patient that I've had said his pain decreased significantly once traction was applied. In fact, he went from "don't even look at my leg, let alone touch it" to "let's get in the ambulance and get this taken care of" simply with traction. Fentanyl took care of the rest of his pain.

 

[Jambi]

I personally can't answer your question, but I can tell you that the one isolated femur fracture patient that I've had said his pain decreased significantly once traction was applied. In fact, he went from "don't even look at my leg, let alone touch it" to "let's get in the ambulance and get this taken care of" simply with traction. Fentanyl took care of the rest of his pain.

Had the same experience, only it's happened 3 times with me. All 3 times the patients were super happy that the splint was used.

 

[Nickoliah123]

traction on really reduces pain for femur fractures because the quad muscles are so damn strong they pull the bone in a very uncomfortable position. on your tib/fib fracture, i dont think the doc was pulling traction to help pain, i think he did it to realign your bones

 

[kaisardog]

skiers loved traction splints...

I've seen the hare traction splint used on numerous skiers' midshaft femur fx s . the relief they got was quite impressive . we judged that by the lessening of the screaming in our ears as we ski patrollers loaded them into the toboggan for the joyful trip down the hill ..:lol:

 

[firemedic0227]

I recently had a 10yof that was in a head on car crash that had a broken femur. She was screaming in pain when I got to her, I told her that it was going to be painful until we got a splint put on it. I told her when we move her it's going to be really bad (the pain). She said okay, she immediately stopped screaming upon application of the Sagar Splint. I was unable to give any pain meds due to not being able to find a IV spot on the patient. The entire 8 minute ride to the hospital the patient did not complain of any pain in that leg. It does work and it works well to help with the pain.

 

[medicdan]

I recently had a 10yof that was in a head on car crash that had a broken femur. She was screaming in pain when I got to her, I told her that it was going to be painful until we got a splint put on it. I told her when we move her it's going to be really bad (the pain). She said okay, she immediately stopped screaming upon application of the Sagar Splint. I was unable to give any pain meds due to not being able to find a IV spot on the patient. The entire 8 minute ride to the hospital the patient did not complain of any pain in that leg. It does work and it works well to help with the pain.

Sounds like things went well, but you were lucky you were so close to the hospital. Sidenote: Did you consider an IO?

 

[NomadicMedic]

IN fentanyl.

You know, for kids.

 

[the_negro_puppy]

Sounds like things went well, but you were lucky you were so close to the hospital. Sidenote: Did you consider an IO?

or IM????????

 

[medicdan]

or IM????????

I was thinking of a way to get fluids in as well... given the possibility of internal hemorrhage in the femur. It's not likely this patient will be discharged from the ED-- they're likely going to the OR, and the hospital will likely like some vascular access early... no? Isn't the party line that IOs were initially designed for peds, because of their easy access and few long-term effects?

 

[firemedic0227]

IN and IM are not in my protocols and we don't use Fent. I wasn't going to cause the patient more pain by starting a very painful IO on a conscious alert 10 year old. I have short transport times in my local area.

 

[Carlos Danger]

IN and IM are not in my protocols and we don't use Fent. I wasn't going to cause the patient more pain by starting a very painful IO on a conscious alert 10 year old. I have short transport times in my local area.

That's probably reasonable with such a short (8 min) transport time AND a hemodynamically stable patient whose injuries appear isolated. The ED likely has resources to facilitate venous access that you don't.

But in general, I don't think it's a good practice to forgo IO placement for fear of causing pain. IO placement isn't that painful. Infusion under pressure is what really hurts, but you could place the IO, flush it quickly, and then just not give anything else until you really need to. Things can change quickly in trauma patients - especially kids - and you don't want to be caught with your pants down without any access, if things go south.

I might not give analgesia either, with such a short transport. Especially if I don't have venous access.

 

[jefftherealmccoy]

Finally got my first femur fracture last week. 17y/o girl sobbing for mommy after an ATV rolled over her leg. morphine and valium first, then traction. squeeled like a stuck pig at first, but then said it was much better.

on a side note, we pulled traction first to see if it would really help with the pain. it was a little questionable whether it was fracture or dislocation. after she had relief with traction we were sure it was fracture and applied splint. is this how everyone goes about it?