Traction Splint

truetiger

Forum Asst. Chief
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This is probably more aimed at our medical students but does anyone know of any situation a traction splint would be indicated in a pt that had a right femur fx as well as a right tib/fib fx? One of our ER Docs asked one of my co-workers to put one on in this situation. We asked our Asst Med director and he could think of no reason to use it, would of asked the doc that ordered it but he is not one to field questions regarding his orders.
 

reaper

Working Bum
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If orders are out of ordinary, always ask questions. You don't work for him.

But ask in a way that seems like an educational question. He is more likely to tell you his thinking.
 

wyoskibum

Forum Captain
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This is probably more aimed at our medical students but does anyone know of any situation a traction splint would be indicated in a pt that had a right femur fx as well as a right tib/fib fx? One of our ER Docs asked one of my co-workers to put one on in this situation. We asked our Asst Med director and he could think of no reason to use it, would of asked the doc that ordered it but he is not one to field questions regarding his orders.

Perhaps the ER Doc didn't catch the part about the distal injury or was thinking that the tib/fib Fx was on the other leg. My response would be:

"Did you copy that patient has a possible tib/fib Fx distal to femur Fx which would be a contraindication to traction splinting. My protocols state that I should immobilize extremity with vacuum splint and provide pain management."
 

TransportJockey

Forum Chief
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I've seen a tib/fib fx stabilized using a traction splint. It was done by an oil rig medic prior to us picking the guy up. Seemed to work pretty damned well, and made for a more comfortable ride for the patient going down the patch roads. Now I've not seen on yet that is both a tib/fib and femur fx.
 

usafmedic45

Forum Deputy Chief
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The use of traction for lower leg long bone fractures is well documented. The reason it's limited among EMS personnel to the femur is because of the need to minimize movement of the femur and the fact that severe damage of the thigh can lead to massive blood loss. Also, a lot of people have concerns that EMS personnel would not adequately "weed out" those persons with fractures of the lower 1/3 of the lower leg. Also, the risk of compartment syndrome is much higher in lower leg injuries so one has to be be careful in how you manipulate them. In lower leg fractures, it's generally much easier to put a pin or wire through the leg and use that for tracture should it be necessary, rather than relying upon the field standard of a harness.
 

Veneficus

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The use of traction for lower leg long bone fractures is well documented. The reason it's limited among EMS personnel to the femur is because of the need to minimize movement of the femur and the fact that severe damage of the thigh can lead to massive blood loss. Also, a lot of people have concerns that EMS personnel would not adequately "weed out" those persons with fractures of the lower 1/3 of the lower leg. Also, the risk of compartment syndrome is much higher in lower leg injuries so one has to be be careful in how you manipulate them. In lower leg fractures, it's generally much easier to put a pin or wire through the leg and use that for tracture should it be necessary, rather than relying upon the field standard of a harness.

This is extremely well written.

I would just like to add that you can get compartment syndrome in the lower extremity and still have a pulse.

In the lower limb the pressure required for compartment syndrome is 30mmhg, hopefully your systolic pressure is always higher than that.

There is also some issue about the location of the muscle insertions in the lower 1/3 of the tib/fib. traction there may actually cause pulling and stretch damage of structures instead of realigning them.

As with everything in medicine...

"The rules are more like guidlines."
 
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