Traction Splints

Pelvic fractures and fractures of the femoral shaft are potentially life- and limb-threatening. Stabilization of pelvic fractures is difficult. Indeed, the only effective method in the field or in the emergency department is using the MAST garment with all compartments inflated. Radiographs can be performed through the garment.

Fractures of the femur can damage vessels and nerves from movement of bony fragments. Stabilization of femur fractures in the field is imperative to minimize blood loss and soft tissue damage. While MAST garments are often used to immobilize femur fractures, they do limit the assessment of the patient and cannot reduce the fracture. The femoral traction splint is the preferred device for femur fractures.

Several leg traction splint variations are commercially available. The two most commonly used types are the Hare splint (Dyna Med, Carlsbad, CA) and the Sager splint (Minto Research and Development, Inc.) (Fig, 2-4 and Fig 2-5). Other traction splints (Thomas Ring, Donway, and Klippel) are less commonly used. The underlying principle is the application of traction by a hitch on the ankle against resistance when the splint impinges proximally on the pelvis. The padded proximal end of the Hare splint abuts the ischial tuberosity ( Fig 2:4). The proximal end of the Sager splint rests against the ischial tuberosity medial to the shaft of the femur

(Fig.2-5). These splints cannot be used if a pelvic fracture is suspected, since the pressure on the pelvis may further displace a fracture and cause more bleeding. Another contraindication to the use of femoral traction splints is a hip dislocation.

FIG. 2-4. Hare traction splint.

Leg traction splints may also be used for tibial shaft fractures. Traction splints should not be used for fractures near the knee; since longitudinal traction may damage the neurovascular structures in the popliteal area. Traction splints for the tibia should be reserved for angulated or displaced fractures; otherwise, an air splint or the MAST would suffice.

Before applying a femoral traction splint at the scene, enough clothing must be cut or removed so that the extremity can be assessed for injury and distal neurovascular function. If the Hare splint (Fig...2-4) is used, the proximal half ring is placed in the crease of the buttocks against the ischial tuberosity. Traction is placed on the ankle with the padded ankle strap by one rescuer while the splint is strapped to the leg. The ankle strap is then attached to a ratcheting mechanism, and traction is applied. If a Sager splint (Fig.2-5) is used, the splint is placed on the medial side of the limb up against the groin. The padded ankle hitch is applied, and traction-applied elastic straps are then secured to hold the splint to the leg. With both splints, traction is applied until malalignment is reduced and pain is relieved. Overtraction can be harmful.

The Hare splint can be longer than an ambulance stretcher when fully extended, and care needs to be taken when closing the rear door of the ambulance. The Sager splint is shorter than the Hare splint, and one Sager splint can be used to splint both legs simultaneously. The Sager device is less bulky and therefore takes up less room in an ambulance or a helicopter, which can be very important in the latter.

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