ArticlePDF Available

Improvised Traction Splints: A Wilderness Medicine Tool or Hindrance?

Authors:

Abstract and Figures

To investigate whether a traction splint made from improvised materials is as efficacious as commercially available devices in terms of traction provided and perceived comfort and stability. This was a prospective randomized crossover study utilizing 10 healthy, uninjured volunteers. The subjects were randomized to be placed in 4 different traction devices, in differing order, each for 30 minutes. Three of the traction splints are commercially available: The HARE, Sager, and Faretech CT-EMS. The fourth traction device was an improvised splint made as described in Medicine for the Backcountry: A Practical Guide to Wilderness First Aid. At the end of 30 minutes the pounds of force created by each device was measured. The volunteers were also asked at that time to subjectively report the comfort and stability of the splint separately on a scale from 1 to 10. All traction splints performed similarly with regard to the primary outcome measure of mean pounds of traction created at the end of 30 minutes of application with results ranging from 10.4 to 13.3 pounds. There was little difference reported by participants in regard to stability or comfort between the 4 traction devices. In this small pilot study, an improvised traction splint was not inferior to commercially available devices. Further research in needed in this area.
Content may be subject to copyright.
BRIEF REPORT
Improvised Traction Splints: A Wilderness Medicine
Tool or Hindrance?
Lori Weichenthal, MD; Susanne Spano, MD; Brian Horan, DO; Jacob Miss, MD
From the Department of Emergency Medicine, UCSF-Fresno Medical Education Program, Fresno, CA (Drs Weichenthal, Spano, and
Horan); and the University of California, San Francisco, San Francisco, CA (Dr Miss).
Objectives.—To investigate whether a traction splint made from improvised materials is as effica-
cious as commercially available devices in terms of traction provided and perceived comfort and
stability.
Methods.—This was a prospective randomized crossover study utilizing 10 healthy, uninjured
volunteers. The subjects were randomized to be placed in 4 different traction devices, in differing order,
each for 30 minutes. Three of the traction splints are commercially available: The HARE, Sager, and
Faretech CT-EMS. The fourth traction device was an improvised splint made as described in Medicine
for the Backcountry: A Practical Guide to Wilderness First Aid. At the end of 30 minutes the pounds
of force created by each device was measured. The volunteers were also asked at that time to
subjectively report the comfort and stability of the splint separately on a scale from 1 to 10.
Results.—All traction splints performed similarly with regard to the primary outcome measure of
mean pounds of traction created at the end of 30 minutes of application with results ranging from 10.4
to 13.3 pounds. There was little difference reported by participants in regard to stability or comfort
between the 4 traction devices.
Conclusions.—In this small pilot study, an improvised traction splint was not inferior to commer-
cially available devices. Further research in needed in this area.
Key words: backcountry, traction splint, wilderness medicine, prehospital
Introduction
In wilderness and austere environments far from defini-
tive medical care, a femur fracture is a potentially life-
threatening injury. Long bone fractures can cause signif-
icant blood loss, and the high force mechanisms
associated with such injuries frequently result in multi-
system trauma. Femur fractures in remote settings also
can require significant resources to stabilize, package,
and evacuate the patient.
First developed for treatment of mid-shaft femur frac-
tures in 1860 by Hilton and further refined by Thomas,
traction splints gained recognition in World War I when
they were reported to decrease mortality from 80% to
15.6%.
1
Since 1961, the American College of Surgeons
(ACS) has mandated that all ambulances in the United
States carry traction splint devices.
2
This recommendation currently is jointly endorsed by
the ACS and the American College of Emergency Phy-
sicians. This practice has carried over to wilderness and
remote settings, with the construction and placement of
improvised traction splints being promoted in most wil-
derness medicine textbooks.
Despite the fact that traction splint placement is con-
sidered the standard of care, there are no definitive stud-
ies demonstrating efficacy or decreased morbidity or
mortality from their prehospital application. Similarly,
there is no research supporting use of improvised splints
in the wilderness. The potential benefits of traction
splints are thought to include decreased pain and amount
of potential bleeding space in the thigh; stabilization and
realignment of the fractured bony ends; and diminished
soft tissue injury including progression to an open frac-
ture.
3
Recent authors have questioned the utility of trac-
tion splints in the prehospital setting, citing occurrences
Corresponding author: Lori Weichenthal, MD, Department of Emer-
gency Medicine, UCSF-Fresno Medical Education Program, 155 N.
Fresno Street, Suite 206, Fresno, CA 93701 (e-mail: lweichenthal@
fresno.ucsf.edu).
WILDERNESS & ENVIRONMENTAL MEDICINE, 23, 61– 64 (2012)
of inappropriate application, skin ulcerations, peroneal
nerve injuries, and increased on-scene time for emer-
gency medical services (EMS) crews with subsequent
delay to definitive care.
1,4,5
The Wilderness Medicine
Society’s most recent Practice Guidelines for Wilderness
Emergency Care in 2006 even stated, “a traction splint is
no more efficacious than a good packaging technique.”
6
Clearly, there is controversy regarding the risks and
benefits of the use of traction splints in the prehospital
setting, and the debate regarding the use of these devices
is not well supported on either side by recent research.
Improvised traction splints in the wilderness setting take
some knowledge and time to create and should only be
used if they can be shown to be efficacious.
The goal of this pilot study is to investigate whether a
traction splint made from improvised materials is not
inferior to commercially available devices in terms of
traction provided and perceived comfort and stability.
Methods
This was a prospective randomized crossover study us-
ing 10 healthy, uninjured volunteers. Subjects were re-
cruited using e-mail and posted notices to employees and
residents at Community Regional Medical Center and
the University of California, San Francisco—Fresno
Medical Education and Research Center. Only individu-
als older than 18 years of age, who self-reported being in
good health and who were capable of signing informed
consent, were eligible to participate in the study. Once
the 10 selected subjects were educated on the specifics of
the study and had signed the consent form, they were
randomly assigned to be placed in 4 different traction
devices, in differing order, each for 30 minutes. Traction
splints were consistently placed on the same leg within
subject testing. Three of the traction splints are commer-
cially available: the Hare, Sager, and Faretech CT-EMS.
The Hare and Sager traction splints are frequently used
in urban and rural prehospital settings and in the emer-
gency department. The Faretech CT-EMS is a more
lightweight device designed for use in remote settings
including search and rescue and ski patrol. The fourth
traction device was an improvised splint made as de-
scribed in Medicine for the Backcountry: A Practical
Guide to Wilderness First Aid.
7
Creation of this splint
involved using a strip of something long and soft to tie
around the ankle with a loop at the sole of the foot,
securing a shaft that is at least 1 foot longer than the
injured leg to the patient’s upper thigh with a strap of
material that is well padded, and using a piece of rope or
cord to make a trucker’s hitch that is pulled from the loop
at the sole of the foot and the end of the shaft until
traction is achieved.
7
For our study, we used a 1-inch
webbing for the foot strap, a 4-foot (1.22 m) stick as a
shaft, and a 1-inch webbing for the leg strap with a
Prusik knot with cord at each end. A similar cord was
used to create traction.
Three of the commercial traction splints were applied to
the volunteers by one of the principal investigators follow-
ing the instructions provided by the manufacturers of the
devices.
8 –10
The improvised traction splint was constructed
and applied by the same investigator for consistency in
application. All subjects were monitored through the study
period and were instructed to notify an investigator at any
time if a traction device became too uncomfortable, at
which time the splint would be removed.
At the end of 30 minutes, an inline Lewis N Clark
BZ200 digital scale (Balanzza, Miami, FL) was placed
on each traction splint to measure the pounds of force
created by each device. The volunteers were also asked
at that time to subjectively report the comfort and sta-
bility of the splint separately on a scale from 1 to 10. For
comfort, 1 was equal to nothing noticeable on the leg,
and 10 was the rating for the splint being unbearable. The
scale for stability ranged from 1, meaning no added
stability, to 10 representing complete immobilization of
the leg. Subjects were also asked to report any perceived
side effects such as pain or paresthesia.
All collected data were entered into an Excel (Mi-
crosoft Corp, Redmond, WA) spreadsheet, where mean
and standard deviation were calculated. This information
was then imported to SAS (SAS Institute Inc, Cary, NC),
where means were compared and 95% confidence inter-
vals were determined.
This study was approved by the Community Regional
Medical Center institutional review board.
Results
The mean age of the 10 study participants was 27 years,
and there were 5 women and 5 men. The mean weight of
the participants was 72.7 kg (160 pounds). All traction
splints performed similarly with regard to the primary
outcome measure of mean pounds of traction created at
the end of 30 minutes of application, with results ranging
from 10.4 to 13.3 pounds. The mean pounds of traction
created for each device with the 95 % confidence inter-
vals listed in parentheses were Hare traction, mean of
13.3 (2.56); Sager splint, mean of 10.8 (3.33); Faretech
CT-EMS, mean of 10.4 (2.85); and improvised splint,
mean of 11.6 (3.77). There was little difference reported
by participants in regard to stability or comfort among
the 4 traction devices (Figures 1 and 2, respectively).
The majority of side effects reported by volunteers
occurred with the Faretech CT-EMS (8 of 10 subjects)
followed by the Sager splint (7 of 10 subjects). The
62 Weichenthal et al
least number was reported with the improvised splint
(2 of 10). The 3 most commonly reported side effects
were pain in the ankle, pain in the hip, and numbness
in the foot. No side effect was so severe that the
subject requested early removal of a traction device.
Discussion
Our study suggests that an improvised traction splint is
not inferior when compared with 3 commercially avail-
able traction devices in healthy and uninjured volunteers,
both in regard to measured pounds of traction created
and with respect to subjective evaluations of stability and
comfort.
Guidelines for the application of traction splints recom-
mend applying a force equal to 10% of the body weight of
the patient not exceeding 15 pounds. A recent study of the
Hare traction splint showed that 30 minutes after applica-
tion only half of the initial traction force remained.
4
At 30
minutes in our study, all of the splints tested had an applied
traction of at least 10 pounds or 7.4% of the mean volunteer
body weight. These results were achieved while also scor-
ing good subjective evaluations of stability and comfort
with limited reported side effects.
LIMITATIONS
This study is a first step at looking at the efficacy of
improvised traction splints in the wilderness setting. Its
results are limited by the small size of the study, the use
of healthy, uninjured volunteers, and the fact that the
commercially available devices that the improvised
splint is being compared with have not been well vali-
dated. Further limitations include that these devices were
not subject to the prehospital and wilderness environ-
ments of long carries and transfers that might reveal
instabilities of these devices not recognized in the more
controlled environment of this study.
Further areas that need to be investigated include eluci-
dating the role of commercially available traction splints in
the wilderness, rural, and urban prehospital settings; com-
paring improvised traction splints with good packaging
techniques in the wilderness setting; evaluation of the sta-
bility of these devices in long transports and transfers; and
further clarification of the potential side effects of these
devices, especially during long transports.
Conclusions
In this small pilot study, improvised traction splints were
not inferior to commercially available devices. Further re-
0.
0
1
2
3
4
5
6
7
8
9
10
*Stabil
a
97 (5.73 - 7.6
7
Hare
ity rang was ba
s
scale from 1-10 (
7
)
1.02 (6.
S
a
s
ed on the parci
p
1isnoaddedst
58 - 8.62)
a
ger
p
ants percepon
o
ability and 10 be
1.21 (5.19 - 7
.
Faretech CT-
E
o
f stability aer
3
ing complete im
61)
0.83
(
E
MS I
m
3
0 minutes of tra
c
mobilizaon of yo
(
6.17 - 7.83)
m
provised
c
on based on
ur leg).
Figure 1. Subjective stability rating for traction devices on a scale of 0 –10 (mean is graphed with bar representing 95% confidence interval).
Improvised Traction Splints 63
search is needed in this area including, but not limited to,
how these devices hold up during prolonged transport and
transfer scenarios that are common to wilderness settings.
References
1. Bledsoe B, Barnes D. Traction splint. An EMS relic?
JEMS. 2004;29:64 – 69.
2. American College of Surgeons Committee on Trauma: Minimal
equipment for ambulances. ACS Bull. 1961;46:136–137.
3. Mänsson A, Rüter A, Vikström T. Femoral shaft fractures
and the prehospital use of traction splints. Scand J Trauma
Resusc Emerg Med. 2006;14:26 –29.
4. Sturdee SW, Templeton PA, Dahabreh Z, Cullen E, Gian-
noudis PV. Femoral fractures in children, is early interven-
tional treatment beneficial? Injury. 2007;38:937–944.
5. Wood SP, Vrahas M, Wedel SK. Femur fracture immobi-
lization with traction splints in multisystem trauma pa-
tients. Prehosp Emerg Care. 2003;7:241–243.
6. Forgey WW, ed. Wilderness Medical Society: Practice
Guidelines for Wilderness Emergency Care. 5th ed. Guil-
ford, CT: The Globe Pequot Press; 2006:31.
7. Tilton B, Hubbell F. Fractures, In: Tilton B, Hubbell F,
eds. Medicine for the Backcountry: A Practical Guide to
Wilderness First Aid. 3rd ed. Guilford, CT: The Globe
Pequot Press; 1999:96 –99.
8. Dyna Med Hare traction splint. Skills procedures manual.
Lexington, KY: Galls Inc; 2002.
9. Sager traction splint. Instructor manual. Redding, CA;
Minto Research and Development Inc; 1998.
10. Faretec CT-EMS traction splint. User manual. Painesville,
OH; Faretech Inc; 2009.
0.8
4
0
1
2
3
4
5
6
7
8
9
10
*Comfo
r
scale fro
4
(2.66 - 4.34)
Hare
r
t was based on t
h
m
1-10 (1 is as
0.79 (3.7
1
Sa
g
h
e parcipants p
e
comfortable as if
m
1
-5.29)
0
g
er
F
e
rcepon of comf
o
nothing was on th
ust come off no
w
0
.73 (2.67 - 4.
1
F
aretech CT-E
M
o
rt aer 30 minu
t
e leg and 10 bei
w
).
1
3)
2.05 (
2
M
SIm
p
t
es of tracon ba
s
ng unbearable, th
2
.65 - 6.75)
p
rovised
s
ed on a
e splint
Figure 2. Subjective comfort rating on a scale of 1–10 (mean is graphed with bar representing 95% confidence interval).
64 Weichenthal et al
Thesis
Wstęp. Złamania trzonu kości udowej są problemem zdrowotnym obecnym w medycynie od lat. Jedną z potencjalnych możliwości postępowania na etapie przedszpitalnym i wczesnoszpitalnym jest zakładanie chorym unieruchomienia w postaci szyny wyciągowej. Cel pracy. Celem pracy było zbadanie w jakim stopniu Państwowe Ratownictwo Medyczne w Polsce jest przygotowane do stosowania szyn wyciągowych. Materiał i metody. Praca miała charakter badawczy i wieloetapowy. Pozyskano dane z Narodowego Funduszu Zdrowia z lat 2015-2018 do oceny zapadalności na złamania trzonu kości udowej. Przeanalizowano akty prawne dotyczące możliwości stosowania szyn wyciągowych. Uzyskano dokumenty dotyczące kształcenia przeddyplomowego ratowników medycznych z sześciu różnych szkół wyższych oraz przeanalizowano obowiązujące akty prawne i dokumenty doskonalenia zawodowego ratowników medycznych, aby ocenić stan kompetencji ratowników medycznych do korzystania z szyn wyciągowych. Zbadano wyposażenie Lotniczego Pogotowia Ratunkowego w szyny wyciągowe. Wysłano kwestionariusze ankietowe do wszystkich 208 dysponentów zespołów ratownictwa medycznego oraz do wszystkich 235 szpitalnych oddziałów ratunkowych w Polsce. Przeprowadzono badanie edukacyjne wśród studentów III roku, 6 semestru, kierunku ratownictwo medyczne z pięciu różnych szkół wyższych, celem oceny czasu potrzebnego do nabycia kompetencji w dziedzinie szyny wyciągowej i porównania kilku modeli szyn wyciągowych. Wyniki. W latach 2015-2018 zaobserwowano tendencję wzrostową w liczbie złamań trzonów kości udowej od 4046 przypadków w roku 2015 do 4396 pacjentów w roku 2018. Częstość występowania złamań trzonów kości udowej wynosi 10,5/100 000/ rok, aczkolwiek zmienia się zależnie od wieku. W pierwszych 10 latach życia jest większa (około 11,1 / 100 000 osób / rok), po czym obserwuje się zmniejszanie się częstości występowania, aż do 2,9 / 100 000 osób / rok w przedziale 40-49 lat. Następnie wartość ta zaczyna istotnie wzrastać, by w grupie powyżej 70 roku życia odnotować skokowe wzrosty, aż do 55,1 / 100 000 mieszkańców / rok w grupie osób powyżej 90 lat. W Polsce dopuszczalne jest użytkowanie szyn wyciągowych w systemie Państwowe Ratownictwo Medyczne, ale nie ma obowiązku posiadania szyn wyciągowych na wyposażeniu jednostek systemu. Po analizie dokumentów z sześciu uczelni kształcących ratowników medycznych, należy przyjąć, że w trakcie kształcenia przeddyplomowego ratownicy medyczni w co najmniej połowie z badanych szkół wyższych zapoznają się z tematyką dotyczącą szyn wyciągowych, w pozostałej części brak takich dowodów. Na podstawie analizy programów kursów doskonalenia zawodowego ratowników medycznych każdy ratownik medyczny, który odbył kurs doskonalący powinien zapoznać się z zasadami stosowania szyn wyciągowych oraz wykorzystać szynę wyciągową w trakcie zajęć praktycznych. Lotnicze Pogotowie Ratunkowe nie korzysta z szyn wyciągowych. Otrzymano kwestionariusze ankietowe dotyczące ponad 556 zespołów ratownictwa medycznego (35% wszystkich). W badanej próbce jedynie 11% zespołów ratownictwa medycznego posiadało szyny wyciągowe z przewagą zespołów specjalistycznych nad podstawowymi (17% vs 10%). Otrzymano kwestionariusze ankietowe z 24% wszystkich szpitalnych oddziałów ratunkowych, wśród których jedynie 18% dysponowało szynami wyciągowymi. Jedynie w dwóch przypadkach odnotowano istnienie procedury wymiany szyny wyciągowej w trybie „sztuka za sztukę” pomiędzy szpitalnym oddziałem ratunkowym a zespołami ratownictwa medycznego. Przeprowadzono zajęcia edukacyjne dla 116 studentów 6 semestru studiów licencjackich na kierunku ratownictwo medyczne, wśród których jedynie 41% miało w ich trakcie styczność z szyną wyciągową. Najwięcej studentów chciałoby użytkować szynę STS (50%) i uzyskała ona ogólną najwyższą ocenę (średnia 4,39 w skali 1-5). W czasie testu końcowego szyna STS była również najszybciej zakładana (przeciętnie 154 sekundy). Wnioski. Zapadalność na złamania trzonu kości udowej oceniono na 10,5/100 000 osób / rok. Zaobserwowano zwiększone ryzyko zgonu w ciągu roku dla osób doznających złamanie trzonu kości udowej. Nie wszyscy ratownicy medyczni uzyskują kompetencje do korzystania z szyn wyciągowych w czasie kształcenia przeddyplomowego, ale na etapie doskonalenia zawodowego powinni mieć oni styczność z szyną wyciągową. Lotnicze Pogotowie Ratunkowe nie korzysta z szyn wyciągowych. Większość zespołów ratownictwa medycznego i szpitalnych oddziałów ratunkowych nie korzysta z szyn wyciągowych Godzinne zajęcia edukacyjne powinny w sposób wystarczający zapewnić podstawową wiedzę o zasadach korzystania z szyny wyciągowej. Szyna STS Slishman Traction Splint jest najlepiej ocenianą szyną i ma potencjalnie najszersze zastosowanie w warunkach systemu Państwowe Ratownictwo Medyczne. Abstract Introduction. Fractures of the femoral shaft are present health problem in medicine for years. One of the potential options for pre-hospital and early hospital management is to immobilize patients in the form of a traction splint. Aim. The aim of the study was to examine to what extent the State Emergency Medical Services in Poland is prepared to use traction splints. Material and methods. The work was research and multi-stage. Data from the National Health Fund from 2015-2018 was obtained to assess the incidence of femoral shaft fractures. Legal acts regarding the possibility of using traction splints were analyzed. Documents were obtained regarding the pre-graduate education of paramedics from six different colleges and the existing legal acts and documents on professional development of paramedics were analyzed to assess the state of competence of paramedics to use traction splints. The equipment of the Air Ambulance with traction splints was tested. Questionnaires were sent to all 208 dispatchers of emergency medical teams and to all 235 hospital emergency departments in Poland. An educational study was conducted among 3rd year students, 6th semester of paramedic education from five different colleges, to assess the time needed to acquire competences in the field of the traction splints and to compare several models of the traction splints. Results. In 2015-2018, there was an upward trend in the number of femoral shaft fractures from 4046 cases in 2015 to 4396 patients in 2018. The incidence of femoral shaft fractures is 10.5 / 100,000 / year, although it varies depending on age. In the first 10 years of life it is higher (about 11.1 / 100,000 people / year), followed by a decrease in the incidence, up to 2.9 / 100,000 people / year in the range of 40-49 years. Then, this value begins to increase significantly, in the group over 70 years of age to increase in jumps, up to 55.1 / 100,000 inhabitants / year in the group of people over 90 years. In Poland, it is permissible to use traction splints in the State Emergency Medical Service but there is no obligation to have traction splints on the system units. After analyzing the documents from six universities training paramedics, it should be assumed that during pre-graduate education paramedics in at least half of the examined colleges learn about the subject of traction splints, the rest lack such evidence. Based on the analysis of paramedic training programs, every paramedic who has undergone a refresher course should become familiar with the principles of using traction splints and use the traction splints during practical classes. Air Ambulance does not use traction splints. Questionnaires were received for more than 556 emergency medical teams (35% of all). In the sample examined, only 11% of emergency medical teams had traction splints with the majority of physician teams over the paramedic only (17% vs 10%). Questionnaires were received from 24% of all hospital emergency departments, of which only 18% had traction splints. Only in two cases was there a procedure for replacing the splints in the "piece-by-piece" mode between the hospital emergency department and medical emergency teams. Educational classes were held for 116 students of the 6th semester of bachelor studies of paramedic education, of which only 41% had contact with the traction splint during their lifetime. Most students would like to use the Slishman Traction Splint STS (50%) and it received an overall highest rating (average 4.39 on a scale of 1-5). During the final test, the STS was also installed the fastest (154 seconds on average). Conclusions. The incidence of femoral shaft fractures was estimated at 10.5 / 100,000 people / year. An increased risk of death during the next year was observed for people who suffered a fracture of the femoral shaft. Not all paramedics acquire the competence to use the traction splints during undergraduate education, but at the stage of professional development they should have contact with the traction splints. Helicopter Emergency Medical Service in Poland does not use traction splints. Most emergency medical teams and hospital emergency departments do not use traction splints. Hourly educational activities should sufficiently provide basic knowledge about the principles of using the traction splint. The STS Slishman Traction Splint is the best rated splint and has potentially the widest application in the conditions of the State Emergency Medical System.
Chapter
Isolated or combined musculoskeletal trauma comprises a significant percentage of all injuries in both civilian and military populations. For both groups, the use of personal protective equipment reduces the rate and severity of injuries but also increases the percentage of orthopedic injuries. Long-distance aeromedical evacuation (AE) for these patients presents several challenges. Some fracture stabilization techniques used on the ground, such as free weight traction and military anti-shock trousers (MAST), should not be used during AE. Other methods are appropriate during AE, although circumferential casts that are tight should be split prior to flight. In-flight complications in stable orthopedic patients are relatively rare more than 72 hours after injury or surgery and include fat embolism syndrome, compartment syndrome, and pulmonary venous thromboembolism. However, they can have limb- and life-threatening consequences if not recognized and appropriately treated. Adequate planning and early identification are crucial for improving outcomes for patients who require AE. Whenever possible, long-distance AE for orthopedic patients should be delayed until 72 hours after injury or surgery to minimize the risk of in-flight complications. After microvascular reattachment of a limb or digit, AE should be delayed for at least 7 days.
Article
Background: Femoral fracture is a common battlefield injury with grave complications if not properly treated. Traction splinting has been proved to decrease morbidity and mortality in battlefield femur fractures. However, little standardization of equipment and training exists within the United States Armed Forces. Currently, four traction splints that have been awarded NATO Stock Numbers are in use: the CT-6 Leg Splint, the Kendrick Traction Device (KTD), the REEL Splint (RS), and the Slishman Traction Splint (STS). Objective: The purpose of this study was to determine the differences between the four commercially available traction devices sold to the U.S. Government. Methods: After standardized instruction, subjects were timed and evaluated in the application of each of the four listed splints. Participant confidence and preferences were assessed by using Likert-scaled surveys. Free response remarks were collected before and after timed application. Results: Subjects had significantly different application times on the four devices tested (analysis of variance [ANOVA], p < .01). Application time for the STS was faster than that for both the CT-6 (t-test, p < .0028) and the RS (p < .0001). Subjects also rated the STS highest in all post-testing subjective survey categories and reported significantly higher confidence that the STS would best treat a femoral fracture (p < .00229). Conclusions: The STS had the best objective performance during testing and the highest subjective evaluation by participants. Along with its ability to be used in the setting of associated lower extremity amputation or trauma, this splint is the most suitable for battlefield use of the three devices tested.
Article
Full-text available
BACKGROUND: Traction splints are generally accepted as standard prehospital treatment of femoral shaft fractures. The effects of different splints are not suffi ciently studied and the use of traction splints is not evidence-based. The aim of study was to determine the incidence and epidemiology of femoral shaft fractures and the prehospital use of traction splints in these fractures and to determine the force of traction exerted by traction splints over time. MATERIAL AND METHODS: a) Retrospective study of all adult patients with femoral shaft fractures treated at a university hospital during a 5-year period. b) Study of traction force exerted by traction splints on ten healthy volunteers. RESULTS: Femoral shaft fractures were caused by low energy trauma in 77% of the cases. There were no signifi cant differences in age, gender, and mechanism of injury or on scene time between patients treated with tractions splints and patients not treated with traction splints. In the experimental study the initial force of traction decreased by 58% during the fi rst 30 min, with the fastest rate of decline within the fi rst fi ve minutes. CONCLUSIONS: Low energy trauma may today be the most common cause of femoral shaft fractures. Traction splints were in this study probably not used on all patients were this was indicated. The force of traction exerted by the traction splint decrease considerably after application. Future studies need to investigate the clinical signifi cance of this.
Article
Objective: To evaluate the frequency of concomitant injuries that can complicate and/or contraindicate the use of traction splints (TSs) for femur fracture immobilization (FFI) in a population of multisystem trauma patients. Methods: This was a descriptive, prospective study utilizing a data collection tool to identify patients with multisystem trauma for which a TS was in place for FFI. Patient care records and follow-up diagnoses were reviewed to identify patients with positive femur fracture(s) who concurrently had injuries that can complicate and/or contraindicate TS use. Injuries considered to complicate or contraindicate traction splint use include 1) pelvic injury, 2) patellar fracture or ligamentous knee injury, and 3) tibia/fibula fracture. Results: Forty patients were identified as having a TS in place with an underlying diagnosis of multisystem trauma. All 40 had follow-up diagnosis information available, 39 of which were positive for femur fracture on the side of the extremity on which the splint was placed, or bilaterally. The incidence of complicating and/or contraindicating injuries was 38%. Conclusion: Traction splints are commonly used in the prehospital and transport setting for immobilization of femur fractures. There are limited data available on the benefit of traction splint use for femur fracture in the prehospital or transport environment. This study identified that concomitant injuries that complicate and/or contraindicate traction splint use are common.
Article
To evaluate the frequency of concomitant injuries that can complicate and/or contraindicate the use of traction splints (TSs) for femur fracture immobilization (FFI) in a population of multisystem trauma patients. This was a descriptive, prospective study utilizing a data collection tool to identify patients with multisystem trauma for which a TS was in place for FFI. Patient care records and follow-up diagnoses were reviewed to identify patients with positive femur fracture(s) who concurrently had injuries that can complicate and/or contraindicate TS use. Injuries considered to complicate or contraindicate traction splint use include 1) pelvic injury, 2) patellar fracture or ligamentous knee injury, and 3) tibia/fibula fracture. Forty patients were identified as having a TS in place with an underlying diagnosis of multisystem trauma. All 40 had follow-up diagnosis information available, 39 of which were positive for femur fracture on the side of the extremity on which the splint was placed, or bilaterally. The incidence of complicating and/or contraindicating injuries was 38%. Traction splints are commonly used in the prehospital and transport setting for immobilization of femur fractures. There are limited data available on the benefit of traction splint use for femur fracture in the prehospital or transport environment. This study identified that concomitant injuries that complicate and/or contraindicate traction splint use are common.
Article
Traction splints have been used in EMS for more than 40 years. However, they were originally designed for the treatment of femoral fractures -- not temporary stabilization. Multisystem trauma and other injuries contraindicate traction splint usage for many femoral fractures. Thus, with the relatively low usage of the traction splint, it may be time to revisit guidelines that require traction splints on every ambulance and rescue vehicle. They may be, in essence, an EMS relic we may want to part with.
Article
A protocol of early intervention (flexible intramedullary nails, early hip spica, and external fixation) was started in 1999 and during a 3-year period there were 25 children who sustained a femoral shaft fracture (early intervention group). These were prospectively reviewed with a minimum follow up of 24 months (Range 24-35 months). A historical control group of 41 children was used. These children were injured between February 1996 and February 1999 and were retrospectively reviewed. They had traditional in patient treatments with either Gallows or Thomas splint traction (traditional treatment group). Over the 6-year period from 1996 to 2002 there were a total of 66 femoral shaft fractures in the study that presented to our hospital. The mean length of hospital stay was 29 nights in the traditional group and 10 nights in the early intervention group. This difference is significant (p<0.001). The malunion rate was slightly higher in the early active group at radiological union but most of these remodelled over the 2 years of follow up. The protocol of early intervention used in our institution, of flexible nails, early hip spica or external fixation depended on the age of the child, and has resulted in a shorter hospital stay for the children. This has benefits for the child, the family and the hospital.
Medicine for the Backcountry: A Practical Guide to Wilderness First Aid
  • B Tilton
  • F Hubbell
  • Fractures
Tilton B, Hubbell F. Fractures, In: Tilton B, Hubbell F, eds. Medicine for the Backcountry: A Practical Guide to Wilderness First Aid. 3rd ed. Guilford, CT: The Globe Pequot Press; 1999:96 -99.
Wilderness Medical Society: Practice Guidelines for Wilderness Emergency Care
  • W W Forgey
Forgey WW, ed. Wilderness Medical Society: Practice Guidelines for Wilderness Emergency Care. 5th ed. Guilford, CT: The Globe Pequot Press; 2006:31.
EMS traction splint. User manual
  • Ct Faretec
Faretec CT-EMS traction splint. User manual. Painesville, OH; Faretech Inc; 2009.