Traction splints

[smugalov]

Hi boys and girls

Last year I took the WMA (wilderness medical association) Wilderness EMT course.
I was very lucky because the instructors were the main guys with WMA Dr David Johnson and Jeffrey Isaac
(WMA is one of 2 leading Wilderness medic schools in the USA Along with SOLO)
There was a discussion about the use of traction splints in the remote setting and the instructors were not very fund of them. They said there were no studies that showed they did any good for the patient in the prehospital setting and that a proper administration of pain medicine’s was a much better way to go, of course we talked about open fractures and if it was better or not to put the bone ends back inside and keep it there with the traction but the conclusion was that they really don’t make that much of difference and also when putting the bone ends back inside you are creating a very nice environment for the bacteria to start having a nice party!! which can become a big problem very quickly

I work in setting´s that is about 300 KM away from a decent ER and about 450 km from a good one.
We have had patients with open fractures that got a serious infection in just 3 hours so now as a rule we give all PT with open fractures a dose of Ceftriaxon (Rocephalin) at the first chance before we transport them, witch can take up to 5 hours on the bus (ambulance)
(if we have an airlift we let the flight doctors decide)



So I was just wondering what your thoughts on the hole traction matter are


Hasta Pronto

[Legioner]

i imagine that in a country like iraq for exemple it wouldn't be the best option.
cause of infections.(Sand and stuff like this)
but otherwise what to do if you are days our hours away from an hospital?
however there is always something that can turn wrong!!

[gasman]

Well in a wilderness environment it could make sense a traction splint could get in the way and cause more discomfort for the pt. But there have being some form off studies relating that traction does help with pain relief but not for long periods. Open fractures have always got a good chance of infection especially in a remote area were transportation can be delayed by hours if not day, really good idea of the antibiotics not going to really harm the patient will just help it on to prevent infection. A good dose of sterile water over the wound will get rid of un-wanted debris tough if you loose a few bone fragments the bone is going to heal anyway.

Well I guess at the end of the day you can only do so much for the pt. depending on what resources you have at hand. It sound like a good question to do a case review or paper on as there are so many other complications with fractures especially crushing fractures and so on.

[Paul999]

The use of traction splints is something that could be debated for ever and a day I reckon, so I thought that I'd offer up what the Joint Royal Colleges Ambulance Liason Committee (JRCALC) have laid down in there guidlines.

For those not familiar with JRCALC it is a large committee with representatives from the UK Ambulance Services, the Royal Colleges of Physicians, Surgeons, Anaesthetists, Obstetricians & Gynaecologists, General Practitioners, Nursing, Paediatric and Child Health, the Faculty of A&E Medicine and observers from the Department of Health, The Scottish Ambulance Service and NHS Training Executive and The Institute of Healthcare Development.

Basically they steer what is current best practice for Ambulance staff in the UK.

Anyway, heres what they say, scroll to page 3 for info on traction splint use and open fractures: http://www2.warwick.ac.uk/fac/med/re...rauma_2006.pdf

Regards,
Paul.

[Micky]

Hi Guys,

If I may offer my personal view.

Traction splints are great for pian relief if the broken ends of the femur are rubbing together cose thats what they are designed to do, Sagar make a traction splint that you can use to immobilise a single or bi-lateral fracture. Its compact and it works great, if your going to get one thats what I reccomend, no i'm not on comission!

If you have one, use it if you can, if not good pain releif and immobilise as best you can.

As for an open fracture, personaly, I'd clean it with saline and cover it with with a wet sterile dressing, pain relief, immobilise and medi-vac.

Hope thats not teaching you to suck eggs.

Mick.

[Invictus]

Pain medication is a wonderful thing, but if you can reduce the amount of pain stimulus by good traction and immobilisation, you will find that your pain meds will go a lot further.

Traction is also helpful for restoring good peripheral circulation in the fractured limb. If open, the wound will be dirty anyway, the least you can do is reduce his pain, aid packaging and transport, aid circulation and, as mentioned before, get 1 - 2g Ceftriaxone on board to give him a fighting chance against infection.

I would recommend the Kendrick Traction Device without hesitation, anyone who has used it will know why.

Just my opinion gents, hope it helps.



I

[KEVTHEMED]

Im with you on the kendrick traction device invictus. Its childs play to use and packs down smaller than an MRE ration pack so can be carried in even small trauma packs.
The sager traction splint is ok if your in vehicles due to size, but again a good bit of kit.
Betadine soaked dressings is also a good stop gap measure for open fractures in a remote setting in the absence of antibiotics.
KTM out

[rescueme]

When I was still active with the Mountain Rescue team we used to use the HARE which was spot on, I have never liked the SAGAR becuase of that strange 'T' piece at the top.

The Donway and the FernoTrac are fine, but as Kev says they are not practical unless you are providing soley a medical presence. I have a Kendrick in my kit bag, and although I have never used it in anger, it is a spot on bit of kit that is simple to use and is small enough to actually be practical.



The only draw back with traction splints, in my experience, is often there are lower leg # as well as the femur#. And you are not supposed to use traction is there are tib/fib# although I have watched a BASICS doctor do a double femur traction when the patient had bi-lateral tib/fib# as well.

[Invictus]

I have used it with success on a Tib / Fib before. The only real contra-indications are # patella, # pelvis and # head of Femur. Basically, anything which isn't mid shaft, therefore, not requiring traction anyway.

Hope this helps


I

[Resusruss]

I have to agree with everybody re the Kendrick Traction Device, a great piece of kit. works wonders makes the pain relief go further.

Resusruss