Traction splint

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A traction splint is used to treat severe bone fractures by traction along toe broken portion's length. The use of traction splints by pre-hospital care providers may reduce the pain of trauma from such fractures, and traction splints are a near-universal, although a relic, piece of ambulance equipment.

Traction splints are most commonly used for mid-shaft fractures of the femur, or upper leg bone. In such fractures, the surrounding muscles often cramp (contract), pulling the bone ends past each other and causing pain.

Ambulance crews typically apply a traction splint only when the femur fracture is isolated and there are no other associated traumatic injuries.

Principles and models

There are four basic types: the Thomas half-ring, the Hare Traction Splint, the Sager, and the KTD. The basic principle is that one end of the traction splint is possitioned aginst the hip, and pushes upward against the pelvic bone. A strap around the foot and ankle is connected to the other end of the splint, and tightened to counteract the muscle tension and produce traction. Only then are additional straps added to aid immobilisation of the limb.

One common type of traction splint is the Thomas half-ring, which consists of a padded half-circle of steel which is strapped to the hip, hinged to a U-shaped rod that extends along both sides of the leg. An ankle strap may be fashioned from cloth, and tied or twisted to apply traction force.

Another type is the Hare traction splint. It is generally similar, but more sophisticated. Its length is adjustable via telescoping rods, and it has built-in straps for the hip, and to support the leg at several points along its length. It also provides a more comfortable ankle strap and a small winch that makes it much easier to apply (and adjust) traction force.

The Sager splint consists of something like a metallic splint (pole-like) that is generally placed between the patient's legs -- although some models may be placed on the side closest to the injury for bilateral femur fractures without pelvic trauma. Straps are then applied, first at the thigh and then at the ankle, to strap the injured leg to the pole and provide support. The pole is extended to supply the needed traction, and then both legs are wrapped with cravat-like straps (ends overlapping at the front).

The KTD (Kendrick Traction Device) eliminates the need for leg-raising and unnecessary rolling of the patient, and can be easily applied to both pediatric and adult applications. It consists of a round pole that can be located on the lateral aspect of the leg (extended/shortened as necessary), with straps at the upper thigh and ankle for immediate placement, and three wider straps (equally distributed) for immobilisation. It is very light at 20 ounces. The KTD does not afford the rotational stability normal seen in long bone traction splints.

Problems

Some researchers have evaluated the safety of using traction splints in patients with multiple trauma, and have demonstrated that use of the splint is NOT safe when underlying injuries that may contraindicate the use of the splint occur. Injuries such as pelvic fractures and knee injuries may be exacerbated if the splint is used on the affected extremity.

Still, there is a definite need for more research on the use of and efficacy of traction splints.