EMS Traction Splint

Excerpt

The femur is the longest and strongest bone of the body, and it carries the weight of the entire body. It is the heaviest tubular bone of the body that requires high-energy force to fracture, for example, as from motor vehicle accidents. Fracture of the femur carries high-risk complications like hemorrhage, fat embolism, and infection. Inappropriate management of femur fracture can also cause prolonged morbidity with shortening, misalignment, and deep venous thrombosis (DVT). The annual incidence of midshaft femur fracture is approximately 10 per 100,000 person-years. The incidence of femoral diaphyseal fractures follows a bimodal distribution that peaks in young adults and the elderly, secondary to high-energy mechanisms in the young and low-energy falls in the elderly with decreased bone density. Emergency medical service (EMS) personnel should immobilize the femur to prevent further injury during transport. Traction splints are recommended on all mid-shaft femur fractures to establish patient comfort and better fracture alignment. Traction splints have utility in the management of both closed and open fractures of the femoral diaphysis. They are designed to provide temporary stabilization at the scene for transport to the hospital for definitive treatment/management. Traction splints are a temporary form of immobilization, as prolonged use of traction splints can cause pressure sores.

The diaphysis of the femur has a normal anatomic alignment that is 5 to 7 degrees from the physiologic axis of the femur, which can be drawn from the center of the femoral head to the center of the knee. The normal femur exhibits an anterior bow, providing flexibility to withstand large amounts of axial force.

The determination of displacement seen in femur fractures is by the pull of the muscles proximal and distal to the fracture. Fractures of the diaphysis typically will result in external rotation of the proximal segment due to the pull of the external rotators and abductors such as the gluteus medius, and internal rotation of the pull of the adductor complex.

While injuries to surrounding nerves are rare in diaphyseal femur fractures, the femur does have a robust blood supply, which can lead to large amounts of blood loss. The large compartments of the thigh can hold up to 3 liters of hemorrhaged blood. A patient with a femur fracture can be expected to lose about 1 TO 1.5 liters of blood or up to 30% of the normal body's blood volume. Therefore, medical personnel must keep a close eye on the hemodynamic status of patients with a suspected femur fracture.