Traction splint

Traction splint
Traction splint
Specialty	orthopedic
	[ edit on Wikidata]

Last updated March 02, 2024

A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction (used in an attempt to reduce pain, realign the limb, and minimize vascular and neurological complication) to the limb.

Medical uses

Traction splints are most commonly used for fractures of the femur (or upper leg bone).^[2] For these fractures they may reduce pain and decrease the amount of bleeding which occurs into the soft tissues of the leg.^[2]

Some state that they are appropriate for middle tibia fractures which are displaced or bent.^[3] Others state they should not be used for lower leg fractures.^[2] Often a pillow splint or rigid splint is best in this situation.^[3] All agree that traction splints should only be applied when there are no fractures of the pelvis or knee and the fracture has not broken through the skin with bone visible.^[2]

Use of a traction splint while other fractures in the leg exist will cause the weaker fracture site to pull apart and not the targeted femur fracture.^[4]

Models

There are two groups of traction splints:

The Thomas half-ring group, which includes the Thomas splint, the modified Thomas splint, the QD-4 Hare traction splint and the Donway traction splint
Non-half-ring group, which includes the Sager splint, and the most advanced; CT-EMS, Carbon Fiber traction system.

The basic principle is that one end of the traction splint is positioned against 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 immobilization of the limb.

The Thomas half-ring splints consist 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. It was devised by H.O. Thomas, initially for immobilization for tuberculosis of the knee. It is now commonly used for the immobilization of hip and thigh injuries.

The modified Thomas splint adapted the original Thomas splint to include a traction screw and foot plate and limb support built into the splint body.

The Hare traction splint is a further adaptation of the Thomas splint. Its length is adjustable via telescoping rods, and it has built-in straps to support the hip and 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 a metallic splint that is placed between the person's legs. 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 "tensor cravats"^[5] (strap-like bandages,^[6] in this application usually elastic, to supply tension.)

The Kendrick traction device (KTD) 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, with straps at the upper thigh and ankle for immediate placement, and three wider straps for immobilization. It is very light at 20 ounces. The KTD does not afford the rotational stability normally seen in long bone traction splints.

The CT-6 was introduced in the 21st century and utilizes a 4:1 pulley system to achieve precise and powerful, when necessary, traction. This splint is built with carbon fiber tubing and weighs 500 grams. In 2003 the CT-6 was chosen as the splint of choice by the US military and currently has over 30,000 in the field. Its compact and light design, along with its greatly improved traction method, had greatly enhanced its popularity.

The Donway traction splint is a pneumatic splint that can be applied to a patient in situ. Acting on the ankle and groin pressure is then applied via an integrated pump. The devices itself consists of a metal frame that surrounds the leg that is then strapped into place.

The STS (Slishman Traction Splint) is another lateral monopole traction splint. It is lightweight and compact, however, it differs from the KTD and CT-6 in that it does not stick out past the foot. It offers a proximal point of traction, rather than distal, making it better suited for tight transports in ambulances, helicopters or baskets. The STS can also be used despite lower extremity trauma, because the distal strap can be applied proximal to the calf or patella. Rotational stability is provided by one mid leg strap which can be wrapped around both legs.

Dynamic traction splint

In 1986, Robert R. Schenck used the same principles applied to treating femur fractures to develop a device for treating intra-articular fractures of the finger. The apparatus consists of a 6-inch-diameter circular splint that provides a rigid arc, with a 3-inch radius equidistant from the involved joint. A wire is placed horizontally through the distal head of the middle phalanx. The wire is attached by rubber band to a movable component attached to the hoop of the splint. The amount of traction can be controlled by using different types of rubber bands or tying knots in them.^[7]

History

The first widely used model of traction splint was introduced by Hugh Owen Thomas, a Welsh surgeon, considered by many to be the father of modern orthopaedic surgery.

Related Research Articles

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.

The femur, or thigh bone is the only bone in the thigh. The thigh is the region of the lower limb between the hip and the knee. In many four-legged animals the femur is the upper bone of the hindleg.

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

The tibia, also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates ; it connects the knee with the ankle. The tibia is found on the medial side of the leg next to the fibula and closer to the median plane. The tibia is connected to the fibula by the interosseous membrane of leg, forming a type of fibrous joint called a syndesmosis with very little movement. The tibia is named for the flute tibia. It is the second largest bone in the human body, after the femur. The leg bones are the strongest long bones as they support the rest of the body.

A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

A splint is defined as "a rigid or flexible device that maintains in position a displaced or movable part; also used to keep in place and protect an injured part" or as "a rigid or flexible material used to protect, immobilize, or restrict motion in a part". Splints can be used for injuries that are not severe enough to immobilize the entire injured structure of the body. For instance, a splint can be used for certain fractures, soft tissue sprains, tendon injuries, or injuries awaiting orthopedic treatment. A splint may be static, not allowing motion, or dynamic, allowing controlled motion. Splints can also be used to relieve pain in damaged joints. Splints are quick and easy to apply and do not require a plastering technique. Splints are often made out of some kind of flexible material and a firm pole-like structure for stability. They often buckle or Velcro together.

$Bone fracture Physical damage to the continuity of a bone$

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

$Orthopedic cast Medical aid for the treatment of bone fractures$

An orthopedic cast, or simply cast, is a shell, frequently made from plaster or fiberglass, that encases a limb to stabilize and hold anatomical structures‍—‍most often a broken bone, in place until healing is confirmed. It is similar in function to a splint.

$Distal radius fracture Fracture of the radius bone near the wrist$

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.

$Hip fracture Broken bone in hip joint region$

A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk.

$Smith's fracture Medical condition$

A Smith's fracture, is a fracture of the distal radius.

<span class="mw-page-title-main">Hip</span> Anatomical region between the torso and the legs, holding the buttocks and genital region

In vertebrate anatomy, the hip, or coxa(pl.: coxae) in medical terminology, refers to either an anatomical region or a joint on the outer (lateral) side of the pelvis.

$Ankle fracture Medical condition$

An ankle fracture is a break of one or more of the bones that make up the ankle joint. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis.

<span class="mw-page-title-main">Hip dislocation</span> Orthopedic injury

A hip dislocation is when the thighbone (femur) separates from the hip bone (pelvis). Specifically it is when the ball–shaped head of the femur separates from its cup–shaped socket in the hip bone, known as the acetabulum. The joint of the femur and pelvis is very stable, secured by both bony and soft-tissue constraints. With that, dislocation would require significant force which typically results from significant trauma such as from a motor vehicle collision or from a fall from elevation. Hip dislocations can also occur following a hip replacement or from a developmental abnormality known as hip dysplasia.

Hugh Owen Thomas was a Welsh orthopaedic surgeon. He and his nephew Robert Jones have been called "the Fathers of orthopaedic surgery".

$Calcaneal fracture Medical condition$

A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.

An elastic bandage is a "stretchable bandage used to create localized pressure". Elastic bandages are commonly used to treat muscle sprains and strains by reducing the flow of blood to a particular area by the application of even stable pressure which can restrict swelling at the place of injury. Elastic bandages are also used to treat bone fractures. Padding is applied to the fractured limb, then a splint is applied. The elastic bandage is then applied to hold the splint in place and to protect it. This is a common technique for fractures which may swell, which would cause a cast to function improperly. These types of splints are usually removed after swelling has decreased and then a fiberglass or plaster cast can be applied.

$Femoral fracture Broken femur, at shaft or distally$

A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter; those are conventionally called hip fractures. Thus, mentions of femoral fracture in medicine usually refer implicitly to femoral fractures at the shaft or distally.

References

↑ Bledsoe, B; Barnes, D (August 2004). "Traction splint. An EMS relic?". Journal of Emergency Medical Services. 29 (8): 64–9. PMID 15326449.
1 2 3 4 Marx, John A. (2014). Rosen's emergency medicine: concepts and clinical practice (Eighth ed.). London: Elsevier Health Sciences. p. 680. ISBN 9781455749874.
1 2 Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. p. 9. ISBN 978-0-07-148480-0.
↑ AAOS (October 2010). "29". In Andrew N. Pollak (ed.). Emergency Care and Transport of the Sick and Injured (Print) (10 ed.). Sudbury, Massachusetts: Jones and Bartlett. pp. 1025–1031. ISBN 978-1-4496-3056-0.
↑ Sager. Sager Emergency Splints: Users' handbook (Manufacturer's instruction manual). Retrieved 17 July 2021.
↑ Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health (Seventh ed.). Saunders; Elsevier. 2003. cravat bandage - one made by bringing the point of a triangular bandage to the middle of the base and then folding lengthwise to the desired width
↑ Schenck, Robert R. (May 1994). "Dynamic Traction Method - Combining Movement and Traction for Intra-Articular Fractures of the Phalanges". Hand Clinics. 10 (2): 187–197. doi:10.1016/S0749-0712(21)01282-8. PMID 8040197.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.

[1] Bledsoe, B; Barnes, D (August 2004). "Traction splint. An EMS relic?". Journal of Emergency Medical Services. 29 (8): 64–9. PMID 15326449.

[Marx2014-2] 1 2 3 4 Marx, John A. (2014). Rosen's emergency medicine: concepts and clinical practice (Eighth ed.). London: Elsevier Health Sciences. p. 680. ISBN 9781455749874.

[Tint2010-3] 1 2 Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. p. 9. ISBN 978-0-07-148480-0.

[4] AAOS (October 2010). "29". In Andrew N. Pollak (ed.). Emergency Care and Transport of the Sick and Injured (Print) (10 ed.). Sudbury, Massachusetts: Jones and Bartlett. pp. 1025–1031. ISBN 978-1-4496-3056-0.

[5] Sager. Sager Emergency Splints: Users' handbook (Manufacturer's instruction manual). Retrieved 17 July 2021.

[MKenc-6] Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health (Seventh ed.). Saunders; Elsevier. 2003. cravat bandage - one made by bringing the point of a triangular bandage to the middle of the base and then folding lengthwise to the desired width

[7] Schenck, Robert R. (May 1994). "Dynamic Traction Method - Combining Movement and Traction for Intra-Articular Fractures of the Phalanges". Hand Clinics. 10 (2): 187–197. doi:10.1016/S0749-0712(21)01282-8. PMID 8040197.

[1]

[2]

[3]

[4]

[5]

[6]

[7]