Traction splint
Encyclopedia
A traction splint most commonly refers to a splinting device
that uses strap
s 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 to reduce pain, realign the limb, and minimize vascular and neurological complication) to the limb. A traction splint is commonly used to treat complete long bone fractures of the leg, femur
or tibia
and fibula area. Traction splints have been instrumental in the reduction of morbidity and mortality from traumatic events. The use of traction splints by prehospital care is a near-universal skill and thereby essential piece of ambulance
equipment.
A dynamic traction splint has also been developed for intra-articular fractures of the phalanges of the hand.
of the femur
(or upper leg bone) and for fractures of the tibia and fibula. The femur is the longest bone in the body, the muscle
s surrounding the bone are also strong, when the bone is broken, the surrounding muscles often contract
, pulling the bone ends past each other, causing additional injury and blood loss, pain, muscle, vascular and nerve damage.
Traction splints are applied only when the fracture is isolated to the femur and there are no other associated traumatic injuries to the leg or pelvis. 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.
, a Welsh surgeon
, considered by many to be the father of modern orthopaedic surgery. Prior to the introduction of the Thomas splint c. 1916, mortality from femur
fractures ran as high as 80%. Use of this splint reduced the death rate to less than 8%.
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 deviced by H.O. Thomas, initially for immobilization for tuberculosis of the knee. It is now commonly used for the immobilisation 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 is an innovative splint that has introduced a new concept in the fixation of the consists of a metallic splint that is placed between the patient'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 cravat
-like straps.
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, 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 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.
s or tying knots in them.
In 1993, a study conducted by Chinchalker and Patterson et al involving 14 patients concluded "[I]mmediate mobilization of intra-articular fractures with dynamic traction predictably resulted in a functional joint".
Splint (medicine)
A splint is a device used for support or immobilization of limbs or of the spine.It can be used:* By the emergency medical services or by volunteer first responders, to immobilize a fractured limb before the transportation; it is then a temporary immobilization;* By allied health professionals such...
that uses strap
Strap
A strap, sometimes also called strop, is an elongated flap or ribbon, usually of fabric or leather.Thin straps are used as part of clothing or baggage, or bedding such as a sleeping bag. See for example spaghetti strap, shoulder strap...
s 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
Traction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
(used to reduce pain, realign the limb, and minimize vascular and neurological complication) to the limb. A traction splint is commonly used to treat complete long bone fractures of the leg, femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
or tibia
Tibia
The tibia , shinbone, or shankbone is the larger and stronger of the two bones in the leg below the knee in vertebrates , and connects the knee with the ankle bones....
and fibula area. Traction splints have been instrumental in the reduction of morbidity and mortality from traumatic events. The use of traction splints by prehospital care is a near-universal skill and thereby essential piece of ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
equipment.
A dynamic traction splint has also been developed for intra-articular fractures of the phalanges of the hand.
Principles
Traction splints are most commonly used for shaft fracturesBone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
of the femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
(or upper leg bone) and for fractures of the tibia and fibula. The femur is the longest bone in the body, the muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s surrounding the bone are also strong, when the bone is broken, the surrounding muscles often contract
Contract
A contract is an agreement entered into by two parties or more with the intention of creating a legal obligation, which may have elements in writing. Contracts can be made orally. The remedy for breach of contract can be "damages" or compensation of money. In equity, the remedy can be specific...
, pulling the bone ends past each other, causing additional injury and blood loss, pain, muscle, vascular and nerve damage.
Traction splints are applied only when the fracture is isolated to the femur and there are no other associated traumatic injuries to the leg or pelvis. 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.
History
The first widely used model of traction splint was introduced by Hugh Owen ThomasHugh Owen Thomas
Hugh Owen Thomas was a Welsh surgeon. He is considered the father of orthopaedic surgery in Britain.-Early life:...
, a Welsh surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
, considered by many to be the father of modern orthopaedic surgery. Prior to the introduction of the Thomas splint c. 1916, mortality from femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
fractures ran as high as 80%. Use of this splint reduced the death rate to less than 8%.
Models
There are two groups of traction splints:- The Thomas half-ring group, which includes the Thomas splint, the modified Thomas splint, the hare traction splint and the Donway traction splint
- Non-half-ring group, which includes the Sager splint, the Kendrick Traction Device (KTD), and the Slishman splint
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
Ankle
The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus bone in the foot...
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 deviced by H.O. Thomas, initially for immobilization for tuberculosis of the knee. It is now commonly used for the immobilisation 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
Telescoping (mechanics)
Telescoping in mechanics describes the movement of one part sliding out from another, lengthening an object from its rest state. In modern equipment, this is often done by hydraulics....
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
Winch
A winch is a mechanical device that is used to pull in or let out or otherwise adjust the "tension" of a rope or wire rope . In its simplest form it consists of a spool and attached hand crank. In larger forms, winches stand at the heart of machines as diverse as tow trucks, steam shovels and...
that makes it much easier to apply and adjust traction force.
The Sager splint is an innovative splint that has introduced a new concept in the fixation of the consists of a metallic splint that is placed between the patient'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 cravat
Cravat
The cravat is a neckband, the forerunner of the modern tailored necktie and bow tie, originating from 17th-century Croatia.From the end of the 16th century, the term band applied to any long-strip neckcloth that was not a ruff...
-like straps.
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, 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 Donway traction splint is a pneumatic splint that can be applied to a patient in situ
Situ
The words situ and situs are Latin for "site" . They also have other meanings .Situ can refer to:* in situ, Latin phrase meaning on-site or in-place...
. 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.
Dynamic traction splint
In 1986, Dr. Robert R. Schenck used the same principals 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 bandRubber band
A rubber band is a short length of rubber and latex formed in the shape of a loop and is commonly used to hold multiple objects together...
s or tying knots in them.
In 1993, a study conducted by Chinchalker and Patterson et al involving 14 patients concluded "[I]mmediate mobilization of intra-articular fractures with dynamic traction predictably resulted in a functional joint".
External links
- Hare Traction Splint, history, userguide, clinical article
- Sager Splints, a Sager splint research corporation
- Traction splints, tips of the trade
- Donway Traction Splint