Question on pelvic wraps / splinting

[scope2776]

Today I had a typical call to the nursing home for a fall. Pt fell onto their R hip. My pt has 10/10 pn shooting down their leg from the R hip, external rotation and tenderness to palp over the hip/proximal femur and inability to make gross movement of the R leg, including lifting the R leg off the ground. The pt had fractured the R hip before, requiring surgery. My pt's pelvis is stable. This was a typical hip fracture based on my exam and confirmed with radiological exam upon arrival in the ER.

My question is: would you apply a pelvic wrap or commercial pelvic girdle/splint to this patient? Particularity the SAM pelvic sling? It was my impression that pelvic splinting is for pelvic instability and may actually harm a broken or dislocated hip. I cannot find any literature or contraindications to pelvic splinting with a through search on Google. I ask because the FD was about to put this device on my pt before I said something, and, needless to say I was more concerned with pain management. FD was not mistaken about the hip either, they knew it was a hip issue and were going to apply the device anyway. So I thought maybe I was missing something....

[crotchitymedic1986]

Typically, I would not apply anything to the pelvis, as the movement of the patient that is required to do so is too painful and may make a nondisplaced fracture displaced. I generally just "pad" the effected leg/hip with pillows, blankets, sheets, in the position of comfort (assuming good distal circulation).

[Arctickat]

typically we will either scoop or use the spineboard to move the patient with pillows under the knee of the affected leg to abduct the hip joint. They tend to be most comfortable like this.

[firedoc5]

Typically, I would not apply anything to the pelvis, as the movement of the patient that is required to do so is too painful and may make a nondisplaced fracture displaced. I generally just "pad" the effected leg/hip with pillows, blankets, sheets, in the position of comfort (assuming good distal circulation).

I concur. Now if poss. hip fx. non-displaced you could go with a KED upside down. But that's old school.

[JPINFV]

Why not place the splint on what ever you are moving the patient to and then move the patient onto the splint and gurney/scoop/LSB combination? I agree that there is generally little point in moving the patient to splint then moving the splinted patient onto the gurney. You're still going to have to transfer the patient at the hospital anyways. It's reasons like this that if I'm at a commercial care facility (assisted living, skilled nursing, etc) and my patient is in a wheel chair I'll grab a linen sheet anyways. Place the linen on the gurney then transfer patient to gurney and now you can use the draw sheet to transfer at the hospital.

[fiznat]

I generally just pad everywhere. I don't think I'd apply any pelvic pressure at all, mostly for what other posters have said: don't want to make a non displaced fx a displaced one. Assuming the fx is at the proximal head of the femur, this part actually sticks out farther lateral than the rest of the hip/pelvis. Applying pressure to this area seems like it would cause undesirable forces on the injured area:

If the fracture is in the Illium, maybe, but even then just padding would probably be a better solution. I think you did the right thing stopping the FD from applying that splint.

[Happiness]

I place the pt in a position of comfort, pad the area well, place a blanket between the legs and then zap strap it (not tight) strap the knees and the ankles if possible. Check the pedals. Then the pt is scooped and sand bags are placed on the sides for stability. I have never been told not to do this and the docs here have always encouraged it. I like the upside down KED idea because its my favorite piece of equipment.

[rock_shoes]

Get creative, because every situation is a little bit different. Just do whatever you have to do to put the patient in the best position of comfort and eliminate unnecessary movement.

[iMac]

Coming from one who's done this not once but twice, a pillow under the knee(s) to take pressure off IS the best and most comfortable position. Watch for those pedal pulses.

[fiznat]

Youve broken your hip twice?

...Or you've taken care of two patients with broken hips?