Question on traction spints

[Lucky~13]

I have class today in which we get a treat, a 4 hour lecture from the county's med director on musculoskeletal injuries.

I'll run this scenario by him and see what he says. :occasion5:

[Ridryder 911]

Most medical direction prefer not to apply traction to open fractures. Mainly, when applying traction one can perform a reduction of the bone, thus causing an increase in possibility of infection and osteomyelitis. Of course, traction when there is no pulses to restore circulation is important..

R/r 911

[becksdad]

Yah, I should have been more specific when I said "this open femur fracture". As described, it sounds like the "open" part was from an extrinsic source - a gunshot. Not from the femur actually ripping through or protruding from the leg. If it were, as Rid said, I would not want to manipulate the extremity unless it was found to be pulsless distal to the injury.

[Just Plain Ruff]

all I can say is this HOLY CRAPOLA BATMAN THAT HAD TO HURT

[firefighter523]

I don't know where and who thought of the idea that open femur fractures are contraindicated for traction splining. You need to get the bone ends away from each other and main arteries. Pt will thank you for the pain relief also. What will kill them first, infection or a transected femoral artery? Before traction, make sure you flush the wound with NS or sterile water.

[Ridryder 911]

Duh.. apparently you have never seen or attempted to treat osteomyelitis. Do you really think pouring a bottle of saline is going to really going to cleanse an open fxr. Orthopedic surgeons scrubs for hours and debride around the bone and tissues. The chance of osteomyeletis is higher than a lacerated artery. Furthermore, traction on a open fracture is "actually reducing" it, and not stabilizing it from causing further harm, which strictly contraindicated.

Please, read the NHSTA Basic EMT curriculum as well as the manufactures recommendation, unless you have "special" protocols, I highly suggest not to placing any type of traction splint on any open femur fracture, since this is what will be testified against you in court.

R/r 911

[Lucky~13]

Well, our med director threw in his two cents....

If the MOI is the result of a GSW, like a large caliber round, then it's best NOT to place the pt in traction. But if it's from a small caliber round, like a .22, then you might be okay. Either way though, you really should call med control, paint them a picture, and see what they want you to do.

[DwayneEMTP]

Did he say why in each case?

Dwayne

[Ridryder 911]

I would imagine with single small caliber such as a 22 does not have much tumble and aw, as well as not causing such fractures such as a comminuted fractures, like a large caliber.

R/r911

[firefighter523]

Rid, this is a direct quote from the Revised Fifth Edition of the NAEMT PHTLS book by Mosby, chapter 10, page 284.

" In the case of open femur fractures, the prehospital care provider should first apply a sterile dressing to the wound and then use a traction splint to straighten the extremity and stabilize the fracture. If the bone ends return into the wound, the outcome will not be altered as long as the physician who cares for the patient is informed that the bone ends initially were outside the body. The application of traction, both manually and by the use of a mechanical device, will help promote tamponading of the internal third-space bleeding and decrease the patient's pain. "

Contraindications to the use of traction splints include: Fractured pelvis, Hip injury with gross displacement, Any significant injury to the knee, Avulsion or amputation of the ankle and foot.

Second, I don't appreciate the Duh's either! We are both adults!