Question on traction spints

[DwayneEMTP]

Wow firefighter523, I'm glad you posted that....We were taught, like Rid said, in the Basic curriculum that you never cause, or allow bone ends to retract back into the body if it can be helped...because of the contamination...They pounded this into our heads...

I dug out my "Emergency Care. Brady, 10Th ed." to see what it said. I found a ton of stuff on traction splinting but nothing about retracting bone ends, but it showed the same contraindications you mentioned above.

Though I did find this..."Don't push protruding bone ends back into place. However, when you realign deformed open injuries, they may slip back into position under traction." (chapter 28, pg 646) I believe this is talking about manual traction and not traction splints specifically, though it would seem to be the same issue...

I can't wait to see what others have to say on this....

Dwayne

[HellsBells]

I was also taught that its acceptable to use traction on open compound fractures, I do see how returning the bone ends into place could introduce some pretty nasty infections. But on the other hand, its already a deep, open wound and chance for infrection is already high.

[JPINFV]

^

Even though there already is a high chance of infection, why would you risk increasing it?

[firefighter523]

Because the benefits of traction FAR exceed any negative effects of possible infection DOWN THE ROAD in his recovery period!!

[JPINFV]

Because loss of the entire limb is good? Correct me if I'm wrong, but the main point of traction is to prevent further tissue damage from the end of bone the bones moving around in the deep fascia. It also is used for restoring perfusion distal to the injury. In an open fracture, one half of the bone is in a position where it can only cause limited further damage. By realigning the bone of an open fracture (especially a dirty open fracture), you are increaseing the chance that the patient will lose their limb to infection. Furthermore, if the patient is elderly or immunocompromised, you are increasing the chance of death by sepsis.

Why is it better to reduce an open fracture again?

[firefighter523]

College boy, I know you probably have it all figured out, since you have all of about 3 years tops in EMS. Don't you think that physicians are aware of the fact that they could get an infection? Do you think they were high on the smoke when they wrote the text of PHTLS?? Yes that text (PHTLS) is sponored by physicians!! You probably didn't take it yet, better yet, I noticed you DONT have a certification down in your profile. You must be a NEW EMT, judging by your stupid statements, that is what I would guess. Sit back, keep your mouth shut, and learn from this sight!!

GO TO SCHOOL BEFORE YOU MAKE SUCH IDIOTIC STATEMENTS, AND TAKE A LOOK AT MY PREVIOUS POSTING REGAURDING THE PAGE NUMBER OF THE MOST RECENT PHTLS TEXT!!

END OF CONVERSATION

[Happiness]

Okay here goes my opinion if this was my call i wouldn't use a traction splint. This is how I would have handled this call. First i can't figure out how the femur can twist as the pt is being loaded. I would have packaged this pt with a blanket between the legs and then use zap straps at the hips above the knees (if they are not going to cover the injury) or below the knees and at the ankles. Then i would use the clam shell or a back board to place the pt onto the stretcher. If the discription of the femur twisting like taffy is a true statement that would tell me that the bone would be shattered and the traction splint wouldn't be of any benifit because it wouldn't create any stability and wouldn't relieve any pain. Infection is going to be an issue from the gunshot not from the open fracture being reduced. This is just my opinion and it isn't a stupid question it made me think of what I would do wrong or right

happiness

[whit72]

Actually infection is a strong possibility in open femur fx's, and contrary to popular belief some infections do not just go away. That in itself could be life threatning, if he has pedal pulse, a warm foot, good color, splint in in the position found and be on your way.

There are so many different opinions for traction in an open femur. Whatever.

Also placing traction on and open femur fx can cause just as much damage as the when the injury occured. You cant see the vascular anatomy of what lies or could possibly be tangled in the splintered ends of a bone.

In my opinion if your hospital is a trauma center then leave it alone. the leg has a pulse, warm, and good color, Let the surgeons do there job.

If you have a stable pt and you yank the leg and he blows an artery = really really bad

Stable pt with angulated open fx = bad, but not really really bad.

[Ridryder 911]

College boy, I know you probably have it all figured out, since you have all of about 3 years tops in EMS. Don't you think that physicians are aware of the fact that they could get an infection? Do you think they were high on the smoke when they wrote the text of PHTLS?? Yes that text (PHTLS) is sponsored by physicians!! You probably didn't take it yet, better yet, I noticed you DONT have a certification down in your profile. You must be a NEW EMT, judging by your stupid statements, that is what I would guess. Sit back, keep your mouth shut, and learn from this sight!!

GO TO SCHOOL BEFORE YOU MAKE SUCH IDIOTIC STATEMENTS, AND TAKE A LOOK AT MY PREVIOUS POSTING REGAURDING THE PAGE NUMBER OF THE MOST RECENT PHTLS TEXT!!

END OF CONVERSATION

WHOA!!!!

Before you start slamming people, know a little about medicine as well!

I am a PHTLS Instructor Coordinator since its conception about 1983. So I am quite aware of the "PHTLS" recommendations. Now, please if you will read as well these are "recommended standards"..and just like another trauma course, the BTLS is sponsored by one physician group and association, PHTLS is sponsored by another... semantics and some different standards. Remember, there is committees that work upon these for years, and then as well to take the least resistance, then summit for publication, which takes years.. Remember it is just a course.. that's it... just like AHA ACLS is a suggested standard from an organization, does not mean that it is the only and proper way of treatment of cardiovascular emergences. If you were to ask many cardiologist of their opinon of that program, one would find it to be very controversial. There is more than one way to treat patients.... appropiately..that is the difference, from education and training.

Remember the intent for traction is to reduce muscular spasms and reduction of risk for possible laceration of the femoral artery. Now, compare that with the ratio of lacerated arteries and with osteomyelitis. I believe you would be surprised, the numbers. so yes, in PHTLS, I teach this as well as informing it still a controversial area and to follow their local protocols...

R/r 911

[JPINFV]

College boy, I know you probably have it all figured out, since you have all of about 3 (currently in 4th) years tops [s:3fd64a731a]in EMS[/s:3fd64a731a] at a university. Don't you think that physicians are aware of the fact that [s:3fd64a731a]they[/s:3fd64a731a] the patient [Just clarifying, the physican could get an infection?] could get an infection? Do you think they were high on the smoke when they wrote the text of PHTLS?[s:3fd64a731a]?[/s:3fd64a731a] [Am I missing a sentence here?] Yes that text (PHTLS) is sponored by physicians![s:3fd64a731a]![/s:3fd64a731a] You probably didn't take it yet [sorry, I currently have a full plate with intro to psych, upper-division anatomy, neurobiology lab, and research [sensory gating in patients with bipolar and schizophrenia disorders]. Next quarter doesn't look much better], better yet, I noticed you DONT have a certification [That's because I don't rely on my certification nearly as much as I rely on my education in biology] down in your profile. You must be a NEW EMT [i'll give you that, I've been working for a year, part time. My work goes around my school schedule, period], judging by your stupid statements [try educating me instead of going off half cocked and looking like a fool], that is what I would guess. [s:3fd64a731a] Sit back, keep your mouth shut, and learn from this sight [site][/s:3fd64a731a]![s:3fd64a731a]! [/s:3fd64a731a] [i've never liked being passive with my job or education. I find conversing much more interesting and helpful]

[s:3fd64a731a]GO TO SCHOOL BEFORE YOU MAKE SUCH IDIOTIC STATEMENTS[/s:3fd64a731a] [i'm in school. It grants a degree, not a certificate, though], AND TAKE A LOOK AT MY PREVIOUS POSTING [s:3fd64a731a]REGAURDING [/s:3fd64a731a][regarding] THE PAGE NUMBER OF THE MOST RECENT PHTLS TEXT![s:3fd64a731a]![/s:3fd64a731a]

END OF CONVERSATION

Might I recommend an English and microbiology course?