Fractures

[Yummymedic05]

Sorry Doc didn't see your reply.

Pretty much one attempt, a straight pull outward, and hope you do something. Not any formal training, and was taught the same thing in basic and medic school, then the hospital I am employed at.

[katbemeEMT-B]

Although it will hurt like hell we were taught to use traction splint unless it us an open fracture. We would then use manual traction. If no distal pulse after first attempt transport immediately.

By the way I am an EMT-B in MN

[BEorP]

Although it will hurt like hell we were taught to use traction splint unless it us an open fracture. We would then use manual traction. If no distal pulse after first attempt transport immediately.

By the way I am an EMT-B in MN

What traction splint do you use? I don't see the ankle strap of the sager going so great around a fractured ankle.

[katbemeEMT-B]

Sager. Never actually had to use it so I am guessing you are making a good point. In that case I would assume we would use manual traction. The only ankle fracture I've had to deal with had a strong distal pulse. The ankle was already splinted by school personnel when we got there.

[canuckEMT]

Same training here. Try to align into anatomical position to regain distal pulses then splint.

And BE, the only fracture I would use a Sager for would be mid-shaft femur ( non-compound)...... :wink:

[JakeEMTP]

Same training here. Try to align into anatomical position to regain distal pulses then splint.

And BE, the only fracture I would use a Sager for would be mid-shaft femur ( non-compound)...... :wink:

I'm with canuckEMT on this one. I can't see a traction splint be used for a ankle fracture.

[scope2776]

That is all the education on reduction that most prehospital providers receive.

"One attempt to reduce, then splint in place." Nowhere in the curriculum is it mentioned to properly align the bone ends, techniques for application, or how to best splint the injury site. "One attempt..." and move on.

As I best understand it, the attempt is designed to get the bone ends back into their neutral position without damaging the vasculature. Unfortunately, the right way to perform this isn't taught very often. :roll:

What are some of the finer points of reducing a fracture or dislocation with no distal pulses? What are a few things we should know, that most likely have not been taught in class? And what are some things to avoid doing?

All I was taught is you pull it inline. If you can find a link to another site or article that'd be great!!

Thanks!

[AZCEP]

http://www.google.com/search?sourceid=navc...cture+reduction

Here you go. Trouble with reading about it, you will not know how much force to apply, and when you have gone too far.

[Doczilla]

This is a topic which is badly glossed over in paramedic school, and is often not even covered in EMT school. Virtually nobody teaching these classes has ever done it before or done it more than once.

Bones should never be reduced with a "jerk" like in the movies. Steady, firm traction followed by reversing the presumed mechanism of injury will suffice for most bones. For example, if an ankle was fractured and rotated outward, steady traction then rotation inward should be applied. Fingers are a different story, as there are some special considerations because of the anatomy of the lumbrical muscles and the tendons.

Much of the time, you are providing traction against the muscles that are deforming the bone. Once you stretch those out, the bone will often fall back into place or close to it, then traction is all that is needed. Traction splints help overcome the very strong muscles surrounding the femur.

As a general rule, hips and shoulders shouldn't be reduced without xrays, even if neurovascularly compromised. The exception is the hockey player who has dislocated his shoulder 50 times before and knows exactly how it feels and probably knows better than his orthopedic surgeon how to put it back in. There are good techniques for doing it, but I would again discourage anyone from doing it in the field.

'zilla

[akroeze]

If we have a knee with compromise distally then we are to attempt reduction.

If we have an elbow then we are to call the doc for advice on manipulation/in-line traction.

[edit]

Sorry.... those are dislocations, not fractures

[/edit]