Fractures

[tniuqs]

We use Sager splints on compound fractures and have been doing so since we invented it around 20 years ago. I checked with an orthopedic surgeon at our trauma center here in Vancouver after reading this thread and he completely agreed it is an acceptable practice, in fact the surgeons are big fans of proper application of traction splints to reduce tissue damage and stabilize limbs in place prior to surgery.

I know this tread is about ankle fractures BUT I just can't help myself .. must be cause I have no life either ERDoc ! LOL.

The next new standard "I believe" will be the REEL Splint for all long bone fractures, both Posterior and Anterior Traction applications (its super adjustable for everything down to a 4 year old and capabilities with adjustable "leeway" for knee involvement) ...

as well as Extrication, instead of the old tie the legs together OFA thing out of a SUV or LAV ... it pays to go to EMStock and get free, very cool stuff !

Show your Medical Directors ... after they see it the REEL Splint they will throw the Sager away, I did, as once you do a comparison you will understand why every branch of US forces bought them.

cheers

[Katiebug]

I little off topic... but why not use a sager to reduce a compund fracture?

You can. It used to be taught not to because of risk of infection secondary to pulling an exposed bone back in the body. It is now taught that it is not a concern and to traction it. At least that's what we're taught here.

[Scott]

here in ny we are allowed one attempt only if there is lack of distal perfusion, motor, and/or sensory. otherwise just splint and go.

Just a question: are talking about a true reduction, aligning bones, etc... or are we talking about having absent lower extremity pulses and aligning the limb to restore the pulse and subsequently, blood flow? Most protocols in our area allow for the re-positioning of angulated limbs in an attempt to restore pulses x1.

[FireMedic65]

Just a question: are talking about a true reduction, aligning bones, etc... or are we talking about having absent lower extremity pulses and aligning the limb to restore the pulse and subsequently, blood flow? Most protocols in our area allow for the re-positioning of angulated limbs in an attempt to restore pulses x1.

The goal is of course to align properly. Unless the fracture is severe, such as multiple breaks, it should not be too hard to align the bones back up properly. We aren't setting the bones for casting or a healing process, we just want to get flow of blood back to the extremity. If you have a pulse, you splint it as is. If not, you try to realign it to regain blood flow.

There is not enough info being taught in schools for this though. It is touched on briefly and not mentioned much at all ever again. There should be more specifics taught, and at least some clinical rotations with orthopedics. Just my opinion.

[funkytomtom]

You can. It used to be taught not to because of risk of infection secondary to pulling an exposed bone back in the body. It is now taught that it is not a concern and to traction it. At least that's what we're taught here.

I was taught the only compound fracture that you can pull back in is the femur. Funny related story, while off duty biking with my friend the other week, he sustained a compound tib fib. I assessed for pms, splinted as was, and we carried him off the mountain. I got to sit in while the orthopod put traction on it, and it did seem complicated indeed, he had a portable x-ray machine to get everything in place correctly. Feel bad for the guy, out for 4-6 months.

[scubanurse]

I know this tread is about ankle fractures BUT I just can't help myself .. must be cause I have no life either ERDoc ! LOL.

The next new standard "I believe" will be the REEL Splint for all long bone fractures, both Posterior and Anterior Traction applications (its super adjustable for everything down to a 4 year old and capabilities with adjustable "leeway" for knee involvement) ...

as well as Extrication, instead of the old tie the legs together OFA thing out of a SUV or LAV ... it pays to go to EMStock and get free, very cool stuff !

Show your Medical Directors ... after they see it the REEL Splint they will throw the Sager away, I did, as once you do a comparison you will understand why every branch of US forces bought them.

cheers

I got to mess with one at the EMS Today conference in Baltimore and spoke in length with the distributor about it. It is a VERY nice and adaptable system, but it's cost is in my opinion really high. The feature I particularly liked was its ability to adapt to angulated fractures with minimal effort and creativity on the providers part. The other downside to this product is the number of knobs and such which I know can be distracting to some. The hare splint is nice as it only has one place to adjust, but again that severely hinders its adaptability.

Just my 2 cents worth on them ...

[Lone Star]

In my EMT-B class in MI, we were taught that slow steady traction would be applied (only one attempt), and then when the pedal pulse had returned, you slowly release the traction, splint in place and transport.

We were further taught that ortho only needs about a 75% overlay to consider the fracture 'properly reduced'. Anything above the 75% was just 'gravy'.

I don't know what the 'rule' is here in GA, as we haven't covered that yet.

While we're taught this information, it was explained that the muscles contracting is what has caused the fracture to become misaligned, and that by slowly providing traction, we get the muscle to lengthen, and thereby allow the bone ends to relatively 'fall back into place'.

In 12 years, I've never had to perform this procedure, but I'm sure that it's gonna hurt like hell!

As far as a pelvic fracture, we're taught that an inverted KED works well to stabilize the fracture long enough for transport.

I was also taught that traction splints like the Sager and Hare were for simple femur fx, and that for simple tib/fib, we should use a long padded splint to stabilize the joint above (knee) and joint below (ankle).

[HERBIE1]

In my EMT-B class in MI, we were taught that slow steady traction would be applied (only one attempt), and then when the pedal pulse had returned, you slowly release the traction, splint in place and transport.

We were further taught that ortho only needs about a 75% overlay to consider the fracture 'properly reduced'. Anything above the 75% was just 'gravy'.

I don't know what the 'rule' is here in GA, as we haven't covered that yet.

While we're taught this information, it was explained that the muscles contracting is what has caused the fracture to become misaligned, and that by slowly providing traction, we get the muscle to lengthen, and thereby allow the bone ends to relatively 'fall back into place'.

In 12 years, I've never had to perform this procedure, but I'm sure that it's gonna hurt like hell!

As far as a pelvic fracture, we're taught that an inverted KED works well to stabilize the fracture long enough for transport.

I was also taught that traction splints like the Sager and Hare were for simple femur fx, and that for simple tib/fib, we should use a long padded splint to stabilize the joint above (knee) and joint below (ankle).

An inverted KED for a pelvic fx? Interesting. I never heard of that before.

I have never actually used a KED in a strictly auto accident setting- the method I was trained for. I have used it to immobilize guys who fell into elevator shafts or holes- works great for that.

I've used a KED/long board for immobilizing infants many times- akin to the "Papoose board" used to keep kids still in an ER. Works great- the kids don't move at all.

Thanks for the tip- I'll need to consider the KED the next time we have a pelvic fx.

[Happiness]

If there is no pedals manipulate ankle until pulse returns, splint and go. I personally like pillows for splints for ankles. I have never used a sagar for an ankle and to tell ya the truth i cant even think of were you would put the strap.

PS North medic why are you in Vancouver (and out of your cage) and EMPTY your mail box

[rajuguntuka]

If you have enough time & there is no other serious injuries to the patient,you can attempt to reduce to regain the distal pulse and go.

If the patient has any other complicated injuries,just load and concentrate on life threatning areas...easy...................

regards,

Raju Guntuka,

Emergency Medical Services,

KSA.