Traction Splints

Overview of Traction Splints

• In-line traction = gentle, continuous pulling force applied along the normal anatomical axis of a limb.
• Primary purpose → realign long-bone shaft fractures (especially femoral shaft) so that definitive splinting is feasible and tissue damage, pain, & hemorrhage are minimized.
• Typical femoral-shaft presentation: severe pain, swelling, obvious mid-thigh deformity.
• Excessive traction is harmful; properly applied traction stabilizes bone fragments & improves limb alignment without forcing fragments into perfect anatomical position.

Goals of In-Line Traction

• Stabilize fracture fragments
• Achieve enough alignment to fit limb into a splint
• Prevent/limit neurovascular compromise (compression, occlusion, or stretching of nerves & vessels)

Types of Commercial Lower-Extremity Traction Splints

• Hare traction splint
• Sager traction splint
• Reel splint
• Kendrick traction splint (Fig. 31-26)
→ Each device has a unique application sequence; frequent hands-on practice is mandated by agency protocols.

Indications & Contraindications

• Indicated for isolated fractures of the femoral shaft.
• NOT used for:
– Injuries of the upper extremity (axillary neurovascular structures cannot tolerate countertraction).
– Injuries close to or involving the knee joint.
– Pelvic fractures.
– Partial amputations/avulsions with bone separation.
– Lower-leg, ankle, or foot injuries.

General Principles of Application

• Minimum of two EMTs recommended (except Sager splint can be applied solo if necessary).
• Control external hemorrhage first.
• Typical traction force ≤ 15 lb15\ \text{lb} (≈ 7 kg7\ \text{kg}); for Sager: ≈ 10%10\% of patient body weight, max 15 lb15\ \text{lb}.
• Maintain manual traction once initiated until mechanical traction is fully secured—interruption permits muscle spasm → fragment migration & further damage.
• Traction vector aligns with the imagined position of an uninjured limb (Fig. 31-27).
• Stop & splint in current position if traction causes persistent pain or strong patient resistance.

Hare Traction Splint (Skill Drill 31-6)

  1. Expose injured thigh (cut pants), standard precautions, assess & document distal PMS (pulse, motor, sensation).
  2. Lay splint beside uninjured leg; adjust length so ring sits at ischial tuberosity & distal end extends ≈ 12 in12\ \text{in} (30 cm30\ \text{cm}) beyond foot. Prepare 4 Velcro straps (mid-thigh, above knee, below knee, above ankle).
  3. Partner stabilizes fracture site while EMT applies appropriate ankle hitch (shoe usually removed).
  4. Maintain support at fracture; partner applies gentle longitudinal traction via ankle hitch—only enough to fit limb into splint (no forced anatomical reduction).
  5. Slide splint beneath injured limb; ensure ischial ring is properly seated.
  6. Pad groin; fasten ischial strap (protects perineum from countertraction pressure).
  7. Connect ankle-hitch loops to splint end; tighten ratchet gently until:
    • Limb length matches uninjured leg or
    • Patient experiences marked pain relief.
    → Caution: over-ratcheting overstretches limb, risks neurovascular damage.
  8. Secure Velcro support straps (proximal → distal).
  9. Reassess distal PMS.
  10. Position patient on backboard; consider loading feet-first so ambulance doors clear distal splint.

Sager Traction Splint (Skill Drill 31-7)

  1. Expose limb; record distal PMS.
  2. Pre-adjust thigh strap to lie anteriorly when tightened.
  3. Estimate length against uninjured leg (traction wheel at heel level).
  4. Fit ankle pads to patient size.
  5. Place splint medially; slide thigh strap high & proximal so perineal cushion seats snugly in groin against ischial tuberosity; tighten strap.
  6. Apply ankle harness just above malleoli; pull cable ring firmly against sole of foot.
  7. Extend inner shaft to deliver traction ≈ 10%10\% body weight (max 15 lb15\ \text{lb}/7 kg7\ \text{kg}).
  8. Secure entire limb to splint with elasticized cravats (prevents rotation & sagging).
  9. Secure patient to backboard; reassess distal PMS.

Post-Application Considerations & Transport

• Pad groin/ischaial areas well; avoid genital pressure.
• Always use commercially supplied padded ankle hitches—improvised rope/cord may cause pain or vascular occlusion.
• Continual monitoring of distal circulation & neuro status is mandatory; document any changes.
• Immobilize splint during moves to prevent loss of traction; secure splint to backboard/stretcher.
• Ethical duty → regular skill maintenance, correct device selection, minimal additional harm.

Key Takeaways & Clinical Significance

• Proper traction splinting dramatically reduces pain, bleeding, and secondary soft-tissue injury in femoral-shaft fractures, improving patient outcomes and facilitating safer transport.
• Incorrect use (wrong indication, excessive force, interrupted traction) may exacerbate fractures, produce neurovascular injuries, or delay definitive care—highlighting the importance of rigorous training and protocol adherence.
• Visualization technique (imagining position of uninjured limb) serves as simple cognitive aid to estimate alignment in the field.