II. Indications

  1. Midshaft Femur Fracture

III. Contraindications

  1. Other Fractures of the same extremity (other than midfoot Fractures and distal)
  2. Transport concerns
    1. Helicopters may be unable to accommodate the traction device length
    2. Standard gurney or Backboard may be too short for traction device with stand

IV. Efficacy

  1. Decreases Femur Fracture related Hemorrhage (based on expert opinion, controversial)
  2. Reduces pain
  3. Mortality may be reduced

V. Complications

  1. Pressure injuries and other Skin Injury
  2. Neurovascular injury
  3. Compartment Syndrome
  4. Injury to perineum or Urethra
  5. Other Fracture displacement

VI. Technique

  1. Images
    1. erTraumaFemurTraction.png
  2. Informed Consent
  3. Opioid Analgesics and consider Leg Regional Anesthesia
    1. PENG Block
    2. Femoral Nerve Block
    3. Fascia Iliaca Block
  4. Preparation
    1. Remove all clothing from the affected leg, exposing skin to the Pelvis
    2. Examine for other extremity injuries or Fractures
    3. Distal neurovascular exam
    4. Gather staff to apply splint (at least 2)
  5. Traction Splint Setup
    1. Adjust the splint length to extend from Pelvis to 6 inches beyond the heel
    2. Unfold and lock the splint's heel stand (if present)
    3. Open all straps ready to apply to the leg
    4. Apply ankle harness device (typically separate from the splint)
  6. Apply the Traction Splint
    1. One staff member applies manual traction in-line or longitudinal with the anticipated splint angle (with stand if available)
    2. Slide traction device in place
      1. The saddle at the top of the splint should be applied to the ischial tuberosity of the Pelvis
    3. Attach the ankle harness to the traction pulley and rotate the winch until adequate traction is achieved
    4. Apply splint straps
    5. Reassess distal neurovascular exam frequently while applied

VII. Resources

VIII. References

  1. Warrington (2022) Crit Dec Emerg Med 36(10): 14-5

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