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A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

Published online by Cambridge University Press:  15 August 2017

Joshua Nackenson*
Affiliation:
University of Texas Southwestern Medical Center Department of Emergency Medicine, Dallas, TexasUSA
Amado A. Baez
Affiliation:
Kings County Hospital/SUNY Downstate Department of Emergency Medicine, Brooklyn, New YorkUSA
Jonathan P. Meizoso
Affiliation:
University of Miami/Jackson Memorial Medical Center, Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, Miami, FloridaUSA
*
Correspondence: Joshua Nackenson, MD, NRP University of Texas Southwestern Medical Center Department of Emergency Medicine Dallas, Texas USA E-mail: [email protected]

Abstract

Study Objectives

Traction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).

Methods

This is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.

Results

There were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).

Conclusion

Although signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.

NackensonJ, BaezAA, MeizosoJP. A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest: none

References

1. Peltier, LF. A brief history of traction. J Bone Joint Surg Am. 1968;50(8):1603-1617.Google Scholar
2. HMIW, Gray. The Early Treatment of War Wounds. London, United Kingdom: Henry Frowde and Hodder and Stoughton; 1919.Google Scholar
3. Henry, BJ, Vrahas, MS. The Thomas splint. Questionable boast of an indispensable tool. Am J Orthop (Belle Mead, NJ). 1996;25(9):602-604.Google Scholar
4. American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, et al. Equipment for ground ambulances. Prehosp Emerg Care. 2014;18(1):92-97.Google Scholar
5. Mihalko, WM, Rohrbacher, B, McGrath, B. Transient peroneal nerve palsies from injuries placed in traction splints. Am J Emerg Med. 1999;17(2):160-162.Google Scholar
6. Watson, AD, Kelikian, AS. Thomas splint, calcaneus fracture, and compartment syndrome of the foot: a case report. J Trauma. 1998;44(1):205-208.CrossRefGoogle ScholarPubMed
7. Abarbanell, NR. Prehospital mid-thigh trauma and traction splint use: recommendations for treatment protocols. Am J Emerg Med. 2001;19(2):137-140.Google Scholar
8. Wood, SP, Vrahas, M, Wedel, SK. Femur fracture immobilization with traction splints in multi-system trauma patients. Prehosp Emerg Care. 2003;7(2):241-243.CrossRefGoogle Scholar
9. Daugherty, MC, Mehlman, CT, Moody, S, LeMaster, T, Falcone, Ra. Significant rate of misuse of the hare traction splint for children with femoral shaft fractures. J Emerg Nurs. 2013;39(1):97-103.Google Scholar
10. Hoppe, S, Keel, MJB, Rueff, N, Rhoma, I, Roche, S, Maqungo, S. Early versus delayed application of Thomas splints in patients with isolated femur shaft fractures: the benefits quantified. Injury. 2015;46(12):2410-2412.Google Scholar
11. Irajpour, A, Kaji, NS, Nazari, F, Azizkhani, R, Zadeh, AH. A comparison between the effects of simple and traction splints on pain intensity in patients with femur fractures. Iran J Nurs Midwifery Res. 2012;17(7):530-533.Google Scholar
12. Rowlands, TK, Clasper, J. The Thomas splint--a necessary tool in the management of battlefield injuries. J R Army Med Corps. 2003;149(4):291-293.Google Scholar
13. Melamed, E, Blumenfeld, A, Kalmovich, B, Kosashvili, Y, Lin, G. Prehospital care of orthopedic injuries. Prehosp Disaster Med. 2007;22(1):22-25.CrossRefGoogle ScholarPubMed
14. National Association of Emergency Medical Technicians. PHTLS: Prehospital Trauma Life Support. 8th ed. Burlington, Massachusetts USA: Jones & Bartlett Learning; 2014.Google Scholar
15. Sanders, MJ. Mosby’s Paramedic Textbook. 4th ed. Burlington, Massachusetts USA: Jones & Bartlett Publishers; 2011.Google Scholar
16. American Academy of Orthopedic Surgeons, (AAOS), Caroline, N, Elling, B, Smith, M. Nancy Caroline’s Emergency Care in the Streets. 7th ed. Burlington, Massachusetts USA: Jones & Bartlett Learning; 2012.Google Scholar
17. Enninghorst, N, McDougall, D, Evans, JA, Sisak, K, Balogh, ZJ. Population-based epidemiology of femur shaft fractures. J Trauma Acute Care Surg. 2013;74(6):1516-1520.Google Scholar