Femoral shaft fractures are a serious but infrequently seen injury in the pre-hospital environment. Management of these fractures includes immobilisation, analgesia, fluid administration and appropriate conveyance. Despite traction splints being widely used since World War I, there has been no systematic review published to date. In order to support evidence-based practice this systematic review will attempt to determine if the use of traction splints in the pre-hospital management of patients with femoral shaft fractures reduces the complications compared to traditional splinting.
A systematic review using the MEDLINE database (1946 to 27 August 2019) using a combination of keywords and medical subject headings. The reference lists of all relevant papers were reviewed to identify further papers. The title and abstracts of all records retrieved by the search strategy were reviewed by one independent author to identify potentially relevant papers. All potentially relevant papers were read in full text.
A total of 42 papers were identified from the search strategy; 10 met the inclusion criteria and informed the results of this paper. Five key themes were identified: inappropriate application; on-scene times; effect on pain; vascular complications; and nerve complications.
Traction splints are frequently applied incorrectly but no statistical increase in on-scene times was found. A statistically significant decrease in the need for blood transfusions was demonstrated with the application of a traction splint.
Australian Institute of Health and Welfare. Trends in hospitalised injury, Australia 1999–2000 to 2014–2015. Canberra: AIHW; 2018. Available at: www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-1999-00-to-2014-15/contents/table-of-contents
Myers P, Laboe P, Johnson KJ, et al. Patient mortality in geriatric distal femur fractures. J Orthop Trauma 2018;32:111-5.
Mansson E, Ruter A, Vikstrom T. Femoral shaft fractures and the prehospital use of traction splints. Scand J Trauma Resusc Emerg Med 2006;14:26-9.
Cameron P, Jelinek G, Kelly A-M, Brown AFT, Little M. Textbook of adult emergency medicine. Edinburgh: Elsevier Ltd.; 2014. Available at: www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20120022417
Australian Institute of Health and Welfare. Use of emergency department data to enhance routine injury surveillance: technical report, 2013–14. Canberra: AIHW; 2018. Available at: www.aihw.gov.au/reports/injury/emergency-department-data-routine-injury-2013-14/contents/table-of-contents
Feldstein AC, Black D, Perrin N, et al. Incidence and demography of femur fractures with and without atypical features. J Bone Miner Res 2012;27:977-86.
Conway D, Albright P, Eliezer E, et al. The burden of femoral shaft fractures in Tanzania. Injury 2019;50:1371-5.
Enninghorst N, McDougall D, Evans JA, Sisak K, Balogh ZJ. Population-based epidemiology of femur shaft fractures. J Trauma Acute Care Surg 2013;74:1516-20.
Skinner DV, Driscoll PA. ABC of major trauma. Chichester, West Sussex: Wiley-Blackwell; 2013. Available at: www.123library.org/book_details/?id=62732
Willis S, Dalrymple R. Fundamentals of paramedic practice: a systems approach. Hoboken, NJ: Wiley Blackwell; 2020. Available at: hwww.r2library.com/Resource/Title/1119462959
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;39:97.
Robert Jones Centenary Volume. J Bone Joint Surg Br 1957;39-B:180-217.
Kirkup J. Foundation lecture. Fracture care of friend and foe during World War I. ANZ J Surg 2003;73:453-9.
Studer NM, Grubbs SM, Horn GT, Danielson PD. Evaluation of commercially available traction splints for battlefield use. J Spec Oper Med 2014;14:46-55.
Madhuri V, Dutt V, Gahukamble AD, Tharyan P. Interventions for treating femoral shaft fractures in children and adolescents. Cochrane Database Syst Rev 2014(7).
Bledsoe B, Barnes D. Traction splint. An EMS relic? JEMS 2004;29:64-9.
Webb T, Ley E, Chesters A. Essex and Herts Air Ambulance: a focused case series for pre-hospital practice case 3: a femoral shaft fracture. Journal of Paramedic Practice [Internet] 2014;6:502-8.
Runcie H, Greene M. Femoral traction splints in mountain rescue prehospital care: to use or not to use? That is the question. Wilderness Environ Med 2015;26:305-11.
Nackenson J, Baez AA, Meizoso JP. A Descriptive analysis of traction splint utilization and IV analgesia by emergency medical services. Prehosp Disaster Med 2017;32:631-5.
Mihalko WM, Rohrbacher B, McGrath B. Transient peroneal nerve palsies from injuries placed in traction splints. Am J Emerg Med 1999;17:160-2.
Watson AD, Kelikian AS. Thomas splint, calcaneus fracture, and compartment syndrome of the foot: a case report. J Trauma 1998;44:205-8.
Wood SP, Vrahas M, Wedel SK. Femur fracture immobilization with traction splints in multisystem trauma patients. Prehosp Emerg Care 2003;7:241-3.
Abarbanell NR. Prehospital midthigh trauma and traction splint use: recommendations for treatment protocols. Am J Emerg Med 2001;19:137-40.
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;17:530-3.
Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jet al. The influence of prehospital time on trauma patients outcome: a systematic review. Injury 2015;46:602-9
Spano S, Campagne D, Cagle K, et al. Prehospital midthigh trauma and traction splint use: a retrospective review of a trauma registry. Blood 2014;1:24.
Hoppe S, Keel MJB, Rueff N, et al. Early versus delayed application of Thomas splints in patients with isolated femur shaft fractures: the benefits quantified. Injury 2015;46:2410-2.
Inglis D. Combating skill fade: basic life support refresher training in the remote military environment. Resuscitation 2019;142(S1):e53-4.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.