ADVERTISEMENT
Letters to the Editor: The Traction Splint
Readers respond to an article in the August 2014 issue of EMS World Magazine by Sacred Cow Slaughterhouse: The Traction Splint.
“Intuitively, the need for a traction splint is clear. Common sense would dictate that a device to align those bone ends would be beneficial.”1
In “Sacred Cows: The Traction Splint” in the August 2014 issue of EMS World Magazine, William Gandy and Steven Grayson argue against their intuition/common sense and posit that simple splinting can provide the same level of care and treatment as that of a traction splint. They question whether traction splints add any significant benefit. They frame their argument by stating that, “Splinting as a packaging technique can increase a patient’s comfort, protect soft tissue and nerves from injury by jagged bone ends and perhaps minimize bleeding and reduce the possibility of fat emboli.”1 That’s a big “perhaps.”
The fact of the matter is that serious hypovolemic shock and blood loss can and does occur with a fractured femur. Blood loss of two–four units is not uncommon with femoral fractures.
Is “splinting as a packaging technique” sufficient enough to address the issue of blood loss and other relevant issues? Can it outweigh the “traction splint” benefit of aligning the femur and reducing the amount of muscle in spasm as well as the degree of spasm? The answer to this question is readily apparent when one considers the basic anatomy and pathophysiology of a fractured femur: “When a patient suffers a fractured femur, the amount of pain felt by the patient is in part related to the amount of muscle in spasm, as well as the degree of spasm. This is why a fractured femur typically results in much more pain than a fractured humerus. The application of traction on the muscle tires it and pulls it out of spasm, consequently relieving much of the patient’s pain. It also restores the cylindrical shape of the leg and, in the process, increases tissue pressure within the thigh, which inhibits further blood loss, and aids in shock prevention.”2
Misuse of traction splints suggests educational and training deficits— this clearly needs to be addressed. There needs to be increased emphasis on the indications and contraindications of the use of traction splints. As important, there needs to be a fundamental increased awareness of product design.
Is it time to toss traction splints into the dustbins of history? The answer to this question is a most emphatic “No.” Why? Not all traction splints have limited usage (in terms of indications and contraindications), not all traction splints take upwards of 15 minutes to apply, not all traction splints require two-person application, not all traction splints complicate patient transport, and not all traction splints subject the patient to additional pain and suffering. As with any product in medicine, design, form and function must be taken into consideration.
Minto Research & Development, Inc., MINTORD@aol.com
References
1. Gandy WE, Grayson S. Sacred Cows: The Traction Splint. EMS World, 2014 Aug; 44(8): 25–30.
2. Borschneck AG. Traction Splint: proper splint design & application are the keys. JEMS, 2004 Aug; 29(8): 69.
I agree that in the face of a multisystems trauma patient the time needed to apply a traction splint is not worth the benefit. I have worked both urban EMS and ski patrol for 30 years and while I don’t place a traction splint in my ambulance job too often, I do apply a traction splint about once a year at the ski area. In the case of isolated trauma, pain relief is most often obtained with proper application.
Greg, via EMSWorld.com
As noted, there aren’t many (or any) actual controlled studies on field application of traction splinting. And, much like the authors, in my 18 years of EMS the number of patients I’ve encountered with indications for traction splinting and no contraindications can be counted on one hand. But, I will say this: With only one exception, every single one of those patients indicated significant pain relief as soon as traction was applied.
Rapid non-pharmacological pain relief is certainly a significant benefit in the rare cases that the traction splint can be used.
Further study is definitely indicated, but unlikely to happen. Given the existing anecdotal evidence of the benefits, I’m not sure traction splints are something we should give up yet.
Jake, via EMSWorld.com
The authors respond: The title of our series, “Sacred Cows,” says it all. In this series, we are tasked to examine some of our most long-held EMS practices under the cold light of scientific scrutiny, and see if we can justify their continued practice. We are grateful to the editors of EMS World for their willingness to allow us to court such controversy. That’s how we grow as a profession—by questioning dogma, and constantly re-examining our current practices in the light of new evidence. That growth is sometimes painful, but always necessary.
A wise doctor once said, “Half of everything that is taught in medicine is wrong. The problem is, nobody knows which half.” The way we find out which half is by questioning what we think to be true. A number of readers, both here and in social media, thoughtfully disagreed with our position on traction splinting. While we remain unconvinced, some of their counterarguments have merit, and beg further scrutiny.
Everything we do we must be able to justify with sound research and quantifiable results. If the research doesn’t exist, then we need to design studies and conduct them. But be prepared to have your assumptions shattered. Science is funny that way.
