Femur fracture traction

DayDreamin ER CRNP · May 3, 2017

Long knee immobilizer is what we are using these days.

nurse2033, MSN, RN · May 4, 2017

HARE traction still good. No protocol, just common sense. Do you have the right splints available?

akulahawkRN, ADN, RN, EMT-P · May 4, 2017

The thing with traction and femur fractures is that the fracture must be mid-shaft for this to work effectively. If it's a femoral neck fracture, it's a no-go. If the ED has a traction splint available, that would be awesome to use in these situations but if they don't, or if the MD isn't used to thinking about applying a traction splint, then you may be SOL. One potential downside to using a traction splint is that you risk skin injury because of the pressure applied to the foot and ankle. There is going to have to be some kind of balance with using them. Sager and Hare splints both do work well.

Wuzzie · May 4, 2017

Hi, I have a question that I haven't been able to get a reasonable answer to. Should we be putting femur fractures in traction asap? We used to do it routinely a long time ago but not anymore. I have had patients in ER all day, femur fracture, but no traction ordered. I am afraid to move them because of proximity to the femoral artery, severe pain and muscle spasms. What is protocol in your hospital?

Like Akulahawk stated, a traction splint is only indicated for mid-shaft fractures, is contra-indicated for any other fracture location and can actually cause more damage if used incorrectly. A knee-immoblizer is appropriate only for distal fractures. Proximal fractures (femoral neck)are splinted with a back board in the field but it's okay to remove it once they have been transferred to the ED cot. When in doubt a simple long leg splint (from hip to foot) is appropriate until the fracture location can be determined. Traction splints are not a benign intervention. Close monitoring of the patient is required to avoid further injury.

So says Wuzzie who's first experience in traction splinting was with a Thomas Half-Ring and the leg off a pair of panty hose. No stinking Hare or Sager splints for us (cuz they hadn't been invented yet)! :whistling:

drollette · May 5, 2017

Depends, what is the patients BP? Where is the fracture? is there an accompanying ankle fracture? What is the patient's pain level? Is a trip to the OR imminent or delayed? If you've asked all the right questions and feel that traction is appropriate then be an advocate, say something and do something!