I Hate Traction Splints

Once upon a time, the police decided to chase a stolen car. (You can tell how long ago this happened, being that it involves a pursuit.) Inside the car were at least two teenaged boys. The pursuit led into a neighborhood, curving back and forth on small residential streets, but it was a fairly safe chase being that it happened at three in the morning.

Eventually, the chase got a little too fast for the teen driver to handle. The street they found themselves on ended at a T intersection. Apparently the driver couldn’t decide whether to go right or left, so he went straight. Straight into a big-ass maple tree in someone’s front lawn at about 30 miles per hour. The driver and the front passenger immediately hopped out and bolted.

The passenger made it one step. On his second step, he discovered he was the proud owner of a left midshaft femur fracture. He found this fact when he planted his left foot and pushed off, attempting to sprint after his driver friend. The thigh angulated and he collapsed onto the ground. According to the police, the shriek he generated due to the pain was loud enough to break glass and wake dogs several miles away.

He had discovered his busted femur the hard way.

Can't run on that...
© Nevit Dilmen [CC BY-SA 3.0], via Wikimedia Commons

I arrived to find the kid angry and yelling on the front yard. The glovebox inside the car was cracked, so I think he rammed it with his knee, breaking the leg. Aside from the broken femur, I couldn’t find other injuries. He was completely awake and there wasn’t another scratch on him. His femur, though, had developed an extra knee. It was angulated and exquisitely tender. My partner suggested a traction splint. I agreed and asked him to fetch it.

My system uses the HARE traction splint. It is actually the only one I have worked with. It is the traction splint that I learned to use in EMT class in 1994, and it is the only one I have ever put on a patient – imaginary or real.

My partner returned with the splint in the cloth sack. I opened it to find that the HARE was still in the manufacturer’s packaging. It was still shrink wrapped and not assembled. I briefly looked at it, my mouth hung open, I felt irritation rise in my throat, and I tossed the whole mess into a bush in the front lawn with a frustrated two-handed overhand toss. Apparently we wouldn’t be using the traction splint that night. (I don’t know how a traction splint was found in that family’s front yard bush, boss, honestly…)

My partner was used to my drama. He sighed, rolled his eyes, and fetched the splint out of the juniper bush. “Hang on. Slow your roll. Let me put this together. It will just take a few seconds…” he told me. I started an IV while he unwrapped the splint and screwed it together.

It went on the patient with no problem (once it was assembled), but not with the smooth skill that a practiced team of brand-new EMTs fresh out of the National Registry test would do it. If I’m honest, I think we manually pulled traction, realized we forgot a step, had to release the traction to complete the missed step, and then try to start again. Once the contraption was in place, we loaded the kid into the ambulance, I began administering analgesia, and we went to the nearest trauma center.

After I handed the patient off to the trauma team, the attending physician (my medical director at that time) asked why I used the traction splint.

“Because he had a midshaft femur fracture and a traction splint reduces pain, stabilizes the injury, and can help slow bleeding,” I told him, digging up half-forgotten EMT class lessons.

“But it slowed your scene time. Scene times are critically important in emergency trauma,” he pointed out.

“Yeah, but I felt sure the only injury was to his femur. So I felt comfortable taking the extra time.”

“Then why bring him back hot?” he asked.

“Cause it takes a significant hit to transfer enough energy to break a 17-year-old’s femur. That is a lot of force,” was my reply.

“Yeah, that takes a big hit. So we’re back to taking extra time on scene” he pressed. “Either it was a significant energy transfer with a distracting injury, potentially masking subtle life threatening injuries, or it wasn’t.”

I think it finally hit me at that point. What can I say? I am slow to absorb lessons. But he was right. It is pretty difficult to find a balance between “hard enough impact to break a previously-healthy femur” versus “an impact that was gentle enough to ensure the absence of other life threats so I have the time to screw around assembling and placing the infernal device.”

The HARE traction splints require two trained people working together, take quite a bit of time to place (what, like two minutes, minimum, right?), they are difficult-to-impossible to get on a patient while driving, are a treatment we don’t practice and aren’t good at, and they often extend past the end of the bed (ever see someone hit the splint when closing the door?). Traction splints were invented to treat fractures, not for field stabilization¹. Show me a study that shows the efficacy of traction above splinting; I bet you can’t.² I don’t see how the logic for the routine placement of prehospital traction splints holds up very well.

So I am not a fan of the prehospital use of traction splints.

1. Bledsoe B, Barnes, D. Traction splint. An EMS relic? Journal of emergency medical services. 2004;29(8):64–9.

2. Gandy WE, Grayson S. Sacred Cow Slaughterhouse: The Traction Splint. EMSWorld. 2014. Accessed Jul 23, 2016. http://www.emsworld.com/article/11542786/traction-splint-evidence-and-efficacy