Abstract
The application of a Thomas splint when managing a femoral fracture has the potential to be a painful experience for the patient. If movement of the injured limb can be reduced during the application then the patient will likely suffer less pain. In this report, we describe a method that enables the clinician to remove any slack in the tensioning system and apply the traction in a single movement. No additional equipment is required beyond the standard splint and skin traction apparatus. A pulley system is created using the cord, the splint and two overhand knots, minimising movement at the injury site whilst permitting sufficient traction to be applied. Once applied, it can be easily re-tensioned as the thigh musculature relaxes. We believe this method to be simple, more adaptable and quicker to apply than the current standard.
Highlights
The 'Thomas splint', introduced by Hugh Owen Thomas in 1865, was first used for the treatment of tuberculosis of the knee [1]
When the patient has been transferred to a bed, the pressure on the perineum can be relieved by converting the splint from transit to static mode using weighted or balanced traction [6]
Traction was set up with the pulley system that we describe and a reading was taken from the meter (Figure 7)
Summary
The 'Thomas splint', introduced by Hugh Owen Thomas in 1865, was first used for the treatment of tuberculosis of the knee [1]. Longitudinal elevation of the leg will flex the hip and de-tension the Iliopsoas tendon It will lift the posterior thigh/buttock off the padded hoop and reduce the risk of pressure-related soft tissue injury. Flexion of the knee will detension the hamstring and gastrocnemius muscles, both of which cross the joint This may aid in reducing any muscular spasm causing overlap or shortening of the fracture. Traction is applied through both cords, and they are tied to each other under tension around the end of the splint (Figure 4). This final knot can be definitive with a reef knot [8] or temporary with a shoelace bow [9]. When 1 N of force is applied to the free cords it will achieve 3 N of force in traction
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