An Unorthodox Skin Traction Technique for the Initial Management of Distal Femur Fractures in a High-volume Trauma Centre: A Technical Review.

Andrea Mc Carthy,Mark Dolan,Eoghan Meagher

doi:10.7759/cureus.7106

Abstract

Distal femur fractures account for 3% of femur fractures and require definitive fixation to allow for weight-bearing and return of functional capability. However, if these fractures must wait a period of time to be taken to theatre, skin traction is routinely applied in the pre-operative period to maximise pain management, prevent deformity and protect neurovascular status. Pre-made traction kits are usually widely available in emergency departments worldwide, allowing for the rapid application and stabilisation of the limb once analgesia in the form of a femoral block has been delivered. Unfortunately, as in many aspects of healthcare, demand can sometimes outweigh supply. In high-volume-trauma centres or mass-casualty incidents, the pre-made kits designed for skin traction such as Sterotrac (Steroplast Healthcare, Manchester, UK) or Tensoplast (BSN medical GmbH, Hamburg, Germany) kits can be rapidly depleted, leaving emergency and orthopaedic physicians with no means of providing the traction required. Hence, we propose and describe a modified technique that provides a simple and inexpensive way to achieve and maintain skin traction using readily available hospital supplies, which can provide adequate support in a safe manner until definitive surgical fixation. This method not only provides sufficient traction but protects the bony pressure areas around the foot and ankle, thereby reducing the risk of iatrogenic pressure sores.

Highlights

Distal femur fractures account for approximately 3% of all femoral fractures with two demographics representing epidemiologically defined peaks: young men in their thirties and older females [1,2]
Distal femur fractures are rare, level-one trauma centres or mass casualty situations causing highvolume influxes of patients may experience a depletion of resources, and access to the supply of ready-made skin traction kits or Thomas Splints may be diminished [1,2]
The technique reviewed in this paper provides a simple way to create a skin traction system using readily available resources, and it works as effectively as pre-made kits

Summary

Introduction

Distal femur fractures account for approximately 3% of all femoral fractures with two demographics representing epidemiologically defined peaks: young men in their thirties and older females [1,2]. Should a scenario arise wherein ready-made skin traction kits or Thomas Splint kits are unavailable, a simple method using common hospital resources can be employed to produce an effective temporary skin traction kit For preparing this kit, we need one roll of adhesive padding, three crepe bandages, shears or scissors, medical tape (zinc oxide), two surgical pads and an IV giving set with bags of IV fluid (the amount will depend on the degree of traction needed and the patient’s body habitus) (Figure 1). The first crepe bandage is wrapped around the foot and ankle in a figure-eight direction so that it covers the bottom of the padding and the ankle (Figure 5) This will hold the traction kit in place and provide reinforcement to the padding while under the weight so the IV tubing is not dislodged when traction is applied. Left leg: traditional ready-made skin traction kit that has slipped, offering inadequate skin traction

Discussion

Conclusions

Findings

Disclosures