Are you Pulling My Leg? Does the Use of Traction Splints in the Pre-Hospital Management of Patients with Femur Fractures Reduce the Complications Compared to Traditional Splinting?

Abstract

Introduction Femoral shaft fractures are a serious but infrequently seen injury in the pre-hospital environment. Management of these fractures includes immobilisation, analgesia, fluid administration and appropriate conveyance. Despite traction splints being widely used since World War I, there has been no systematic review published to date. In order to support evidence-based practice this systematic review will attempt to determine if the use of traction splints in the pre-hospital management of patients with femoral shaft fractures reduces the complications compared to traditional splinting. Methods A systematic review using the MEDLINE database (1946 to 27 August 2019) using a combination of keywords and medical subject headings. The reference lists of all relevant papers were reviewed to identify further papers. The title and abstracts of all records retrieved by the search strategy were reviewed by one independent author to identify potentially relevant papers. All potentially relevant papers were read in full text. Results A total of 42 papers were identified from the search strategy; 10 met the inclusion criteria and informed the results of this paper. Five key themes were identified: inappropriate application; on-scene times; effect on pain; vascular complications; and nerve complications. Conclusion Traction splints are frequently applied incorrectly but no statistical increase in on-scene times was found. A statistically significant decrease in the need for blood transfusions was demonstrated with the application of a traction splint.