Thomas Splint Research Articles

World War I and the Thomas Splint: A Historical Review.

The Thomas splint, the first practical traction splint for femoral fractures, revolutionized the capabilities of military medicine. Its usage in WWI lowered the mortality rate from 80% to nearly 15%. Its development not only shaped modern orthopedics but also established the splint as standard equipment in hospitals worldwide.

A prospective study of functional outcome of treatment of intra-articular fracture of proximal interphalangeal joint by static traction and early mobilization in adults

Abstract Background: Failure to appropriately address intra-articular fractures of the proximal interphalangeal (PIP) joint may result in enduring pain, stiffness, and post-traumatic arthritis. Our approach employs a straightforward and economical method of creating a static traction splint using an aluminum splint. This splint is removed after 2 weeks, followed by the initiation of early mobilization. Materials and Methods: A flexible aluminum splint is placed on the injured finger. A polypropylene suture passes through the nail and is tied to the splint for sustained traction, and the finger is immobilized for 2 weeks. After this period, the splint is removed, and active assisted finger mobilization begins. Patients are assessed post-surgery using the Ishida score. Results: This study involved 30 treated patients, with a mean age of 31.47 ± 11.11 years, ranging from 18 to 69 years. Among them, 26 were male and 4 were female, with 20 experiencing right-side involvement. Sports-related injuries were reported in 17 cases, followed by road traffic accidents in 7 cases and slips in 6 cases. The mean range of motion, measured in degrees, was 83.3 ± 0.22. Overall, the patients achieved excellent results. Conclusion: Utilizing static traction for intra-articular PIP joint fractures is a safe, relatively straightforward, and cost-effective method with minimal complications. This approach guarantees anatomical joint alignment, promotes favorable fracture healing, and facilitates early mobilization, leading to a swift and satisfactory recovery.

Five historical innovations that have shaped modern orthopaedic surgery.

Throughout history, many innovations have contributed to the development of modern orthopaedic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern orthopaedic surgery: X-ray imaging, bone cement, the Thomas splint, the Pneumatic tourniquet and robotic-assisted surgery. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of orthopaedic surgery and their ongoing relevance in contemporary and perioperative practice.

Mobility Solutions After a Lower Extremity Fracture and Applicability to Battlefield and Wilderness Medicine.

The potential for delayed evacuation of injured Service members from austere environments highlights the need to develop solutions that can stabilize a wound and enable mobility during these prolonged casualty care (PCC) scenarios. Lower extremity fractures have traditionally been treated by immobilization (splinting) followed by air evacuation - a paradigm not practical in PCC scenarios. In the civilian sector, treatment of extremity injuries sustained during remote recreational activities have similar challenges, particularly when adverse weather or terrain precludes early ground or air rescue. This review examines currently available fracture treatment solutions to include splinting, orthotic devices, and biological interventions and evaluates their feasibility: 1) for prolonged use in austere environments and 2) to enable patient mobilization. This review returned three common types of splints to include: a simple box splint, pneumatic splints, and traction splints. None of these splinting techniques allowed for ambulation. However, fixed facility-based orthotic interventions that include weight-bearing features may be combined with common splinting techniques to improve mobility. Biologically-focused technologies to stabilize a long bone fracture are still in their infancy. Integrating design features across these technologies could generate advanced treatments which would enable mobility, thus maximizing survivability until patient evacuation is feasible.

Efficacy of a new artificial muscle-type dynamic traction splint for rheumatoid arthritis-related painful wrist joint contracture: A case study

Efficacy of a new artificial muscle-type dynamic traction splint for rheumatoid arthritis-related painful wrist joint contracture: A case study

ODP026 An Incidental Giant Normotensive Pheochromcytoma with Elevated Metanephrines demonstrated no evidence of hypertensive crisis during a major surgery

Abstract A 48-year-old Caucasian male with no known past medical history admitted to our hospital following MVA resulting in acute severely comminuted displaced fracture of the left femur and tibia. On admission, the patient was in severe pain. His vitals were significant for elevated blood pressure (BP) of 137/100 and pulse rate of 161 per minute, which resolved soon after pain medications and splint placement. On review of systems, he denied episodic spells of headaches, palpitations, pallor, tremors, anxiety, abdominal pain, or diaphoresis. He denied any family history of endocrine disorders. Physical exam was unremarkable, except for the left femur traction splint. He had multiple CT imaging performed for evaluation of his injuries. On CT scan of the abdomen, he was found to have a 7.2cm adrenal incidentaloma with imaging characteristics consistent with pheochromocytoma. He was admitted to the intensive care unit for one day for closer monitoring where he remained hemodynamically stable without any BP lowering medications. Laboratory work up for a pheochromocytoma was pending. However, due to concern of compartment syndrome of left lower extremity, patient underwent two emergent procedures of open reduction and internal fixation of left femur and tibial fracture repair. Robust monitoring of hemodynamics was performed during both surgeries but patient did not require any antihypertensive medications during the procedures. Eventually, serum total metanephrines drawn on admission day two, resulted as 7848 pg/ml (normal <205pg/ml), normetanephrines 3626 pg/ml (normal <148pg/ml), and metanephrines 4224 pg/ml (normal<57pg/ml). Serum cortisol, aldosterone, renin, dehydroepiandrosterone sulfate, and glucose were within normal limits. On day 3 of admission, repeated serum metanephrines were persistently elevated in 4000s. 24-hour (hr) urine studies showed total metanephrines 7353 mg/24hr (normal <832 mg/24hr), metanephrines 4934 mg/24hr (normal <315 mg/24hr), normetanephrines 2419 mg/24hr (normal <676 mg/24hr) and creatinine2.3g/24 hr (normal <2. 0g/24hr) . MRI abdomen confirmed pheochromocytoma abutting the pancreas and left upper pole of kidney. Interestingly, patient remained hemodynamically stable with highest BP measurement of 120/90 throughout the hospital course. He was eventually discharged on Prazosin 1 mg twice daily which was gradually increased to 5 mg daily in divided doses; increase fluid intake and high salt diet. Beta-blocker was not added due to borderline blood pressure. The patient underwent robotic left radical adrenalectomy without any intraoperative hemodynamic instability. Pathology was consistent with pheochromocytoma, confined to the adrenal gland without no capsular invasion. The patient refused genetic testing. Presentation: No date and time listed

Traction Splinting for midshaft femoral fractures in the pre-hospital and Emergency Department environment—A systematic review

IntroductionPain and hemorrhage are common in midshaft femoral fractures. Traction splints (TSs) can reduce pain and control hemorrhage, but evidence of their effectiveness in femoral fractures is still lacking. Through a systematic review, we aimed to analyze and discuss the potential role of TSs in the prehospital and emergency department (ED) setting. MethodsThe Embase, CINAHL, Cochrane, and PubMed databases were searched up to January 2022. All studies on femoral fractures in the prehospital or ED setting that compared TSs with immobilization or no intervention were included. Articles not written in English, German, or Dutch were excluded. Two authors screened all articles, assessed their quality, and included them if both agreed on their inclusion. The risk of bias was assessed using the modified Methodological Index for Non-Randomized Studies (MINORS). The primary outcome measures were pain and hemorrhage control, while the secondary outcome measures were survivability, morbidity, and complications. ResultsA total of 1,248 articles matched the search strategy, 24 articles were assessed for eligibility based on their abstracts, resulting in 20 articles being included in the synthesis. Ten articles reviewed the effects of TSs on pain, while five reported that the use of a TS was appropriate. All five articles that reviewed blood loss found benefits from the use of a TS. One study found significantly fewer pulmonary complications in patients who were splinted earlier at the scene of injury (level III). No difference was found in complications or mortality between prehospital patients receiving a TS or no TS (level III). None of the studies noted that TSs were a necessity in the ED setting; however, some argued that a TS is a necessary and useful prehospital tool in rural or military areas. ConclusionTS use is associated with a decreased necessity for blood transfusions and fewer pulmonary complications. No favorable effects were found in terms of pain relief. We recommend the use of TSs in situations where one is likely to encounter a femoral fracture as well as when the time to definitive treatment is long. Further well-designed studies are required to validate these recommendations.

Mountain Emergency Medicine Review, 1st edition

Mountain Emergency Medicine Review, 1st edition

A study of functional outcome of distal femur fractures internally fixed with distal femur locking compression plate

The femur is the largest bone in the body connecting between the tibia and pelvic bone. Studies have proved this bimodal distribution of supracondylar fractures of the femur. The locking plate's standard is to have an anatomical reduction of the bone under the soft tissue envelope and could be applied without stripping the periosteum.
 The aim: to study the union rates with locking compression plates and clinical outcome associated with this treatment modality, range of movements of the knee, pain relief and return to normal activities and work.
 Methodology: this is a prospective study on patients with distal femur fractures. Conducted at Santhiram medical college and general hospital, Nandyal from October 2018 to September 2020. All patients aged more than 18 years diagnosed with distal femur fractures.
 Results: in our study, around 46 % of them had Muller A1 type, followed by 23 % had Muller C1 and C2 respectively, and the remaining 13.3 % had Muller A2. Around 67 % had a Thomas splint with traction, 16.7 % had B.B. splint, 13.3 % had A/K POP slab, and the remaining 3 % had upper tibial traction with B.B. splint. The majority of the study participants, 53 %, had knee flexion more than 120 degrees. 30 %, took <16 weeks for the union, 33 %, took 16-20 weeks to complete weight-bearing, eight patients (26 %) had excellent outcomes; 21 patients (70 %) had a satisfactory outcome; one patient (3.3 %) had an unsatisfactory outcome.
 Conclusion: in our study, out of 30 patients, eight patients had excellent outcomes, 21 patients had satisfactory outcomes, and one patient had unsatisfactory outcomes. We conclude, open reduction and internal fixation with a locking compression plate resulted in good clinical and radiologic outcomes

The Impact of Trauma Simulation on Pre-Hospital Emergency Operations Staff

Background & Aims: Trauma is the main cause of death and disability in the world. Pre-hospital care is the first line of trauma care and treatment. Pre-hospital emergency services include immediate actions to save lives. Simulation allows employees to acquire basic skills in thinking, evaluating, solving problems, making decisions and analyzing data. Materials & Methods: This is a quasi-experimental study with a pre-test/post-test design. The participants were 60 pre-hospital emergency staff selected from among 200 staff of Fars pre-hospital emergency center . The simulation training was based on an educational model. The clinical skills of the participants in dealing with trauma patients was evaluated by the Objective Structured Clinical Skills Evaluation method in nine areas. After the training, the skills were re-evaluated and analyzed in SPSS v. 22 software. Results: The lowest mean score (from 0 to 100) was related to the skill of using traction splint (71.01±18.73) and the highest score was related to the skill of bleeding control and shock treatment (81.04±22.75). The results of the paired t-test showed that the overall clinical skill and nine standard skills of dealing with trauma patients were significantly increased after simulation training (P<0.001). Conclusion: The simulation training can increase the skills of pre-hospital emergency staff in dealing with trauma patients.

A Novel Approach to Open Reduction and Internal Fixation of Distal Radius Fractures Utilizing a Multi-Degree-of-Freedom Traction and Stabilization Device.

Open reduction and internal fixation (ORIF) is a surgical procedure performed with the objectives of restoring normal alignment and providing stability to broken bone fragments after a fracture. This procedure is increasingly used to treat fractures of the distal end of the radius. Reduction is achieved by the surgeon pulling and manipulating the hand while looking at real-time X-rays, and frequently requires large forces to distract impacted fragments from the proximal bone. This study presents the design and preliminary testing of a multi-degree-of-freedom (DOF) device capable of performing both distraction and reduction of fractured bone fragments using a traction splint mechanism with locking ball joints. A prototype was manufactured, and tests were conducted by a practicing hand surgeon. Both qualitative and quantitative tests using a phantom arm were performed. Quantitative force testing found an 80% reduction in the maximum force required to create needed traction, while qualitative tests with a hand surgeon found the device's ability to reduce and stabilize bone fragments while the hardware is secured to be more intuitive and less obstructive than existing techniques.

An Alternative Method of Tensioning Traction Within Thomas Splint.

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.

Trauma Surgery and War: A Historical Perspective

The aim of this review is to introduce the progress in trauma surgery made during war. In the 16th century, Paré reintroduced ligature of arteries, which had been introduced by Celsus and Galen, instead of cauterization during amputation. Larrey, a surgeon in Napoleon’s military, adapted the “flying artillery” to serve as “flying ambulances” for rapid transport of the wounded. He established rules for the triage of war casualties, treating wounded soldiers according to the seriousness of their injuries and the urgency of medical care. To treat fractures and tuberculosis, Thomas created the “Thomas splint”, which was used to stabilize fractured femurs and prevent infection; in World War I (WWI), use of this splint reduced the mortality of compound femur fractures from 87% to less than 8%. During WWI, Cushing systematized the treatment of head injuries, reducing mortality among head injury patients. Gillies repaired facial injuries, and his experiences became the basis of craniofacial and aesthetic surgery. In WWII, McIndoe discovered that immersion in saline promoted burn healing and improved survival rates, and thus began saline baths and early grafting instead of using tannic acid. A high mortality rate in patients with acute renal failure was noted in WWII and the Korean War. In the Korean War, Teschan used the Kolff-Brigham dialyzer. The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by the US Army in Burma during WWII. As a lotus blooms in the mud, military surgeons have contributed to trauma surgery during wartime.

Review article: Paramedic pain management of femur fractures in the prehospital setting: A systematic review.

Femur shaft and neck of femur (NOF) fractures are often undertreated in the prehospital setting. These injuries can present unique clinical and logistical concerns in the prehospital setting. This systematic review aimed to investigate paramedic prehospital pain management of patients who had suffered NOF or femur fractures, and to investigate which interventions are effective. A systematic review was conducted in line with Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines. Four databases were searched from inception date 23 March 2020. Articles were independently reviewed by two authors and conflicts resolved by a third author, followed by a hand search of the included reference lists. References were included if they addressed paramedic interventions for NOF or femur shaft fractures. Outcomes of interest were the effectiveness and complications of different modalities administered by paramedics. The search yielded 6868 articles, of which 19 met the final inclusion criteria. Studies investigated a variety of interventions including traction splints, intravenous (IV) analgesia and alternative analgesic options. Traction splinting and IV analgesia were consistently reported as underutilised. Alternative analgesics such as auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and fascia iliaca compartment block were found to be effective techniques that could be safely and competently employed by paramedics, reducing pain for patients with limited adverse events. NOF and femur shaft fractures are an undertreated injury in the prehospital setting. Traction splinting and IV analgesia remain the traditional methodologies of treatment for these injuries; however, there are alternatives such as TENS, auricular acupressure and fascia iliaca compartment block that appear to be emerging as safe and effective options for the prehospital setting.

843 Improving Practical Skills Training with In-Situ Trauma Simulation

Abstract Introduction Safe and effective management of trauma patients requires numerous practical skills. Our in-situ trauma simulation identified key areas requiring increased training and exposure. This enabled improvement to education, patient safety and efficiency when managing these emergencies. Method We carried out a simulated trauma call according to ATLS principles, recording the time and person completing each task. Key areas for improvement were identified; most notably the application of Femoral Traction Splints (FTS). 0/7 doctors present were not able to do this. Subsequently, a formal training day was delivered, with 38 attendees across specialties, assessing confidence before and after the session. Results Prior to the training session, 52.6% of attendees did not have formal teaching using FTS and 65.8% had never used one. Confidence with FTS application was measured on a scale of 1 (not confident) to 5 (very confident), with an average score of 2.6/5. After training, the average confidence score was 4.7/5 (p < 0.01). 100% of participants found the session very useful. Conclusions In-situ simulation allows identification of key areas for improvement in training of practical skills. Essential tailored teaching can then be delivered to increase exposure and confidence for these necessary practical skills.

Successful calcaneal common tendon tenorrhaphy in a Dorper lamb

AbstractTendon rupture is an uncommon cause of lameness in small ruminants. This report aimed to present a successful common calcaneal tendon (CCT) tenorrhaphy in a Dorper lamb after rupture during a tail docking procedure. The lamb presented a 3.5 cm linear open wound over CCT. During surgery, an incision was made over the skin on the caudolateral aspect of the distal tibia over CCT. The tendon stumps were isolated using haemostats, repair was performed via a locking‐loop suture pattern using non‐absorbable suture material. Postoperative limb immobilisation was conducted using a full‐limb compressive bandage and a modified Schroeder–Thomas splint, and follow‐up continued for 4 weeks. Ten months postsurgery, a fibrous callus was evident and the lamb exhibited no lameness. In this report, CCT tenorrhaphy using non‐absorbable suture in a locking‐loop pattern was a successful approach. Limb immobilisation in extension and specific physiotherapy are important methods to fasten the patient's rehabilitation.

Study of outcome of knee joint in patients with fracture distal femur versus fracture ipsilateral femur and tibia

The posture on the two wheeler at the speed we travel, makes knee the vulnerable joint of all in any of the mishaps. We as orthopedic surgeons see the fractures around the knee joint as one of the most studied concept in the subject. This is a prospective study conducted, over 2 years, in Krishna Institute of Medical Sciences, Deemed to be University, Karad. In this study, 20 cases of fracture distal femur and 20 cases of ipsilateral fracture femur and tibia were studied to evaluate outcome of knee joint and post surgical stabilization of fractures. The fractured limb was stabilized with splinting the limb in Thomas splint or plaster slab. The type of fracture, type of fracture fixation, duration of hospital stay, time of union and time to start weight bearing are evaluated. According to Neer’s score, Good outcome was found in both Fracture Distal femur and Ipsilateral Fracture Femur and tibia. The functional outcome was found to be better in diaphyseal fractures femur and tibia treated with intramedullary interlock nailing which allowed early mobilization and weight bearing than in intra-articular fractures treated with plating. Bony union occurred early in closed, diaphyseal and simple transverse or oblique fractures and delayed in open, intraarticular and comminuted fractures.

A guide to an improvised femoral traction splint in a resource-limited setting.

A femoral traction splint is a mechanical device that uses traction to align and provide stability to femoral fractures. The use of this device has many benefits however there is still limited availability in low- and middle-income countries. This article provides the reader with a step by step guide to improvise a femoral traction splint built from recyclable materials readily available in most hospitals. The authors' concept will give patients access to a potentially life-saving device in a resource-limited setting.

Clinical observation on pulley suspension traction reduction combined with self-made splint fixation for the treatment of extended distal radius fracture

To explore clinical effects of pulley suspension traction reduction combined with self-made splint fixation in treating extended distal radius fracture. From December 2017 to December 2019, 60 patients with extended distal radius fractures were divided into observation group and control group, 30 patients in each group. In observation group, there were 12 males and 18 females, aged from 50 to 75 years old with an average of (59.63±8.08) years old;according to AO classification, 25 patients were type A2 and 5 patients with type A3;fractures were fixed by pulley suspension traction and self-made splint. In control group, there were 11 males and 19 females, aged from 52 to 76 years old with an average of (59.77±8.03) years old;according to AO classification, 24 patients were with type A2 and 6 patients were type A3;fractures were treated by conventional manipulation with self-made splint fixation. The radius height, ulnar angle and palmar angle between two groups were compared before and after treatment, and clinical effects were evaluated by advanced Green and O'Brien wrist joint scoring after treatment. All patients were followed up from 11 to 13 months with an average of (11.90± 0.80) months. The splint was removed for 42 to 60 days with an average of (50.20±4.94) days. After removal of splint, X-rays indicated that all patients obtained bone healing with smooth of joint surface. In observation group, radius height was (4.57± 1.16) mm, ulnar angle was (12.83±3.25) °, palmar angle were (-21.17±3.36) ° respectively before treatment, (10.10± 1.75) mm, (24.30±3.16) °, (9.40±2.13) ° respectively at 8 weeks after treatment;in control group, radius height, ulnar angle, palm angle were (4.50±1.43) mm, (12.83±3.10) °, (-21.50±3.38) ° respectively before treatment, and (8.90±1.24) mm, (21.20±2.91) °, (6.16±2.94) ° respectively at 8 weeks after treatment;there were no significant difference in radius height, ulnar deviation angle and palmar inclination between two groups before treatment (P>0.05);radius height, ulnar deviation angle and palmar inclination angle of between two groups were significantly improved at 8 weeks after treatment(P<0.05), and observation group was significantly better than that of control group (P<0.05). Green and O'Brien wrist score of observation group was 90.97±7.92 at follow-up ranged from 11 to 13 months with an average of (11.90±0.80) months, which was significantly higher than that of control group (84.77±9.14) (t=2.807, P<0.05);in observation group, 18 patients got excellent result, 10 good and 2 fair;in control group, 10 patients got excellent result, 15 good, 3 fair and 2 poor;there was siginifcantly difference between two groups (Z=-2.15, P<0.05). Compared with conventional manual traction and reduction, pulley suspension traction reduction combined with self made splint fixation for the treatment of extended distal radius fracture has more advantages with stable and reliable traction, good reduction, and better wrist joint function. It could be selected and applied according to the actual situation of patients.

Presentation and Management of an Interprosthetic Femoral Fracture between a Total Hip Arthroplasty and Revised Total Knee Arthroplasty with Distal Femoral Replacement

An 83-year-old female sustained a right femoral interprosthetic fracture following a fall, She had a high BMI with a background history of ischaemic heart disease and type II diabetes. She was placed in a Thomas splint and underwent surgical fixation with a plate on the following trauma list.