Traction splinting of femoral shaft fractures in a paediatric emergency department: Time is of the essence?

Abstract

Objective: To describe the use of traction splinting in children with femoral shaft fracture and to determine if timing of traction splinting application effects outcome. Methods: A retrospective descriptive study conducted over a five and a half year period (1 January 1996 to 1 July 2001) on children presenting with femoral shaft fracture to a Paediatric trauma centre. Data were collected on all children with a radiological diagnosis of fracture to the femoral shaft. Evidence for hypovolaemic shock and neurovascular compromise was sought. The administration of parenteral analgesia and whether a validated pain scale was employed to monitor pain relief was documented. The use of a traction splint or other leg splint device before arrival in the ED and subsequent changes to splinting in hospital were noted. Times to perform radiographic examination and femoral nerve block were also recorded. Results: Ninety‐five (95) patients met the study inclusion criteria with 66.3% having some form of immobilization and 70% administered parenteral analgesia in the pre‐hospital setting. In only 7.3% of patients was a Thomas splint traction applied within 2 h of arrival. Adverse clinical outcome was not reported in any patient regardless of time to application of Thomas splint traction. The application of Thomas splint traction in the ED resulted in a significant delay in the performance of diagnostic radiographs and femoral nerve block. Conclusions: The timing of traction splinting is not associated with poor outcome in isolated paediatric femoral shaft fracture provided effective analgesia has been administered in a timely fashion.

Pain management practices in paediatric emergency departments in Australia and New Zealand: A clinical and organizational audit by National Health and Medical Research Council's National Institute of Clinical Studies and Paediatric Research in Emergency Departments International Collaborative

“…This technique is also supported by the ANZCA scientific evidence statements 24 . Pain relief may also be provided by traction or immobilization, 15 and it is likely that most children had some form of traction or immobilization, but it was not recorded in many cases. Low rates of femoral nerve block have also been reported in a single centre in Australia 44 .…”

“…Of 177 children with femur fracture, 106 (60%) had splinting, backslab or positioning documented, and 33 (18%) had non-pharmacological treatment, mostly play therapy. (7) 7 (4) -20 (4) †Three units saw fewer than 20 cases of femur fracture annually (range [6][7][8][9][10][11][12][13][14][15][16][17]. ‡See Figure 1 for more detailed age distribution.…”

“…6,7 Many minor procedures are performed in children without using readily available, easily implemented analgesic techniques. 8 Yet, a number of organizational policies and educational interventions 4,[9][10][11][12][13] and a range of analgesic and sedative agents [13][14][15][16][17][18][19][20][21] and nonpharmacological techniques 22,23 have been shown to improve pain management in the emergency setting.…”

Part 13: First Aid

“…One LOE 5 195 study on cadavers suggested that straightening angulated fractures decreases compartment size and might increase compartment pressure. One LOE 5 study 196 showed no evidence that traction splints could have prevented any hemodynamic compromise in isolated long bone leg fractures in children. …”