Like JC said, traction splints are for mid femur breaks only. I dont think a snowboard would really make a very good splint either, unless it was a split taped to both sides of the leg. Plus when you splint an injury like that your supposed to immobileise the joint above and below the site of the injury too, and having a snowboard strapped to a leg would make that hard too, since a femur fracture pretty much requires backboarding if possible.

In my WFR class (1 1/2 yrs ago), we were told that in general you don’t traction a femur in the field, Exceptions may be made, but we were told that the general consensus is that most field traction systems are not very effective and that your time and energy are better spent warming and comforting your patient and preparing to evacuate.
I’m curious to hear what others have been taught and even more curious to hear about actual experiences.

Paulster – I took my course last spring and was taught the technique and certainly came away with the impression that it would help if done properly. You bring up a good point though about the reliablity of improvised traction. You don’t want to do more harm than good, so without a solid splint to anchor off of, I could see going the route you discussed. If I had a ski pole or good branch to work with, and the patient was showing signs of internal bleeding, I think I would go for it. Especially if we were deep in the b/c.

Troweller – Like mentioned above, when it comes to using a traction splint, I learned that this was reserved for a mid-femur break only. There are times where an attempt to gently realign a break could be done though. I was taught that you consider it for angulated breaks which are generally accompanied by comprimised CSM (circulatroy, sensory and motor function.) A realignment could include pulling exposed bone under the skin. There were a lot of little rules to follow if you did this – cleaning it properly, noting it was an open wound in your run sheet, etc. At least this is what I remember…

I haven’t seen an improvised litter using a solid board. I’d love to have someone explain it if it is possible. There are some good techniques with skis that could certainly apply to a split.

Great question. A traction splint in the field, if you are properly trained, serves three purposes: eliminate pain, stablize bone, and elimate problems with blood flow/bleeding. It’s basically impossible to move patient or control pain without.

You can put one end of the half splitboard (padded well) in the groin, then use webbing on the other end to pull traction on the ankle. Duct tape probably won’t work here. You can try splinting outside of leg, using webbing around hip or groin tied to one end of splitboard and using webbing on te opposite end. Either way, the biggest problem is a)the board is very long so evacuation is difficult and b)there are no holes in many splitboard to anchor webbing.

Who’s traveling in the backcountry without poles? Poles are much easier to rig a femur traction splint with.

CV

@docwild wrote:

Either way, the biggest problem is a)the board is very long so evacuation is difficult and b)there are no holes in many splitboard to anchor webbing.
CV

Well, in theory if someone has a broken femur you should be immobilising the joints above and below the break, which would be the hip and knee. Backboarding someone in the BC would be a big problem too.
As for when a traction split is approprate, I was taught to follow the rule of hands if the break is one hand space from each joint(hip or knee) you should use a traction splint. If you its closer than one hand space to a joint, you should use a normal splint.

@paulster wrote:

In my WFR class (1 1/2 yrs ago), we were told that in general you don’t traction a femur in the field, Exceptions may be made, but we were told that the general consensus is that most field traction systems are not very effective and that your time and energy are better spent warming and comforting your patient and preparing to evacuate.
I’m curious to hear what others have been taught and even more curious to hear about actual experiences.

In my Wilderness Medical Association WFT class last week they specifically said that you shouldn’t pull traction on a femur break in a wilderness situation if you can help it. It is too hard to maintain traction during an evacuation and you are likely to cut off blood supply and further damage the leg. They say the patient needs a vacuum cast and a rescue litter so it’s best to get a real evacuation together if at all possible.

Tex, great input, as with so many others in this thread. I have seen situations in the field (nothing in the deep snowy bc) that show each injury is different and takes a different level of improvising or approach. I agree that pulling traction is tough and not always the right choice. If the injury is not unbearably painful traction may not be needed, such as in a femur fracture that has not shifted laterally and allowed the powerful quad and hamstring muscles to “shorten”. The femoral artery is also a serious concern, but if nicked internally with no open fracture you may never know this problem exists without carefully and constantly monitoring your partner’s blood flow return to the lower leg (pulses of the ankle, foot or toe nail bed blanching).

Splints are critcal and probably are best made in the field from what you find or from your poles. The handle of a pole is large enough to take a spare mitten or glove to pad the crotch on the sorter side and then you can extend the second pole on the outer side. As many have stated, for a femur fx as in most other fractures you have to mobilize the break to above and below the nearest joints. For the femur this is of course the hip to the top, but you should go to the ankle or beyond below. Two properly placed ski poles with a belt fastening the long one above the hip will be a good start. If you were with me I would sacrice your skins to make wraps below the croch-above the break, below the break-above the knee, mid calf and ankle. If I need more skins, I would then sacrifice my own.

As for the pulling of traction to realign, if this is the route you choose because of the situation it is best to create a pulling device so as not to have to do it manually. Real life testimony in this thread shows how tough it can be and if applied and released periodically it not only makes your buddy scream, but it could cost him that femoral artery in the movement. Even the best of friends must be superhuman to hold traction for an entire extraction rescue, my hats off to the two of you who did so until the helo arrived. Anyone should feel safer travelling with you.

As for the exit, there are a lot of options, one of which is no exit but awaiting help. This may not be possible, or less promising. I often (now maybe always that this has my mind racing) travel with a gore-tex bivy sac. I once used one just like mine after splinting a crushed ankle. I padded and protected the splint and used this bivy as a sled to drag the guy out. That may be the hardest I have ever worked, and it was no pain free process for either of us. Much tougher with a femur, but using a joined splitboard and the bivy may make snow sledding a bit more possible.

This is some crazy and serious shit. Thanks to all for the thought provoking thread, I thought my field emergency medical days were over, I guess the only thing that has changed is the “expected” type of injuries.

Safety to all.