Hare Traction: The Orthopaedic Surgeon’s Perspective
Here’s a curbside consult from Peter Cole MD, Chief of Orthopaedics at Regions Hospital. This is very interesting information for prehospital and ED providers. Length is 5:23.
This video was presented at Trauma Education: The Next Generation last September. Be sure to check out the upcoming 2014 conference materials at www.TETNG.org. Be sure to register now if you want to get continuing education credit for it!
Hare Traction – Putting It On, Taking It Off
Femoral traction devices have been around for a long time. One reader has asked about the timing of removal of these devices after they arrive at the hospital. I learned a number of things while reviewing the literature to answer this question.
Most importantly, there is really only one indication for applying a traction splint to the femur: an isolated, relatively mid-shaft femur fracture. Unfortunately, there are lots of contraindications. They consist of other injuries or fractures that could sustain further damage from traction. Specifically, these include:
- Pelvic or hip fracture
- Hip dislocation
- Knee injury
- Tib/fib, ankle or foot fracture
I did find one interesting study from 1999 that looked at how useful these splints really were. Of 4,513 EMS runs, only 16 had mid-thigh trauma and 5 of these appeared to have a femur fracture. Splint application was attempted in 3, and only 2 were successful. This was the experience in only one city (Evanston, IL) for one year. However, it mirrors what I see coming into our trauma center.
Unfortunately, when it comes to removal, there are very few guidelines out there. My advice is to have your orthopedic surgeon evaluate as soon as imaging is complete. They can help decide whether converting to some type of definitive traction is necessary, or whether it can be changed to a more conventional splint. In any case, the objective is to minimize the total amount of time in the traction splint to avoid any further injury to other structures.
Reference: Prehospital midthigh rauma and traction splint use: recommendations for treatment protocols. Am J Emerg Med, 19:137-140, 2001.