Trauma Skills 2:
Femur Fracture Splinting
Femur fractures can result in the loss of 3 units of blood in the soft tissues. Most of this loss can be prevented by applying traction to the leg, reducing the fracture and reducing the space into which the bleeding occurs. If there is a tib/fib fracture on the same side or if the knee is unstable, pulling on the leg may result in distraction of the bone ends or dislocation of the knee. If this is the clinical situation, use shock trousers to stabilize the whole leg. As the leg compartment of the shock trousers is inflated, pull gently on the leg to at least align the femur fragments. Inflate the compartment to a pressure of 40 mm Hg.
Before applying splint traction to the leg, check the circulation, motor, sensation (CMS) status. Check pulses at the ankle.
Two femur fracture splints are commonly used: Hare and Sager. Both are good splints. Helicopter service may prefer the Sager because it is slightly shorter than the Hare and may fit better in the helicopter, especially if a patient is tall.
- Hare splint steps:
- Check CMS of injured leg.
- Measure the splint on the unaffected leg. Adjust length from the iliac crest to the bottom of the foot. (This is about 6 to 8 inches longer than the leg.)
- Place the ankle hitch on the ankle of the injured leg.
- Exert longitudinal traction firmly by placing one hand behind the heel and one hand over the dorsum of the foot. (Estimate 15 pounds of traction force.)
- Support the fracture site while slowly raising the leg so the splint may be placed under the leg from the padded ishial bar to the end of the splint.
- Secure the groin strap snugly without occluding blood flow.
- Attach the “D” or “O” ring to the “S” hook on the distal end of the splint.
- Turn the ratchet knob to apply mechanical traction. The mechanical traction should equal the manual traction without downward drop of the foot.
- Secure the four Velcro straps: two above the knee and two below the knee. Do not cover the fracture site or the knee with the Velcro straps.
- Raise the heel stand under the distal end of the splint.
- Recheck the CMS.
- Sager Splint steps:
- Place the splint on the medial side of the leg with its ischial bar against the ishium. Apply the ankle strap. Attach the device’s traction strap to the ankle strap.
- Apply traction by turning the traction knob on the distal end of the device. Wrap the supporting straps around the leg and the splint. Adjust the traction so that pain is relieved and leg distortion is corrected.
- Recheck CMS.