Femoral traction splints are designed to apply traction to the lower portion of the leg, distal to the fracture, usually by pulling the ankle away from a stabilized pelvis. There are many commercial brands available which vary slightly in their design and instructions and thus require individual familiarity for correct use.
Traction splints may also reduce and/or decrease pain and bleeding due to femur fractures, particularly those that are shortened.
Femoral shaft fracture
Femoral traction splints are used to stabilize femur fractures prior to definitive care (eg, operative fixation).
Ipsilateral fracture(s) of the ankle, foot, and/or lower leg
Ipsilateral knee injury
Although traction is beneficial to femur fractures, it can be harmful to fractures or ligament injury distal to the femur fracture.
Vascular or nerve traction injuries
Commercially available femoral traction splint kit (eg, Hare®, Sager®, Ferno-tracTM, KendrickTM)
Drugs for analgesia/sedation (eg, fentanyl, morphine, propofol)
Traction splints may not be as effective on proximal femur fractures.
The femoral shaft excludes commonly fractured parts of the femur such as hip and supracondylar fractures.
Lie the patient supine with the injured lower extremity supported.
Step-by-Step Description of Procedure
Follow the instructions and recommendations for the specific product being used.
Ensure that the stretcher or table is long enough to support the distal end of the device (eg, 20 cm [8 inches] beyond the ipsilateral foot). Use the contralateral, uninjured leg as a landmark if the injured leg is shortened.
Give the patient adequate analgesia.
Stabilize the device against the pelvis and the ankle as directed by the product instructions, including the proper sequence of these steps.
Lock the ankle attachment.
Position any leg support straps as directed (eg, 2 above the knee and 2 below).
Apply longitudinal traction on the ankle to straighten and lengthen the shortened leg to the length of the contralateral leg. Use about 10% of the patient's body weight or up to about 7 kg (15 pounds).
Lock the device in place as directed.
Check for distal neurovascular status (eg, capillary refill, distal sensation, toe flexion and extension).
Remove the traction splint as soon as possible when definitive care is available.
Warnings and Common Errors
Assess distal pulses both before and after splint application.
Ensure adequate traction is applied by using the traction scale if available on the specific device.
Ensure adequate traction by frequently assessing pain relief and length of extremity compared to uninjured side.
Tips and Tricks
Use adequate analgesia (usually IV opioids) because traction splinting of femur fractures is painful.