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Can an above knee back slab be used in place of a thomas splint to manage midshaft femoral fractures in the emergency department.

Three Part Question

In [adult patients with an uncomplicated midshaft femur fracture] does [the application of an above knee back slab instead of a thoms splint] alter [the analgesic requirement or the patients outcome]?

Clinical Scenario

A 25 year old man is brought into the emergency department after being hit by a car. He has a closed midshaft femur fracture with no neurovascular compromise and no other injuries. The orthopaedic registrar asks you to put him in a thomas splint. You are unsure how to apply the splint and wonder if an above knee back slab would be reasonable since he is likely to be operated on tomorrow.

Search Strategy

medline 1960 - 2007
Embase 1980 - 2007
Cochrane Database
[exp midthigh OR exp femur OR exp femoral] AND [fracture] AND [splint OR traction splint OR thomas splint OR back slab OR preoperative care]

Search Outcome

There are no papers comparing the use of thomas splints or other traction splint devices with an above knee back slab.


The search did not find any studies which have compared the use of thomas splints (or any other skin traction) with above knee back slabs in the pre operative management of midshaft femur fractures.

Clinical Bottom Line

For the time being it would be safest to continue to use the thomas splint. Despite potential complications including pressure areas and perineal trauma they are believed to limit haemorrhage and relieve pain due to muscle spasm. When introduced during the first world war they significantly reduced the mortality associated with femoral fractures, however this was before the development of femoral nailing. A trial is needed to directly compare traction splints with simple back slab immobilisation prior to surgery to evaluate any differenc in outcome.