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Three Part Question

In [Adults with shaft femur fractures], are [traction splints better than simple splints without traction] at [reducing pain, bleeding and other complications associated with femur fractures].

Clinical Scenario

You are part of a mountain rescue team that has been called to a 22 year old climber who fell from a rockface at a height of 8metres. He landed injuring his left leg. His thigh is deformed, swollen and painful and he is unable to weightbear. You suspect a femoral fracture. Are you able to splint the leg in a box leg splint or do you need to call other team members to bring up a traction splint?

Search Strategy

Medline 1950 to present
Embase 1980 to present
Cochrane library
Uptodate online, accessed 20/11/12
Femoral fractures AND traction splints

Search Outcome

15 articles and one uptodate topic were found relating to the topic.
5 look at the history of traction splints, 5 demonstrate case studies with complications from traction use and 5 discuss traction use.
They are all low level evidence using the Oxford Scale of Evidence- all level 4 or 5, based on single case studies or case series

None directly assess outcomes comparing traction with no traction.

Comment(s)

At present there is no evidence demonstrating the benefits of traction. And the evidence is of low level so cannot be used to draw conclusions on best practice.

Clinical Bottom Line

We would advocate the continued use of traction splints until further research has been performed, but recognise that other splints may be appropriate.