Page 14 - Journal of Special Operations Medicine - Spring 2014

Articulating Tactical Traction Splint Use
on Pulseless Forearm Fracture

Daniel S. Schwartz, MD

ABSTRACT
An articulating tactical traction splint (REEL Tactical only one member of the medical team could safely ac-
™
Traction Splint), commonly issued to U.S. military per- cess the patient.
sonnel, was used to maintain traction in a pulseless fore-
arm fracture during a confined space rescue, with good The patient was responsive to voice and complained pri-
peripheral perfusion maintained through transport. This marily of severe left arm pain. Multiple injuries were
enabled a single rescuer to focus attention and provide identified including a grossly deformed left forearm.
care for other critical aspects of a multisystem trauma The hand distal to the injury was noted to be cyanotic
patient. without a palpable radial pulse. Portable pulse oximetry
analysis of the fingers distal to the injury failed to show
Keywords: articulating tactical traction splint, pulseless a numerical reading.
forearm fracture, fracture
The arm deformity was manually reduced. Distal circu-
lation at the radial artery after reduction could only be
palpated during traction on the hand. Pulse oximetry
Introduction
analysis indicated improved circulation with Spo val-
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ues at 89%–94%. Release of traction resulted immedi-
The incidence of pulseless forearm fractures is low but ately in a loss of the palpable radial pulse and oximetry
must be addressed when identified. The majority of readings.
these injuries may be treated with manual reduction
™
and simple splints. Simple manual traction can often An articulating traction splint (REEL Tactical Traction
1
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be maintained by a medical provider. When only one Splint ), commonly issued to U.S. military personnel, was
provider is available to care for this patient, an alterna- applied to the injured extremity to provide continuous
tive approach is required. This case report demonstrates traction to the hand. With the splint adequately secured
how this device application may be particularly advan- to the reduced arm, the radial pulse was palpable without
tageous for solo medical providers without easily avail- manual traction or continued provider intervention.
able evacuation options, confined space operations, and/
or austere conditions. The total extrication time was 44 minutes. The single
rescuer attended to the airway and breathing needs
with oxygen and physical assessment without further
Case Presentation
intervention or treatment of the forearm injury during
A 28-year-old woman involved in a motor vehicle crash the extrication process. During the extrication process,
collided with an electrical pole at high speed. Extensive pulse oximetry readings of the fingers distal to the injury
damage to the vehicle ensued, and the electrical pole indicated adequate perfusion with Spo readings consis-
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collapsed onto the vehicle, creating an electrical hazard. tently greater than 90%.
Vehicle damage trapped both of the woman’s lower ex-
tremities under a deformed dash. Damage also trapped The patient was transported via air to a Level 1 trauma
the patient’s head and neck in a position that prevented center with the traction splint in place. Pulse oximetry
effective use of heavy extrication tools. Professional was used to verify distal perfusion. After initial hospital
rescue personnel surveyed the scene and predicted ex- stabilization, the traction splint was removed with an
trication time would be 30–40 minutes. Access to the immediate loss of distal perfusion as indicated by loss of
vehicle was extremely limited by damage, positioning, pulse oximetry readings and loss of the palpable pulse
and electrical hazards. For an extended period of time, (Figure 1). The patient was transferred urgently to the

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