Page 15 - Journal of Special Operations Medicine - Spring 2014

Figure 1 Radiograph of fractures of the shafts of the Figure 2 Volunteer demonstrating application of traction to
ulna (top center) and radius (bottom center); the limb the forearm using a tactical traction splint.
was distally pulseless.

operating room, where the fracture reduction was stabi-
lized with an external fixator.

Discussion
Traction splint use on lower extremity long-bone frac-
tures is well described in the prehospitial and military
3,4
medical literature. Timely reduction and splinting of
5
extremity fractures in a field environment are theorized
to provide pain relief and reduce the potential for ad- splints. Simple manual traction can often be maintained
ditional injury during transport. When an extremity by a medical provider. When only one provider is avail-
6,7
fracture includes vascular compromise, early reduction able to care for such a prehospital patient, an alternative
is essential to restore appropriate distal circulation to the approach is required. The articulating traction splint
limb. After reduction, however, the limb must remain allows continuous traction to hold a forearm fracture
splinted in such a fashion that the vascular impairment reduced, while freeing the medical provider to perform
does not recur. Many limbs risk recurrence of vascular other tasks.
impairment when their displaced fracture reduction is
lost as adjacent soft tissue lose tension. For this reason, It is important to note that the standard training manu-
10
traction stabilization and splinting have been used. als for this item do not include instructions for use
of this device on upper extremity fractures. Personnel
Femoral traction splints maintain continuous counter- should discuss this option with supervisory personnel
forces in an effort to prevent unbalanced soft tissue prior to use in a clinical setting.
forces from displacing. Specialized traction splints have
been used by prehospital providers for many years. This case report demonstrates how this device use may
Most traction splints used in emergency care require a be particularly advantageous for single medical provid-
straightened limb and use of a proximal, truncal coun- ers without other available splint options, for confined
terpoint. These two requirements generally limit their space operations, and for care in austere conditions.
3–5
use to long-bone fractures and the lower extremity. Use
with distal fractures and upper extremity injuries has References
been extremely limited.
1. NSN: 6515-01-250-8936: SPLINT, TRACTION-EXT.
2. SKO NSN: 6545-01-471-2857 (MES SP FORCES TACTI-
The REEL Tactical Traction Splint is a modified ver- CAL)/6545-01-100-1675 (MES BATTALION AID STA -
™
sion of the traditional traction splint commonly seen in TION)/6545-01-496-484 (MES FWD SURGICAL TEAM)/
the prehospital setting. This splint is currently a standard 6545-01-141-9476 (MES GROUND AMBULANCE)/6545-
issue item to most military field medical facilities. The 01-141-9477 (MES AIR AMBULANCE).
distinction from the traditional form of traction splint is 3. Wood SP, Vrahas M, Wendel S. Femur fracture immobiliza-
the ability of the REEL to articulate the strut junctions tion with traction splints in multisystem trauma patients.
™
in multiple places and directions yet maintain stability Prehosp Emerg Care. 2003;7:241–243.
and counterforce pressures without requiring complete 4. American College of Surgeons Committee on Trauma. Essen-
straightening of the entire limb. Using this device, trac- tial equipment for ambulances. ACS Bull. 1983;68:36–38.
tion may be maintained on distal limb fractures without 5. National Association of Emergency Medical Technicians.
counter pressure at the buttock, axilla, or trunk. This Prehospital Trauma Life Support (military edition). 6th ed.
St Louis, MO: Mosby; 2007.
enables the device to be applied to an upper extremity 6. Caroline NL. Emergency care in the streets. Boston, MA:
distal to the elbow (Figure 2). Little, Brown and Co, 1987.
7. Advanced Trauma Life Support for doctors: student course
The incidence of pulseless forearm fractures is low but manual. Chicago , IL: American College of Surgeons, 2008.
8
must be addressed when identified. Most of these inju- 8. Simon RR. Emergency orthopedics: the extremities. 5th ed.
9
ries may be treated with manual reduction and simple New York, NY: McGraw-Hill Companies; 2007.

Articulating Tactical Traction Splint and Pulseless Forearm Fracture 7