Page 61 - Journal of Special Operations Medicine - Summer 2014

Table 5 Participant-Reported Advantages and Disadvantages
Kendrick Traction Device REEL Splint Slishman Traction Splint
CT-6 (KTD) (RS) (STS)
ADVANTAGES
• Pulley system used for • Labeled/color-coded straps • Can be adjusted and used for • Only splint that can be
traction gives distinct may aid in recall under patients with disarticulation applied on a patient
mechanical advantage stressful conditions injuries with lower leg injury or
• All components come • Compact storage design with • Bipolar design keeps the leg amputation
attached to the device for some manufacturers offering immobilized to a high degree • Components do not extend
easy accountability external MOLLE below the foot allowing
• Carbon fiber pole is • Knee strap application prior for increased ease of
desirable for strength and to pulling traction prevents transportation
weight savings pole bowing • Slim profile is ideal for
• Lowest unit cost dismounted carry
• Lightest unit weight • Fewer components and
adjustments than other
• Compact MOLLE pouch splints
• Strong, rigid pole that is also
lightweight
DISADVANTAGES
• Pulley system may become • Per manufacturer, the KTD is • Contraindicated on patients • The ability to completely
tangled, which increases a traction “device” and other with coexisting pelvic fracture separate poles when
application time and reduces splinting materials may be • Undesirable weight and adjusting coarse traction due
traction applied required dimensions for dismounted to lack of internal stopping
• Multiple hook & loop • Multiple components that use device may make application
components can become are not attached increase risk • Requirement for assistance more difficult
attached to one another for loss with application removes • Field repair would be
and cause difficulty in • Plastic and thin aluminum another man from the fight difficult if the internal
application components provide • Multiple sites of adjustment mechanism is damaged
• No color coding of straps questionable durability in found to be confusing • No color coding/labeling
combat situations of straps
• Multiple manufacturers

During World War II, the Thomas splint was again used EMS was a rare event and that rigid splinting or long
as a mainstay of care, its success in World War I believed backboard immobilization alone was acceptable, mak-
to be obvious. Allied forces fighting in the rough terrain ing traction splints an expensive luxury if not unneces-
of North Africa modified the Thomas splint by wrapping sary. Another study in Sweden found only 57 patients
it in padding and plaster-of-Paris to create the “Tobruk with femoral fractures over 5 years for one urban EMS
splint.” This allowed for greater stabilization during system. Seventy-seven percent of fractures were caused
17
medical evacuation through rough terrain and better by low-velocity trauma such as household falls, pre-
conservation of limited supplies than the previously-used dominantly in an elderly population. 22
plaster-of-Paris spica. In 1961, the American College of
Surgeons recommended that traction splints be included A retrospective review of 40 multisystem trauma pa-
19
in every ambulance in the United States. Glenn Hare, a tients transported by a helicopter EMS program in Mas-
Los Angeles policeman and ambulance attendant, devel- sachusetts found that 38% of traction splints had been
oped the familiar Hare traction splint in 1969 by adding a applied to patients with contraindications to Hare-type
23
20
ratchet mechanism to a Thomas splint. The first unipo- splints. The primary contraindication listed was an
lar traction splint, the KTD, was first introduced in 1986. associated pelvic fracture, not a concern with unipolar
splints (CT-6, KTD, or STS) which do not rely on an

Civilian Sector Concerns intact pelvic ring to function. A descriptive article at-
More recently, the utility of traction splints in civilian tempted to popularize the position that traction splints
emergency medical services (EMS) with short transport in civilian EMS were a little-used “relic” that should be
times has been questioned. In a “low-volume urban removed from civilian ambulances. These authors ar-
EMS system” in Illinois, only five of 4513 (0.11%) pa- gued there was a paucity of data for their necessity, and
tients seen in 1 year presented with injuries suspicious to there was evidence of harm with the rare complication
field personnel for femoral fracture. In 87.5% of cases, of temporary peroneal nerve palsy associated with the
these patients were treated by placement on a long back- Hare-type bipolar splints most commonly used in the
board alone without negative sequelae noted. This led civilian setting. 24,25 Another article reported an instance
21
the author to conclude that femoral fracture in civilian of popliteal skin breakdown in a frail, elderly patient

Evaluation of Traction Splints for Battlefield Use 51