Page 19 - Journal of Special Operations Medicine - Fall 2016

A Skeletal Traction Technique for Proximal Femur Fracture
Management in an Austere Environment

David S. Lidwell, MD; Colin A. Meghoo, MD

ABSTRACT
Skeletal traction is a useful technique for managing can serve as a useful tool for the management of these
proximal femur fractures in austere environments where complex injuries. 2
fracture stabilization for this injury is difficult. We pres-
ent a technique and a construct appropriate for field Technique
use that facilitates patient evacuation, and we provide A plain radiograph was used to identify the nature and
guidelines for the use of this technique by an advanced extent of this patient’s bony injury, as well as aiding in
medical provider managing these injuries. The objectives excluding associated pelvic or acetabular injuries (Fig-
of this article are to enable to reader to (1) recognize ure 1). Without this capability, the medical provider
the role of skeletal traction in managing proximal fe- must rely on the suspected mechanism and associated
mur fractures in an austere environment, (2) identify the physical examination findings to suggest the specific in-
key steps in placing transfemoral skeletal traction pins, jury. In those circumstances where a fracture is strongly
and (3) identify options and requirements for building suspected but where the precise proximal extent of the
a traction construct in resource-limited environments. injury to the proximal femur is unknown, skeletal trac-
tion is quite useful.
Keywords: traction skeletal; fracture proximal femur
Placement of the skeletal traction pin into the distal
femur was undertaken after intravenous sedation and
Introduction Figure 1 Anterior-posterior radiograph revealing extensive
An adult man presented to the Forward Surgical Team destruction of the right proximal femur from penetrating
with a penetrating wound to the right proximal thigh trauma. Without radiograph capability, the medical provider
from an improved explosive device blast. Upon further must rely on clinical suspicion garnered from the physical
examination.
evaluation, he was found to have an intertrochanteric
femur fracture. This case report presents a technique
useful for advanced medical providers in the manage-
ment of similar injuries in an austere setting.

In the prehospital setting, proximal femur fractures, par-
ticularly in the peritrochanteric region, are challenging.
This is especially true in remote environments where re-
sources are limited and where prolonged time to trans-
fer is commonplace. Optimal management is required
to stabilize these fractures and to facilitate medical
evacuation to definitive care. Early fracture stabilization
minimizes further trauma to the injured extremity and
enhances patient comfort and well-being. Externally
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applied splinting devices may be inadequate, unavail-
able, or potentially injurious, and placing external fixa-
tion pins without radiographic guidance may be limited
by circumstances. The technique presented here for skel-
etal traction is readily learned, adapted to austere envi-
ronments, and tailored to evacuation requirements that

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