Page 95 - JSOM Fall 2023

FIGURE 1. Common splints. Three common prehospital splinting techniques include: (A) a traction splint that pulls the fractured limb distally;
(B) a simple “box splint,” that stabilizes the fracture with a rigid support around three sides; and (C) a vacuum splint that encloses and molds
thousands of small balls around an injured extremity and can provide rigid support after deflation.

TABLE 1 Splint Advantages and Disadvantages – Different Types of Splints That Could Be Used in a Far-Forward Environment and their
Associated Advantages and Disadvantages
Intervention Advantages Disadvantages
Plaster or Fiberglass Bandage Malleable, lightweight, compact, may allow weight Long hardening times (1/2 - 72 hours), limited
bearing wound access, sensitive to environmental factors
(e.g., precipitation)
SAM Splint Adaptable, lightweight, portable, allows wound Difficult to maintain fracture alignment and
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access, short application time (203 seconds) traction, allows motion between the limb and device
Spray Foam Cast Adaptable, lightweight, portable, simple and Limited wound access
rapid application (68 seconds), rapid set time (60
seconds), robust
Traction Splint Adaptable, compact, allows wound access, Does not allow weight bearing
maintains traction, relatively short application time
(≤5 minutes), one person application
Air Splint Lightweight, customizable pressure to tissues, rapid Limited durability and adaptability,
application limited ability to provide traction
Vacuum Splint Adaptable, customizable pressure to tissues, one Limited wound access, does not allow for weight
person application bearing, requires a vacuum apparatus, limited
durability, prone to environmental factors
Improvised Splint Adaptable, uses readily available materials, may Difficult to maintain fracture alignment, allows for
allow wound access, one person application, can motion between limb and apparatus, does not allow
add supplemental traction weight bearing

placing a shoe lift on the contralateral side, the Thomas splint pain, protect neurological and vascular tissues, and reduce
has even permitted ambulation post-injury. 28,31 A primary fracture-related internal hemorrhage in individuals with lower
drawback to the Thomas splint design is its lack of portability, extremity long bone fractures. 20,21,23,32 This class of splint is
which led to the development of collapsible splinting systems, most commonly used to treat femur fractures and fractures
such as the CT-6 traction splint (Faretec Inc., https://www. around the knee. Despite their relatively simple design, several
faretec.com/) and lightweight designs, such as the simple struc- pitfalls have been identified. First, the length of components
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tural aluminum malleable SAM splint (SAM Medical, Tuala- required to span the entire lower limb makes traction splints
tin, OR, https://www.sammedical.com/) (Figures 1A, 1B). relatively cumbersome and requires some assembly. Second,
the ability of various designs to maintain traction over time
The Thomas splint led the way for the modern prefabricated has been brought into question. In one study, simple frame-
traction splint. Traction splints require one or two rigid poles based splints applied by civilian medical personnel were not
running along the long axis of the extremity and a mecha- able to maintain the optimal traction of 10% bodyweight, as
32
nism to pull the extremity distally to minimize motion between measured 30 minutes after application. However, other stud-
bone fragments (Figures 1A, 3). A splint that provides traction ies showed successful application of the same type of splint
of at least 10% of the patient’s body weight may help reduce immediately after application to a mannequin that does not

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