Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Where is the Evidence for Traction Splints?

 

We eliminated tourniquets from ambulances because of anecdotes and some strong opinions, but not because of valid research. Valid research shows that tourniquets work. Tourniquets are back.

We added traction splints because of anecdotes and some strong opinions, but not because of any valid research. Will research result in the same reversal of opinion-based practice.

With so little evidence, devices that are frequently misused, and no apparent need for these Rube Goldberg devices, should we continue to use traction splints?
 


Image credit.
 

Does a traction splint work?

That depends on what we mean by the word work. If work means that it pulls on the leg, then it does work, but if work means that it improves outcomes, then the traction splint is about as effective as eye of newt. Maybe the eye of newt is more effective.

If your have a lot of patients who have no other major injuries, then you may be able to set up a study of traction splints. A ski resort might be a good place for a study. On the other hand, if you are not an isolated femur fracture magnet, then your patients would probably be much better off if you focused on pain management, rather than pulling on their broken bones.
 

The fact is, there were no definitive studies demonstrating efficacy or decreased morbidity or mortality from prehospital use of traction splints 10 years ago, nor are there any now.3 So our use of traction splints is purely anecdotal.[1]

 

What is an anecdote?

An anecdote is misinformation from a know-it-all who doesn’t know what matters.

Anecdotes are just rumors. We believe some things because we want to believe, not because they are true. If we want to know the truth, we look for unbiased information. Unbiased information is the opposite of anecdotes and rumors.

There I was, standing on the corner, minding my own business, when all of a sudden . . .

He was dying and we gave the special sauce and he got better and ran a marathon last year.

These are examples of anecdotes. Anecdotes are what sells alternative medicine.

Footnotes:

[1] Sacred Cow Slaughterhouse: The Traction Splint
By William E. “Gene” Gandy, JD, LP and Steven “Kelly” Grayson, NREMT-P, CCEMT-P
Jul 31, 2014
EMS World
Article

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Comments

  1. I know it’s anectodal, and a very small sample size, but I’ve had good experience with pain being relieved when traction properly applied (or maybe that was the drugs kicking in at just the right time, who knows). No idea on difference in final outcomes (and n=2 is far too small to consider any sort of reliability), but if it provides relief of pain and doesn’t worsen outcomes, it sounds good to me! (now to just prove reliably that it does work for reduction of pain of course. More research required!)

  2. Here’s a nice recent study looking at pain relief with traction splints. Couldn’t do this in the US, so props to our Iranian EMS friends for doing this!

    Open-access article in the (I am not even making this up) Iranian Journal of Nursing and Midwifery Research.

    A comparison between the effects of simple and traction splints on pain intensity in patients with femur fractures.
    http://www.ncbi.nlm.nih.gov/pubmed/23922601

  3. Just like JB, it’s anecdotal and a statistically insignificant sample size, but I can say that every patient I have applied a traction splint to* has indicated an immediate and significant reduction in pain once traction was applied. If that anecdotal effect holds true under a proper analysis, and there are no detrimental effects found, then the possibility of rapid, non-pharmaceutical pain relief is a worthy benefit all by itself.

    I would like to see a nationwide retrospective study, at least to start. It’s more feasible at this point than a proper RCT, especially since there is currently at least some evidence of benefit.

    On the other hand, if you are not an isolated femur fracture magnet, then your patients would probably be much better off if you focused on pain management, rather than pulling on their broken bones.

    It would seem according to current available evidence that, in the case of femur fractures where traction splinting is not contraindicated, “pulling on their broken bones” is pain management.

    * There was one who did not, but she also denied any pain at any point during our call despite an obvious mid-shaft femur fracture. She stated she had never felt pain from her previous fractures, either, as a lasting effect from suffering childhood polio.

  4. Also significant in the study Brooks Walsh linked to was this: “The spent time in the scene showed no significant difference between the two groups (P = 0.0001).”

    All that being said (from both my comments), this was a very small study, and it was very limited in scope (only looking at pain management through 12 hours). We definitely need a larger study to expand on and verify or falsify those results, and one that looks at differences in levels of disability at discharge and at completion of rehab. While improved pain control is a worthy goal, it’s no good if we’re making recovery harder or doing permanent injury in the process.

  5. I’ve been an urban paramedic for 34 years and, prior to that, a voluteer EMT for 9 years. For those who can’t add, ….that’s a long time.

    How many times have I used a traction splint? …… I dunno, let’s guess 10 times.

    Several years ago, after several years of not even thinking about traction splinting, I found myself using it 3 times in 2 weeks.

    Did it help? Yep, clinically, in my opinion, it helped.

    Will Rogue Medic call my experience “anecdotal” and not worthy of consideration? Yes, he will.

    Don’t care what the Rogue Medic thinks.

    I care about what my patients and my Medical Director thinks.

  6. This leads me to ask a basic question:
    What do we have evidence for in EMS?
    Applying direct pressure with 4x4s for mild bleeding? Splinting at all?
    Do the military tourniquet studies generalize to the greater population who are generally older and less fit?

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