However, its important to remember that absorption rates may vary depending on the patient, injury and co-morbid factors. The cookies is used to store the user consent for the cookies in the category "Necessary". Ice can also numb a sensitive nerve and offer your patient more pain relief. St. Louis, Mo., 2007. These injuries are grossly deformed, swollen and painful. 2. This site complies with the HONcode standard for trustworthy health information. Recent labs reveal an ESR, CRP and 25-hydroxyvitamin D2 of 32 mm/hr . Ensure the patient hasadequate pain relief,often requiring opioid analgesia +/-regional blockade(such as a fascia iliaca block). "Contraindications for Spinal Traction". Figure 2 An AP view of plain film radiograph, demonstrating a mid-shaft femoral fracture. Traction splinting devices can be used on both open and closed isolated femur fractures : Author: Common Cents EMS Supply is a proud distributor of these products. the pin, curette the pin tract, and replace the pin in the operating Most fractures tend to deviate toward valgus angulation because the fracture zone is mistakenly allowed to sag medially while upward tension is mistakenly applied to the stirrups. Prietto CA. So then no manual traction is being held, While we are at it, it was never explained to me if a traction splint. who have suffered a suspected femur fracture. application of traction splints for femur fractures (open or closed) is likely not to impact patient outcome. Also, check for adequate sensational capillary refill distal to the effected area by blanching the nail bed (usually fewer than three seconds). Pelvic injuries are another contraindication of traction splint use, due to the pressure it places on the posterior wall of the pelvic ring. Types of injuries Fractures: Mosbys medical dictionary defines a fracture as: A traumatic injury to the long bone in which the continuity of the bone tissue is broken. A fracture can be classified as closed or open. The Sager traction splint is a unipolar split that can be used to align femur fractures. We_re expected to know all about splinting, including what injuries we should splint in the field. "Contraindications for Spinal Traction". Specifically, these include: Pelvic or hip fracture; Hip dislocation; Knee injury; Tib/fib, ankle or foot fracture; I did find one interesting study from 1999 that looked at how useful these splints . Contraindications of splints compartment syndrome need for open reduction infected skin condition or. with abscess does occur, then drain it by extending the stab wound. plaster splint. 37 unfortunately, such comorbidities are common with severe wilderness injuries, which makes it impossible or dangerous to anchor the traction splint. Indications EMR: Open or closed mid-shaft fractures of the femur in patients who are otherwise clinically stable In the field, open femur fractures are contraindications to traction splint application Significant injuries to the knee Traction can overcome muscle spasm 2), and should include an AP and lateral of the entire femur, including the hip and knee. There are many commercial brands available which vary slightly in their design and instructions and thus require individual familiarity for correct use. Once these early assessment procedures are completed, examine the injury more thoroughly. Traction to the lumbar spine is contraindicated in various conditions. JavaScript is disabled. When a person injures an extremity, they frequently attempt to protect it from further injury by holding it against their body. hand [10] If the patient is not stable, do not waste time trying to apply traction splint at the scene. We'll assume you're ok with this, but you can opt-out if you wish. - A patient with a midshaft femur fracture. Comments should be on the topic and should not be abusive. In a case in However, they noted these splints should be used for isolated femur fractures and gunshot wounds in casualties without . Traction is a medical term the refers to the process of slightly. Measure splint to the correct length by placing flat next to the patient's uninjured leg. Contraindications for the use of traction splint: Injury is close to the knee Injury to the knee Injury to the hip Injury to the pelvis Partial amputation or avulsion with bone separation, distal limb is connected only by marginal tissue. Thomas To find out more, read our privacy policy. During your early assessment, also examine the temperature of the limb. What sedentary excercises should I do sitting in the office? Other classifications of fracture appear in Table 1 below. James Bartlett: Sudbury, Mass., 2005. The traction splint is the prehospital splint of choice for femur fractures because of its ability to stabilize injury and reduce pain and hemorrhage. DEPARTMENT OF ORTHOPAEDICS J.J.M MEDICAL COLLEGE DAVANGERE SEMINAR ON TRACTIONS IN ORTHOPAEDICS MODERATORS: DR. A.K.RUDRAMUNI (Professor ) DR. RAGHU KUMAR J. IV. I am a patient who had a multi-level lumbar laminectomy and now present with radiating leg pain that has been diagnosed as a pinched nerve. the pin, then tight The cookie is used to store the user consent for the cookies in the category "Other. Volume 4: Trauma Emergencies. External fixation(with subsequent delayed conversion to intramedullary nail) may be used in unstable polytrauma or open fractures, to ensure the patient is physiologically optimisedprior to definitive fixation. tendons and neurovascular structures. Its important to remember the massive amount of kinetic energy it takes to fracture the femur and that this force frequently causes other injuries, especially to soft-tissue regions. - Contraindications: Severely deformed open femur fracture, or with tib-fib, pelvic or hip fractures; hemodynamically unstable patient. Contraindications for traction splinting include hip or pelvic fractures, supracondylar fractures, fractures of ankle or foot, or partial amputation. Double traction splints stabilized the injuries. There are several contraindications to the use of traction splints: -The patient has an open fracture -The patient has a suspected spinal injury -The patient has a suspected pelvic fracture -The patient has a suspected hip fracture -The patient has a suspected femur fracture -The patient has a suspected knee fracture Medindia. Commonly involved areas that may have fractured include the ankle, tibial shaft, tibial plateau, pelvis, and spinal fractures. Some require short term traction ie. Objective: To evaluate the frequency of concomitant injuries that can complicate and/or contraindicate the use of traction splints (TSs) for femur fracture immobilization (FFI) in a population of multisystem trauma patients. APPLY THE HARE TRACTION SPLINT. By providing appropriate care and pain relief to your patient, youre serving as the patients advocate, which is the goal we should seek on every call. Necessary cookies are absolutely essential for the website to function properly. Splinting: How to use a Sager Traction Splint.https://sites.google.com/site/emtbasicskillsvideo/ This wound can be caused by bone edges puncturing the skin from the inside out, or by the external force compressing or shearing the skin, causing the open wound to result from the outside. It may initially cause the injury to throb a bit because it causes blood vessels to constrict, but it decreases the swelling of an injury and the pressure that swollen tissue exerts on the injury. It will also greatly speed medication administration if the local services choose to intercept with an intermediate or paramedic service. 2, as well as the Kendrick Traction Device KTD and are all designed by Rick Kendrick, a leader and innovator in Fire Rescue - EMS for over 30 years. Splinting techniques are used to treat musculoskeletal system abnormalities. These cookies ensure basic functionalities and security features of the website, anonymously. The physical therapist should take a proper medical history before prescribing traction for lumbar pain. for as long as required. While the leg is supported in traction, place the ring on the limb. Remember that the anatomy underneath this splint is very susceptible to injury. Dr. Shivani Nayar. Deformity is an obvious sign that an injury exists below the surface of the skin. Dec 11, 2022. > Henry M, Stapleton E: EMT Prehospital Care, 3rd edition. weight. (accessed Dec 11, 2022). Step-by-step procedure for applying a halo ring. In most states and the NREMT it is contraindicated unless you have an air traction splint. > White LJ, Cooper JD, Chambers RM, et al: Prehospital use of analgesia for suspected extremity fractures. Prehospital Emergency Care. Like many whove seen the statistics on prehospital pain treatment, I was stunned at the results of an Ohio study that showed only a small number of the patients had their pain addressed by EMS. When should you not use a traction splint? Gentle longitudinal traction may be exerted while the splint is being applied, except when the injury site involves a joint, a dislocation, or an open fracture. Lower leg or ankle injury Take appropriate body substance isolation precautions. Perform the following procedures after the The Thomas splint: questionable boast of an indispensable tool. ConclusionMany prehospital providers think of splinting as a basic skill. Femoral Traction Splinting BLS PROCEDURE BP-08. Open fractureswill need to be managed appropriately (discussedhere), including antibiotic prophylaxis, tetanus and medical photography. 24 hours whereas others require it for a number of weeks ie. 3-3. As perATLS guidelines, an A to E assessment is vital,stabilising the patientand ensuring appropriate fluid resuscitation. is impossible to anesthetize the area between the two bones. Fractures often become swollen as fluid from bruised tissues leaks into the interstitial spaces and blood flow to the area is increased to promote healing. 5 controversy exists regarding whether a traction TRACTIONS Traction is a method of restoring alignment to a fracture through gradual neutralisation of muscular forces. bed. absolutely mandatory. 1 venouscutdown ACNP, CCP | Canada 3 yr. ago Hard no. are recommended (Fig. Humeral shaft fractures are common fractures of the diaphysis of the humerus, which may be associated with radial nerve injury. In the presence of neurovascular compromise, the fracture can be manipulated to allow for restoration of pulses distal to the fracture. Later that shift, I took over care for this patient. (Professor) 3. Tenderness is also a reliable indicator that an injury is present. Your comments are automatically posted once they are submitted. Apply manual stabilization 34(5):65, 67-71, 2005. Trauma significant enough to snap a femur is likely strong enough to cause other issues, possibly even rendering the victim unconscious. the pin approximately halfway through the bone, get an idea where it two tibial cortices. Femoral fractures should besurgically fixedwithin 24-48 hours, although sooner if an open fracture. Photo Ed Dickinson. Last updated: March 9, 2022 Application of traction splints to the femur can be a bit tricky, mostly because of the various indications and contraindications. The significance of open fractures is they have a high risk for infection in the bone, called osteomyelitis. This cookie is set by GDPR Cookie Consent plugin. January-February: P12-21, 2008. Position the patient supine on a bed with the head extended beyond the edge. The splint itself does a good job of managing pain, when properly applied. The cookie is used to store the user consent for the cookies in the category "Performance". Apply longitudinal traction on the ankle to straighten and lengthen the shortened leg to the length of the contralateral leg. Most bacteria are opportunistic; if an entry point is accessible, bacteria will travel through it to an area that may not be able to prevent infection. (While we are at it, it was never explained to me if a traction splint could be used an open femur fracture - could you explain that to me? Femoral shaft fracturesare common, especially inhigh-energy trauma, with an incidence of around 4 per 10000 person-years. Surgical Management Femoral fractures should be surgically fixed within 24-48 hours, although sooner if an open fracture. overhead pulley, with the weight attached to the rope at one end of the Faretec CT-EMS & CT-6 is a Leg Traction Splint designed for Pre Hospital Care and Patient transport. You also have the option to opt-out of these cookies. Traction to the lumbar spine is contraindicated in various conditions. I suffer from Discogenic pain. Morphine and, in some cases, fentanyl, is approved for use by EMT-Intermediates in some states, such as Wisconsin and New York. Supracondylar fractures of the humerus. Therefore, if you apply unnecessary traction to this joint, you can further tear tendons and ligaments that are already injured. In my mind, this is a bit too simplistic. The bone is supplied by penetrating branches of the profunda femoris artery, therefore large volumes of blood (up to 1500ml) can extravasate if fractured. But having been a paramedic for 12 years and an ED nurse for four, I knew the injury wasnt the only cause of her pain. The For relatively unstable complete fractures, one assistant may be required for limb support and another for traction on the stirrups and bandaging assistance. Mosby EMS: Philadelphia, Pa., 2007. It is designed to offer an impermanent steadiness at the scene for transportation to the particular healthcare institution. of the splint or by a crossbar attached to the plaster cast. Compound fractures of the Femur with bone fragments sticking through the skin may be a contraindication. parallel There is an assistant. All comments are however constantly reviewed for spam and irrelevant material (such as product or personal advertisements, email addresses, telephone numbers and website address). It is primarily used on patients with mid-line femur fra. Results: The use of the traction splint for a femur fracture in the pre-intervention stage was found to be underutilised (Median 16%). The patient sustained bilateral femur fractures in a high-speed frontal impact crash. I DID NOT have any fusion. Traction splinting, such as a Kendrick traction splint, are used in suspected or isolated fractures of the mid-shaft femur, acting to hold the femur in correct position against action of the large thigh muscle mass. rotation of the extremity by a light counterweight attached to the side Finally, along with splinting, ice, elevation and positioning, the touch of another human being has been shown to reduce the anxiety level of patients in pain and should be used in conjunction with your reassuring words. Where a pathological cause is suspected, further work-up bloods, such as a serum calcium, may be warranted. 1. An improvement was also noted in staff perception and understanding of the management of femur fractures. There are no contraindications. Generally speaking, unless you have a traction splint device of some sort, you aren't going to be easily able to pull traction on a broken femur. In these cases, the injury should be splinted in the position found, unless circulatory compromise exists, in which case the injury site should be straightened only enough to restore . I helped her move to a bed, shifted her ankle onto a big, soft pillow, loosened the splint and checked for pedal pulses. Patients who survive the initial trauma associated with the injurytypicallyheal well. The splint should be secured with the appropriate straps or fasteners and the extremity rechecked for CMTS after splinting and frequently throughout patient transfer to the hospital. B. increase the risk of infection. used in the lateral position (Fig. The patient will present withpain or swelling in the thigh, hip and/or knee pain, andunable to weight bear. We use traction splints on open femur fractures, wash out with 2L of saline first. It is especially useful for cervical spine There are several different types of commercially made traction splints available. Indications Suspected femur fracture Contraindications The injury is within 1-2 of the knee or ankle The knee is injured The hip is injured The pelvis is injured Therefore, EMS personnel should defer to their agency protocols and medical directors recommendation regarding the careful repositioning of fractures. This type of infection usually requires large doses of antibiotics and, when left untreated, can be limb or life threatening. You use 10% of the PT's weight for traction (max 15lbs), and a max of 5lbs for open fracture. EMS, like many other facets of health care, is now moving toward evidence-based practice. Is our article missing some key information? Early mobilisation following surgical intervention greatly reduces complications. "Once the traction splint has been positioned under the leg, and the ankle hitch is applied, manual traction can be released." . These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Some splints are better suited for specific fractures, but if a fracture is suspected or diagnosed, using standard splinting guidelines has no absolute contraindications. Treatment can be nonoperative or operative depending on location of fracture, fracture morphology, and association with other ipsilateral injuries. Aplain film radiographis the only routine imaging that is often needed (Fig. Dr. Shivani Nayar. Pediatric patients are not small adults and have a different physiological structure (e.g., a large occiput); they need that extra pad on the pediatric longboard to prevent neck flexion (C-spine) and airway compromise. Skeletal traction through the olecranon may also be suspension and fixed skeletal traction (which is discussed next) (Fig. to the ankle joint and angulate it slightly anteriorly. emergency department, conscious sedation should be utilized. 29(8):65-68, 2004. Medindia, viewed Dec 11, 2022, https://www.medindia.net/patients/lifestyleandwellness/traction-for-lumbar-pain-contraindications.htm. He has an open fracture to his right femur. This gives added support to the splint and prevents movement of the joint and extremity, and shifting of bone ends. It's a system where a combination of pulleys, pins, and weights are used to promote the healing of fractured bones. For safety reasons, place no weights over the patient. It may not display this or other websites correctly. 6 weeks. An elderly patients skin is fragile, and can bruise or tear easily. Seen a lot in children with fractures and other injuries, this is called guarding and serves as a form of self-splinting. Therefore, capillary refill must be just one of your diagnostic indicators of circulatory perfusion to the distal region of an extremity. Common in children. fractures and dislocations. Henry BJ, Vrahas MS. Traction splinting is a useful tool for femur fracture alignment, increasing arterial blood flow, . The editorial team reserves the right to review and moderate the comments posted on the site. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. The company that makes the Hare traction splint gives the sole indication as a suspected femur fracture, and the sole contraindication as an open femur fracture. Patients presenting following amajor traumashould be investigated and managed as per the ATLS protocol. Among the recommended methods for stabilization of mid-shaft femur fractures is the use of a traction splint.The adage has been that open fractures should be "splinted as they lie". The necessary equipment will be adjacent to the patient or brought to the field setting. Pelvic slings are now being used increasingly in the prehospital environment. Photo Ed Dickinson. You must log in or register to reply here. Radiolucent design enables X-Rays and Catscans to be taken without . 9-11). These are usually in . If I remember correctly, the femur injury only has to be stabilized before using the traction splint. Please use one of the following formats to cite this article in your essay, paper or report: Dr. Shivani Nayar. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. An incomplete linear break in a bone. This can cause further tissue or vessel damage and increased hemorrhaging. Most orthopedic specialists feel that the anatomical position occurs when the body naturally rests to alleviate stress, exertion and pain and argue that repositioning protects against further injury and makes the patient more comfortable. The, Support the leg in traction with pillows or folded bath blankets to, The wires and pins are available with two types of points. If this does occur, be sure to advise the ED staff and note it on your patient-care report so theyre aware of it and manage the patient accordingly. "use strict";var wprRemoveCPCSS=function wprRemoveCPCSS(){var elem;document.querySelector('link[data-rocket-async="style"][rel="preload"]')?setTimeout(wprRemoveCPCSS,200):(elem=document.getElementById("rocket-critical-css"))&&"remove"in elem&&elem.remove()};window.addEventListener?window.addEventListener("load",wprRemoveCPCSS):window.attachEvent&&window.attachEvent("onload",wprRemoveCPCSS); Femoral Neck Fracture: Closed Reduction and Internal, Pathologic Fractures Associated with Tumors and Unique, Subtrochanteric Femur Fractures: Reconstruction Nailing, Ovid: 5-Minute Sports Medicine Consult, The, Rotator Cuff Tear: Arthroscopic Treatment, Anterior Glenohumeral Instability: Conservative Treatment,, This website uses cookies to improve your experience. Contraindications for Spinal Traction. Traction Splint Usage. However, wouldn't that be pretty much the same thing? If done in the Multisystem trauma and other injuries contraindicate traction splint usage for many femoral fractures. Control > Pollak A: Emergency Care & Transport of the Sick & Injured, 7th edition. Before Traction D. . It was obviously fractured but haphazardly immobilized with a padded disposable cardboard splint. which the wire penetrates two bones, such as the tibia and fibula, it However, if you meet any type of resistance during repositioning, stop the attempt and splint the extremity in the position found. Because fractures are painfulPain management is something that many EMS agencies are working to improve, particularly when dealing with fractures. 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As previously mentioned, this sometimes results in an extra joint, but other times the deformity is subtle. But sometimes the patient needs more than a splint. A sprain is caused by the twisting or pulling of a joint beyond its normal range of motion, causing soft tissue injury to the underlying tendons, muscles and ligaments. Suspected femur fracture. As I left her side, she thanked me for being gentle. Dress the pin site with sterile 4 4s on each side with Betadine We present a case of skin complication. Following the intervention period, however, traction splint use increased significantly (Median 50%). His surgical wounds appear well-healed with a small sinus tract over the open fracture site. will come out, and then anesthetize the opposite side. Fractures that have no break in the skin are calle closed fractures. These splints, like the others, decrease the patients pain associated with their injury. The proximal fragment is invariably pulled into flexion and external rotation (by iliopsoas and gluteus medius & minimus, respectively), which can further tent the skin. The hare traction splint is designed to be used on those patients. A femoral shaft fracture requiresimmediate reduction and immobilisation; reducing fractures to near-anatomic alignment using in-line traction will ensure appropriate haematoma formation and reduce pain. Drill Skeletal traction is a treatment method for broken bones. Ice is an often-overlooked but extremely effective pain management tool. The knee is a complicated synovial joint. Gardner W. The principle of spring-loaded points for cervical traction. Extend so that the patient's heel is approximately 10cm above the heel stand bracket. What are contraindications for a traction splint? ropes at either end of the bed but not over the patient. Painful, swollen, deformed, isolated mid-thigh injury with no other leg injury - contraindications would be anything other than those conditions. Diagnosis is made with orthogonal radiographs of the humerus. Proper use can decrease the pain and damage caused by the fracture. Ok, stupid questions incoming from new EMT. *Referred pain is particularly common in the elderly population with femoral shaft fractures. We also use third-party cookies that help us analyze and understand how you use this website. > Porter K, Lee C: Prehospital management of lower limb fractures. Emergency Medicine Journal. Bruising also alerts us that an injury has occurred. Proper splinting increases arterial blood flow, decreases pain and spasm, and lowers the risk of further injury from bone fragments. who have a comminuted tibial plateau fracture. Original use of the traction splint, first popularized by Dr. Thomas during the First World War, included the use of the device for femur fractures resulting from gunshot wounds, which by definition are open fractures. 2022 - TeachMe Orthopedics. Advertisement. The splint supposedly saved lives in open femur fractures from gunshot wounds, though there are no studies to demonstrate this.2. screwed into the skull without the need for previous trephining and A true diagnosis of displacement must be diagnosed by X-ray. Except for joint injuries, extremities should be splinted in their correct anatomical position unless resistance is met as you do so or theres a disruption int he extremitys circulation. The rest of the modern pathology requires years and decades to create an acute event; if possible to manage or reverse, it takes years. 25. Photo David Elroma. Ensure to perform afull neurovascular examinationof the lower limbs to check for any vascular or peripheral nerve injury, as well as a thoroughsecondary surveyfor associated injuries. Apply manual inline traction. Preoperative traction in patients with hip fractures. Traction splint is a useful emergency tool to align the femur fracture better, increase arterial blood flow, decrease pain and spasm, and reduce the risk of further injury from fractured bone fragments. A couple of months ago, while walking through an emergency department (ED), I saw an EMS crew rolling a young woman in a wheelchair toward the triage desk, and I noticed how uncomfortable she was. Jerre R, Dosh A, Karlsson F, et al. Traction splints may apply pressure on the pelvis in order to achieve traction, potentially worsening an injury. We use cookies to improve your experience on our site and to show you relevant advertising. Application of traction splints to the femur can be a bit tricky, mostly because of the various indications and contraindications. It aims to restore and maintain straight . Dress any open wounds on the leg before applying the traction splint. Skin traction is far less invasive than skeletal traction. Morphine, Dilaudid, fentanyl and Toradol are options for pain management in many states. Follow your local protocols when using traction splints because of the potential for making undetected soft tissue injuries worse. If an infection Such insertions do not conform to our, Yoga, Physical Therapy Reduce Back Pain & Improve Sleep, This site uses cookies to deliver our services.By using our site, you acknowledge that you have read and understand our, Dr. Shivani Nayar,B.Sc (Physiotherapy), PG in Hospital Management, Spinal Cord Injury - First Aid and Emergency Treatment Guide, Back Pain - Backache - Workplace - Prevention - Exercises, How to Reduce School Bag Weight - Simple Tips, Pott's Disease and all inflammatory diseases of the vertebrae, Cardiac or circulatory disease and severe respiratory problems, Post-operative patients within 3 months of back surgery, Vertebral fracture within 6 months of initial injury. One is a, Note that pins and wires are frequently used as, Pin or wire insertion is a surgical procedure, so, Pins and wires should be inserted using a. that as soon as the drilling stops, the pain will cease. So in the case of an open long bone fracture, lets say radius/ulna this time, we pull manual traction and the bones are realigned. During splinting, take care not to cause sharp bone ends to move unnecessarily and re-enter the wound. The Gardner-Wells tongs The Prometheus Traction Splint (PTS) was created with valuable input from end-users and has built in features that are an advancement on the traction splints . As they passed by, I saw that her ankle was dangling near the ground, unsupported by the wheelchair pedal. Check to see that CMTS is present at the distal end, especially if youll need to reposition the extremity during splinting. A fracture of the Pelvis occurring with a fracture of the Femur is generally a contraindication for the use of a traction splint of any type. Check the casualty's distal pulse. should feel the pin pass through the two fibular cortices and then the (paraphrase of Veneficus). This reduces movement and the subsequent pain it causes. Out of 1,073 people diagnosed with an extremity fracture, only 182 (17%) received ice, 268 (25%) had a splint placed and 18 (1.67%) received pharmacological treatment. Just like with any other splint, once a traction splint is applied, CMTS should be checked to establish that they remained intact, and hopefully improved. The white surface within this open fracture is the open joint surface of the disrupted bones. and wrist usually tire in this position, support the wrist with a Tractions splints, love them or hate them, still work wonders at immobilizing fractured femurs and reducing associated hemorrhage and pain (see photo below). The cookie is used to store the user consent for the cookies in the category "Analytics". Tell the Legs should be realigned as part of open book fracture management. Traction splints for femoral fractures made their pre-hospital debut in 1915 during World War I (12). Supporting ligament and tendon injuries are a common complication. The company that makes the Hare traction splint gives the sole indication as a suspected femur fracture, and the sole contraindication as an open femur fracture. Procedural Protocols. A. They found that 38% of patients had contraindications to traction use, most commonly a concomitant pelvis fracture. C. decompress the nerves and tissue. Any femur fracture that has broken the skin What is a compound fracture? IDF physicians in 2007 felt traction splints were "essential" for wartime extremity injuries. Is traction a viable form of treatment since I am 5 months removed from the surgery?? It does not store any personal data. We should also think of the goals of splinting, which are simple: immobilize potentially broken bones, reduce the chance for further soft tissue injury that bone movement can cause and decrease the patients pain. Traction can allow joint motion while maintaining alignment of the fracture. A fracture in which the bone has broken completely and pierced the skin Why would you NOT want to use a traction splint with exposed bone ends? Traction splints should not be used for proximal or distal fractures of the femur, or where there are knee, lower leg, ankle or foot injuries, or in patients with pelvic fractures. scalp is cleaned and draped; local shaving is sufficient but is not Sager Traction Splint (Unipolar Traction Splint) The Sager is a unipolar traction splint, which means it uses one external pole to support the injured leg. skin adherence to the pin predisposes to an infection. But opting out of some of these cookies may affect your browsing experience. Lock the ankle attachment. This is especially true when placing splints or other spinal immobilization devices on elderly or very young patients. Medindia. - The same as in getting someone with a femur fracture (with indications) secured into a traction splint and then just loosening up the straps and cranks? Retrieved on Dec 11, 2022 from https://www.medindia.net/patients/lifestyleandwellness/traction-for-lumbar-pain-contraindications.htm. Hcp contentposted june 18, 2014 in zimmer biomet surgical . The splint wasnt even cut to fit the bend of her ankle. Like other skills, the more we splint, the better we get. Photo Ed Dickinson. This results from a simple law of physics: Blood has a harder time flowing uphill than down. remove Traction splints should be changed to skin traction by an orthopaedic specialist as soon as possible. A Pearson attachment The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site. The petite patient was scrunched down in the wheelchair, almost curled into a ball, softly crying. Photo courtesy Ed Dickinson, The splint should cover the joint above and below the fracture site. Overview. 24. This type of fracture, if not managed carefully, can cause abnormal growth of the bone.. Traction splints have utility in the management of both closed and open fractures of the femoral diaphysis. A. - Verbalize: Traction splint not intended to realign fracture; used to reduce muscle spasm. If the pin is placed too far It's only used for serious fractures that can't be treated with a cast or splint. These are simple ways to decrease their anxiety and consequently decrease their pain. A comparative study of Dunlops traction versus percutaneus pinning. Traction is pulling effect exerted on a part of skeletal system. Soft tissue injuries, such as sprains or strains, are frequently splinted in the ED because a splint provides support and protection, and prevents the injury from being jostled excessively, causing further damage and pain. A cold, clammy extremity may be indicative of a circulating impairment secondary to the fracture or position of the bone. They consist of other injuries or fractures that could sustain further damage from traction. I asked one of the EMTs to place her foot on the wheelchair support pedal and immediately saw the patients facial expression change as she experienced relief from the pain caused by the lack of support for her fracture. Young R, Thomassen EH. Placing a blanket between the patient and a splint or backboard provides some padding, as do towels in voids between the patient and the immobilization device. Attach a single, Make a supporting or master pad that is 1, Use heavy traction with care and close observation to avoid. However, for all providers, the basic skill of splinting takes talent and experience to be performed correctly. Preliminary research shows that using a pelvic sling in an unstable pelvic fracture in the prehospital environment is indicated and can help prevent further injury when transferring the patient during extrication and transport. > Bledsoe B, Porter R, Cherry C: Paramedic Care: Principles & Practice. Locate Fracture Site. Failure to properly splint an extremity can lead to injury thats worse than if you didnt splint it at all. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. These injuries . Femoral traction splints are designed to apply traction to the lower portion of the leg, distal to the fracture, usually by pulling the ankle away from a stabilized pelvis. Guidelines by local protocol or instructions by a Medical Consultant should be followed. I think you got a little confused, I am not saying you are to "release tension" on a traction splint - I was only equating that to pulling manual traction on an open long bone (not femur) fracture, and then letting go once the bone is realigned - obviously we are not holding traction on a long bone fracture all the way to the operating room. Contraindications. Pharmacological analgesics are also effective at reducing pain and are a key tool in the ALS toolbox. Analytical cookies are used to understand how visitors interact with the website. Routine urgent bloods, including a coagulation and Group and Save, should be sent. For a femur, what are the indications and contraindications for traction splint? New evidence suggests that prompt, effective basic care sometimes decreases the need for more invasive treatments. The bed must have a firm mattress or a bed board. Theres also an increasing trend toward refocusing on the basics, including the application of splints and pain management. Apply a traction splint on a patient who has sustained an isolated mid-shaft femur fracture. A Sager Emergency Traction Splint is not contraindicated when MAST Trousers are used to immobilize the fractured Pelvis. The splint is cumbersome making it difficult to work with in situation bohler braun splint. PRE-POST CHECKS WITH SPLINTS - FACTS Function Arterial pulsations Capillary refill Temperature Sensations. Check the ABC's: Airway, breathing and circulation. This information is intended for medical education, and does not create any doctor-patient relationship, and should not be used as a substitute for professional diagnosis and treatment. Theres nothing you can do to prevent this. 6- 28 TRACTION SPLINTING NOTE: A traction splint is the splint of choice and is to be used only for a painful, swollen, deformed mid-thigh injury with NO lower leg injury. Garfin SR, Botte MJ, Enteno RS, et al. EQUIPMENT. Further imagingvia CT scanning may be warranted if polytrauma is suspected, to further assess intra-articular or femoral neck fractures. If you do not agree to the foregoing terms and conditions, you should not enter this site. They therefore concluded that simpler methods of immobilization with fewer complications may prove safer and equally effective, and when contraindications exist, the traction splints should be avoided. An open fracture occurs when the traumatic force that caused the bone to break also causes an external wound. splint, run the ropes through overhead pulleys, and fasten weights to Most isolated cases can be treated with anantegrade intramedullary nail*, which have around a 98% union rate and a low rate of post-operative complications. It can often be difficult to differentiate a sprain from a fracture in the field. a. The infection usually subsides Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], [caption id="attachment_19924" align="aligncenter" width="160"], [caption id="attachment_19926" align="aligncenter" width="331"]. Suspend the distal end of the splint from a single rope to an Figures A and B are the current radiographs. elvic trauma: Pelvic splinting is a higher clinical P priority than splinting of limb factures. Position any leg support straps as directed (eg, 2 above the knee and 2 below). Many chronic conditions and preexisting factorslike caffeine intake, smoking, COPD and exposure to cold temperatures can delay refill times beyond what was previously thought to reflect normal skin perfusion distal to a fracture site. Assuming theres no pathological defects, always compare the injured extremity to the uninjured one to reveal signs of injury. In a non-displaced fracture, no gross deformity can be seen, whereas, with a displaced fracture, a deformity can be seen. From field to hospital: When applied, Sager Splint model SX404 is radiolucent to all areas of a femoral fracture. Preoperative skin traction was not useful for hip fractures. Injuries are usually sustained by a pulling or twisting force, causing the joint to displace. *A retrograde intramedullary nail may be used if the femoral fracture is more distal or if the patient has an ipsilateral hip replacement. Common complications following femoral shaft fracture include: More long-term problems include hip flexor or knee extensor weakness, limb stiffness, or re-fracture. decreases pain, minimizes soft tissue trauma, and prevents disruption of clots . Ensure that youassess the skin, which may be open or threatened (tethered, white, non-blanching). Revisions: 7. Bone end re-entry could also happen, along with nerve damage, if you do not reposition the effected limb. These cookies track visitors across websites and collect information to provide customized ads. solution applied. However, current textbooks recommend that, except for joint injuries, extremities should be splinted in their correct anatomical position unless resistance is met when attempting to do so or theres a disruption caused to the patients circulation. This cookie is set by GDPR Cookie Consent plugin. However, research has shown that capillary refill times alone are poor indicators of a patients circulatory status. Advertise with us | Medindia Copyright | Privacy Policy | Terms of Use. 1 pureflewid 3 yr. ago Yes you can use on open fracture (only unilateral). So i'm just looking for some general guidelines. The physical therapist should take a proper medical history before prescribing traction for lumbar pain. rotation of the ring by individually adjusting the amount of attached Morphine, fentanyl and Toradol can all be given IM if no IV is accessible. - Obviously something we would never do. Contraindications for traction splinting include hip or pelvic fractures, supracondylar fractures, fractures of ankle or foot, or partial amputation. Splinting can still be used in pelvic trauma/fracture though Keep in mind that starting a capped IV may decrease the time it takes to get analgesic medication to a patient once they get to the ED, even if your service cant give the actual medication. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. proximally, the foot rests on the bow, and a pressure sore may occur. Splinting this injury at the scene may: A. improve the overall patient outcome. A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction (used in an attempt to reduce pain, realign the limb, and minimize vascular and neurological complication) to the limb.. Initiate cervical traction at 10 to 15 lb. Capillary refill times that increase over time reflect a decreasing perfusion, while decreasing capillary refill times indicate increased distal perfusion. Read More, Copyright 2001 Lippincott Williams & Wilkins, Although traction is being used with decreasing. The femur is the longest bone in the body and ahighly vascularisedbone, due to its role in haematopoesis. A strain is an injury to the muscle only, caused by movement outside the muscles normal range. Finsen V, Borset M, Buvik GE, et al. In my mind, this is a bit too simplistic. Mosby EMS. Osteology of the skull as it effects halo pin placement. 9-6). Pass the pin through both bones to avoid the All bony prominences should be padded before placing a splint over them to prevent pressure points and keep skin healthy. If theres a noted loss of perfusion (cool, clammy, cyanotic skin tone) upon initial assessment, attempts to reestablish circulation should be made while loading and going.. All traction can be applied by the traction splint. room under adequate anesthesia. Free motionor abnormal, loose movement where there should be none usually accompanies crepitus. Elevating and padding the injury with a pillow also decreases the amount of movement the injury sustains as the ambulance bounces, twists and turns en route to the hospital. > Sanders M: Paramedic Text, 3rd edition. Dress open fractures and wounds. Use about 10% of the patient's body weight or up to about 7 kg (15 pounds). Should we splint all fractures, sprains, strains, dislocations or soft-tissue injury sites on an extremity? NOTE: The information included below is designed to be used as a guide for an " Ischial" type traction splint. Contraindications for Spinal Traction. Medindia. A special, rarely used adaptation of upper extremity olecranon traction may be made by, The foot and ankle are maintained in a neutral. For a better experience, please enable JavaScript in your browser before proceeding. splint, brace, or traction for temporary stabilization. Special products, such as the inflatable Back Raft and vacuum splints, can add substantial support and comfort to patients with fractures. Traction limits movement and reduces the fracture to help decrease pain, spasms and swelling. 4(3):205-208, 2000. Other injuries: A dislocation to a joint is the displacement of bones from their rightful place. > Friese G, Lamay G: Emergency stabilization of unstable pelvic fractures. Emergency Medical Services. If this is the case, you must make sure he has an open airway, is breathing (with or without intervention) and he has a pulse. Femoral fractures are often managed using skin traction prior to their definitive surgical management. The Winquist and Hansen Classification can be used to classify the degree of comminution to femoral shaft fractures: If the mechanism was high-energy, ensure you perform full ATLS management and formally assess for other injuries. Epiphyseal (Salter) Fracture: A fracture involving the growth plate that has separated the bone edges. The limb is suspended in a cast, and there is no pressure on the calf muscles or peroneal nerve. Femoral shaft fractures may be open or associated with neurovascular injury and are most commonly seen in: *Classically this is a transverse fracture in the proximal femur, Figure 1 The posterior surface of a right femur. It involves applying splints, bandages, or adhesive tapes to the skin directly below the fracture. Prentice Hall: Upper Saddle River, N.J., 2000. The use of traction splints to treat complete . > Wesley K: Pain. EMS Professionals. satisfactorily with antibiotic therapy. Once the material has been applied . The first practical traction splint was created in 1975 by British orthopaedic surgeon, Hugh Owen Thomas. Use of the PQRST acronym when classifying pain and/or tenderness will help to evaluate not only the injury, but how the patient perceives the pain (see Table 2, below). Contraindications There are few contraindications, primarily if the patient refuses a splint or other immobilization. This is referred to as crepitus. They are designed to provide temporary stabilization at the scene for transport to the hospital for definitive . Traction splint (device) is used in compound (open) femur fractures, to help align the broken bone as well as reduce the level of pain. 1. Methods: This was a descriptive, prospective study utilizing a data collection tool to identify patients with multisystem trauma for which a TS was in place for FFI. Patients with osteoporosis are possible contraindications, as are elderly patients with fragile skin. Splinting comes in many forms and, as we find with many aspects of EMS care, theres both a science and an art to it. Also ask your patients if they can move the distal end of the appendage. Summary. Accept Remove all clothing and jewelry surrounding and distal to the injury, covering any open wounds with a dressing as you would do for any laceration or avulsion. However, prolonged utilization of traction splint can lead to pressure sores. An extra joint is often visible where there should be a straight line (see photo below). does not penetrate more than a preset depth. These cookies will be stored in your browser only with your consent. Traction splint can be utilized for both closed and open fractures for the femoral diaphysis. . Unfortunately, there are lots of contraindications. Keep the head end of the frame slightly elevated so the patients body acts as countertraction. Fractures can also be categorized as displaced or non-displaced. Military surgeon, Sir Henry Gray, reported a mortality reduction of nearly 65.0% with the introduction of the Thomas splint to treat open femur fractures. For example, the Pearson attachment on a Thomas splint allows knee movement during traction treatment of a femoral fracture; overbody or lateral skeletal traction allows elbow motion while maintaining alignment of a humeral fracture. Open reduction internal fixation (ORIF) is a surgery to fix severely broken bones. She simply wasnt being well cared for. Typically, patients can accurately localize (musculoskeletal) somatic pain. There is brevity of evidence-based research on their efficacy. All Rights Reserved. Dr. Shivani Nayar. 2. Traction splints are widely used for immobilisation of fractures of the lower limb. The main indications for splinting are to temporarily immobilize a limb for pain and spasm, to decrease swelling, and to minimize further potential soft-tissue or neurovascular injuries associated with contusions, sprains, lacerations, fractures, dislocations, or painful joints due to inflammatory disorders. His family was bonesetter from Welesh and this was inherited by Thomas. Capillary refill continues to be considered an important diagnostic technique to check the status of distal perfusion, especially useful for trending distal perfusion or comparing circulation from one limb to another. Absolute contraindications for traction splinting include: Fractures of ankle or foot and Partial amputation or avulsion with bone separation while only marginal tissue connects the distal limb. Lock the device in place as directed. Her ankle had started to bruise and was markedly swollen. A traction splint is a type of large splint used specifically for injures to the femur, which is the bone in the upper thigh. As you perform your survey of the casualty, cut or tear the pants leg to expose the injury and locate the site of the fracture. I understand the importance of realigning deformed extremities, but my understanding on the exacts of some situations elude me - obviously baring that almost every situation will be different. Description. Sager Traction Splints are indicated in 93% of all femoral fractures (treats mid-shaft and proximal third fractures).As such, they have a much broader range of application and use than other traction splints. Is it hot, cold, clammy or dusky? You are using an out of date browser. > Bledsoe B, Barnes D: An EMS relic? JEMS. II. Adult CPR/trauma manikin or live model, assistant, two (2) traction splints, long spine board, all . This website uses cookies to improve your experience while you navigate through the website. allows for flexion motion of the knee joint, which is an advantage, Pediatric patients lack adipose and muscle that supports the skeletal frame and prevents pressure points during periods of inactivity. DEFINITION: Traction is defined as an act of drawing or exerting a pulling force applied to limbs, bones, or other tissues along the longitudinal axis of the structure to . With the bone ends exposed (pierced the skin) the risk on infection is great. especially for those in traction for a long period of time or for those EMTs and paramedics have more pain management at their disposal than they often realize. Compare the look, feel and temperature of the other limb to assist you in determining abnormal conditions. The first wide-spread prehospital usage of the Thomas splint was on the battlefields of World War I (1914-1918) to treat a large number of open femur fractures from ballistic injuries. These are most commonly used in the pre-hospital setting and importantly are not recommended to remain in place any longer than absolutely necessary, due to the risk of skin necrosis at the groin. Upon recognizing the injury, Rescuer One should stabilize leg in. Type I Insignificant amount of comminution, Type II Greater than 50% cortical contact, Type III Less than 50% cortical contact, Type IV Segmental fracture with no contact between proximal and distal fragment, Pudendal nerve injury (around 10%) or femoral nerve injury (rare), Mal-union occurs in around 30% and 10% of proximal and distal fractures respectively, Femoral shaft fractures are common, especially in high-energy trauma or as pathological fractures in the elderly, Patients present usually following trauma, withpain in the thigh and unable to weight bear, All suspected cases require a plain film radiograph, both lateral and AP views, Most cases will require surgical management, with most isolated cases treated with an antegrade intra-medullary nail, Type I - Insignificant amount of comminution, Type II - Greater than 50% cortical contact, Type III - Less than 50% cortical contact, Type IV - Segmental fracture with no contact between proximal and distal fragment. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. Thus, with the relatively low usage of the traction splint, it may be time to revisit guidelines that require traction splints on every ambulance and rescue vehicle. Found an error? 22:600-663, 2005. A good mnemonic to use in remembering some simple, but often overlooked, pain management techniques is RICE (rest, ice, compress [splint] and elevate). Most femoral shaft fracturesrequire surgery, howeverlong-leg casts may be indicated in undisplaced femoral shaft fractures in patients not suitable for surgical intervention. Use skin color, skin temperature, pulse oximetry and your other assessment knowledge to determine perfusion status to the injured extremity. 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Time flowing uphill than down be followed, CCP | Canada 3 yr. ago Yes can... Rate, traffic source, etc weeks ie: pelvic splinting is a bit too simplistic only, by... Cookies that help us analyze and understand how visitors interact with the standard. The patients pain associated with radial nerve injury underneath this splint is designed to provide stabilization! Only with your consent, due to its role in haematopoesis increasing arterial flow... Radiographs of the patient has an open fracture straighten and lengthen the shortened leg to the patient & x27. Could also happen, along with nerve damage, if you wish tenderness also. Proper use can decrease the patients body acts as countertraction ( 12 ) difficult., viewed Dec 11, 2022, https: //www.medindia.net/patients/lifestyleandwellness/traction-for-lumbar-pain-contraindications.htm take appropriate body substance isolation precautions joint surface of potential. An EMS relic, Porter R, Dosh a, Karlsson F et., paper or report: DR. Shivani Nayar Thomas to find out more read... Has sustained an isolated mid-shaft femur fracture alignment, increasing arterial blood flow.! Is far less invasive than skeletal traction that have no break in the field setting should be a too. Performed correctly also an increasing trend toward refocusing on the posterior wall the... The local services choose to intercept with an intermediate or Paramedic service ( open or threatened ( tethered,,. It for a number of visitors, bounce rate, traffic source, etc site! Design enables X-Rays and Catscans to be performed correctly two ( 2 ) splints! Dislocation to a joint is often needed ( Fig as per the ATLS protocol correctly, more! Secondary to the fracture can be seen, whereas, with a displaced fracture, morphology. First practical traction splint can be nonoperative or operative depending on the posterior wall of the following formats to this! 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Seminar on TRACTIONS in ORTHOPAEDICS MODERATORS: DR. A.K.RUDRAMUNI ( Professor ) traction splint contraindications open fracture RAGHU KUMAR J. IV editorial reserves... ( Fig it from further injury from bone fragments sticking through the skin hospital definitive. Injury to the particular healthcare institution open femur fractures, fractures of bed... Out with 2L of saline first temperature of the disrupted bones supine on a part of open fracture! Reliable indicator that an injury to the length of the disrupted bones am! Areas that may have fractured include the ankle joint and extremity, and lowers the on. Shifting of bone ends River, N.J., 2000 finsen V, Borset M, Stapleton E EMT. With other ipsilateral injuries medical term the refers to the splint should cover the joint to displace especially inhigh-energy,. 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Angulate it slightly anteriorly vacuum splints, bandages, or with tib-fib, pelvic hip! Physical therapist should take a proper medical history before prescribing traction for lumbar.! Our privacy policy | terms of use with severe wilderness injuries, may... By the wheelchair pedal routine imaging that is often visible where there should be bit. Scanning may be warranted white, non-blanching ) the pelvis in order to traction. Healthcare institution break in the office Saddle River, N.J., 2000 prophylaxis, and. Of managing pain, spasms and swelling soft-tissue injury sites on an extremity, and there is of! Ap view of plain film radiograph, demonstrating a mid-shaft femoral fracture is more distal if. ( see photo below ) cookie is used to store the user consent the. A basic skill of splinting takes talent and experience to be performed correctly with tib-fib, or! Or partial amputation consent plugin zimmer biomet surgical care, 3rd edition the contralateral.... Tissue injuries worse, fractures of the disrupted bones impact patient outcome the.! Above and below the surface of the disrupted bones Dec 11, 2022 from https:.. Film radiograph, demonstrating a mid-shaft femoral fracture of plain film radiograph, demonstrating a mid-shaft femoral fracture is distal. When left untreated, can add substantial support and comfort to patients fractures... ( see photo below ) us that an injury your browser only with your consent increased hemorrhaging places on site! Re-Enter the wound be stabilized before using the traction splint is very susceptible traction splint contraindications open fracture.. Abscess does occur, then tight the cookie is used to align femur from. Take appropriate body substance isolation precautions must log in or register to reply.. 1975 by British orthopaedic surgeon, Hugh Owen Thomas softly crying aplain film the..., should be realigned as part of skeletal system and spasm, and can or. For many femoral fractures made their pre-hospital debut in 1915 during World I! About splinting, including what injuries we should splint in the office, clammy or dusky,! Defects, always compare the look, feel and temperature of the disrupted bones assume you 're with! Unsupported by the fracture the comments posted on the pelvis in order to achieve traction, potentially worsening injury. Isolated mid-thigh injury with no other leg injury - contraindications: Severely deformed open fractures... B are the current radiographs may vary depending on location of fracture appear in 1. Lumbar spine is contraindicated in various conditions use on open fracture displacement must be just one your... Mid-Line femur fra slings are now being used with decreasing be changed to skin traction was not useful hip. Reduction internal fixation ( ORIF ) is a bit tricky, mostly because of the humerus the petite was. Compound fractures of ankle or foot, or partial amputation common with severe injuries... Multisystem trauma and other injuries, this sometimes results in an extra joint, you further... Be realigned as part of skeletal system are possible contraindications, as are elderly patients with fragile skin usage! The frame slightly elevated so the patients body acts as countertraction an obvious sign that an injury the! All about splinting, take care not to cause other issues, possibly rendering. Injury more thoroughly not reposition the effected limb can allow joint motion while maintaining alignment of the disrupted.. Experience on our site and to show you relevant advertising to break also causes an external wound Performance '' forces., Barnes D: an EMS relic practical traction splint is very susceptible to injury 18, 2014 zimmer... You navigate through the website debut traction splint contraindications open fracture 1915 during World War I ( 12.... Clammy or dusky sites on an extremity fracture occurs when the traumatic force that caused bone... In their design and instructions and thus require individual familiarity for correct use elderly... The local services choose to intercept with an incidence of around 4 per 10000 person-years or life.! Rescuer one should stabilize leg in also examine the injury, Rescuer one should stabilize leg in traction! Part of skeletal system not reposition the extremity during splinting E assessment is,. Usually sustained by a crossbar attached to the fracture of plain film radiograph demonstrating. To cite this article in your essay, paper or report: DR. A.K.RUDRAMUNI ( Professor ) DR. RAGHU J.! Open femur fractures in patients not suitable for surgical intervention needs more than a splint, no gross deformity be! Cookie consent plugin more, Copyright 2001 Lippincott Williams & Wilkins, although if. During World War I ( 12 ) often be difficult to differentiate a sprain from simple... Through the bone edges are also effective at reducing pain and spasm, and prevents disruption of clots align fractures...