HISTORY OF TRACTION SPLINTING
An Extract from “Splinting fractured femurs: Then and now An earlier version was published in On Scene: The Journal of Outdoor Emergency Care , Summer 2006.” http://www.wildernessemergencycare.com/book/splint_femurs.htm
The first practical traction splint was designed by a British orthopedic surgeon, Hugh Owen Thomas, in 1875. Thomas came from a family of Welsh bonesetters, who passed down their secrets from father to son.
1 He offered his splint to the French army during the Franco-Prussian War, but they did not adopt it, and it remained almost unknown outside his own practice until World War I.
2 In 1915, Sir Robert Jones (nephew and onetime apprentice of Thomas) introduced the device to the British and French armies. He called it the Thomas leg splint, and by 1918 it had reduced mortality in military femur fractures from 80 percent to about 7 percent.
3 Because almost all femur fractures in battle (usually from bullet and shrapnel wounds) were open, the Thomas splint saved lives mostly by controlling bleeding. Even in a closed femur fracture, however, the patient can lose more than a liter of blood internally, so traction splinting is still important. The Thomas splint was made from a 3/8″ steel rod bent to fit on either side of the leg, with a V-notch in the cross piece beyond the foot. The upper ends of the rod were attached to a padded ring, which had to be slid up the leg until it was braced against the perineum and buttocks. This ring made the splint awkward to apply to a fractured leg, so it was soon modified into the Keller-Blake hinged half-ring splint (which can be improvised from two ski poles, with the interlaced wrist straps replacing the half-ring). The half-ring is eased under the crease of the buttocks, and secured by an attached strap that goes over the top of the thigh. A variation on the Thomas splint was also developed for arm fractures (the Murray-Jones hinged arm splint).
4 A cravat bandage was used for the ankle hitch–and still is by many patrollers if they are improvising a traction splint, or if a commercial ankle hitch will not fit over the ski boot. The traditional way to apply traction, after connecting the ankle hitch to the V-notch of the cross piece with the tails of the cravat, was the Spanish windlass: Insert a stick between the cravat tails, twist the stick to increase tension, then lash or tape the stick to the splint. However, the leg tended to twist in the opposite direction, and if your hand slipped you could lose the traction, causing more pain and damage. To avoid these problems, many rescuers used an improvised pulley system in which they would pass a cord back and forth a few times between the cross piece and the ankle hitch, pull on the cord until they achieved enough traction, and then tie the cord. The more times they went back and forth with the cord before pulling, the greater the mechanical advantage.
Modern commercial traction splints also apply traction by pulling (with a cord, strap, or ratcheting device) rather than the twisting movement of the Spanish windlass. Several people tried to improve the half-ring splint by adding attachments and accessories to it. In the late 1960s, then-ambulance attendant and policeman Glenn Hare developed a nylon ankle harness and ratchet that could be fitted onto the end of a half-ring splint. After Hare and his brother started their own company, Dyna Med, their improvements evolved into the Hare Traction Splint, which is still used today.
5 A Hare splint applies traction with a ratcheted cylinder mounted on the end of the splint. Cranking the cylinder winds up a strap attached to the ankle hitch. In 1972, Joseph Sager and Dr. Anthony Borschneck developed an alternative traction splint, the Sager, 6 which they patented and began marketing in North America in the early 1980s.
7 The Sager splint, which is placed on the inner side of the leg, has a padded cross-piece that presses against the ischial tuberosity for counter-traction. The ischial tuberosities are bulges on the rings of the pelvis that form the floor of the abdominal cavity and support the body’s weight in a sitting position. Since they are medial to the hip socket, putting pressure on them does not displace the proximal end of a fractured femur, even if the fracture is to the femur neck or close to the proximal end of the shaft.If a commercial Sager splint is not available, for example in a backcountry setting, a similar device can be improvised with a pole, using one of the patient’s shoes as the cross piece and socket for the pole (though this would not work with a massive ski boot). Then you’d attach a loop to the other end of the pole and use the same cord pulley system as with the Thomas splint.
8 In 1986, Richard Kendrick introduced another alternative design, the Kendrick Traction Device (KTD), which was much lighter and more compact. The stabilizing rod resembles a segmented aluminum tent pole, and the KTD fits into a socket on the groin strap. (Kendrick also invented the Kendrick Extrication Device [KED] in 1979, a sort of reinforced corset that immobilizes the cervical spine.) Like the Sager, the KTD can be fitted without lifting the leg, but the splint goes on the outside. A piece of webbing (connected to the ankle hitch) loops over a plastic horn at the foot end of the splint, and traction is applied by pulling on a strap. A device similar to a KTD can be improvised by placing a long pole on the outer side of the leg, securing it to a groin strap, and applying traction with a cord pulley system.
A newer traction splint, the Faretec CT-6 is similar to the KTD, but has a carbon fiber pole rather than aluminum. Traction is applied by pulling a cord that runs through a ratcheted pulley, giving a 4:1 mechanical advantage. An even lighter traction splint was developed by Dr. Sam Slishman. The device, patented under the name Adjustable Support, is a hollow Black Diamond collapsible pole with an inner cord that is looped through a system of pins, which creates a pulley mechanism with a mechanical advantage of 4:1. Like the KTD and CT-6, the Slishman splint goes on the outside of the leg, and connects to a groin strap and ankle hitch, which can be improvised or purchased with the splint. So you can use this splint as one of your two ski poles, since you can improvise the groin strap and ankle hitch from cravats or webbing. One other benefit of the Slishman splint is that it pushes on the ankle hitch connection and does not extend past the foot, which makes it easier to load the patient into a toboggan or helicopter.