Traction Splint.

[EMT001]

Wanted to run this by everyone to see what you think.

Had a run tonight where an elderly lady tripped and fell. She said her leg fell backwards and she heard a "pop". No LOC, No head, neck, or back pn. Only c/o (L) leg pn. When asked where the pn. is, she points midshaft femur. Good pedal pulses, decreased sensation. Obvious deformity midshaft femur, however the area around the lateral portion of the knee was also slightly swollen. No pn. to the hip or knee are on palpation however. The pt. stated that the only thing bothering her was the leg, which hurt a lot. I know injury to or around the knee cap is a contraindication for the traction splint, however I do not think this pt. had a injury to her knee. So, I applied the traction splint. Notable decrease in pn. and even an increase in sensation. Get to the ED, doc chews me out because the splint is on when there is swelling to the knee. I tried to explain everything that I stated above, but he wouldn't hear it. Just want to see what everyone else thinks/would have done. We are waiting on the X-rays to see if the knee was involved as well. No one is questioning that there was a femur fx.

[Ridryder 911]

It all depends. Is there swelling to knee area routinely such as in arthritis ? This would be one of my determining factors. As well, did her pain decrease after application? True one needs to be cautious when applying traction splint with joint injuries, but I much rather even see that the angulated femur ends and quad muscle spasms. Sounds like yur Doc needs to get a life and worry about getting that ortho in to take care of it.

Did you find if there was knee involvement ?

R/r 911

[paramedicmike]

Sounds like maybe the doc got up on the wrong side of bed and wanted to chew someone out for it.

It might have helped if you had pursued some history with your patient regarding prior joint injury or swelling. Sometimes older folks have joint swelling that's normal for them. We don't think too much about it, maybe note it in our documentation. But in cases like this it become important. And this is where getting a complete history from the patient is vital. Imagine what the doc would've done had you replied, "Doc, according to the patient the swelling at the knee is completely normal due to .......". You might've been able to end the conversation there.

Can't say for sure if what you did was right or wrong as I wasn't there. But I'm like Rid in that I'd prefer to see a reduction in the deformity resulting in a decrease in pain and quad spasms. There are orthopedic specialists out there for a reason!

Asking for the opinion of others is a good thing. Follow up on this one to see what the extent of injury was and let us know. Remember to get as complete a history as you can from the patient.

-be safe.

[EMT001]

Just to clarify, I did ask about previous knee injury and precipitating factors that would account for the knee swelling. She had a previous injury to the knee and stated that it was a little more swollen then normal, but not too bad. There was a decrease in pn. and a significant improvement in sensation. Also, I was having the same thoughts as Rid about quad-muscle spasms and free bone ends moving around. Saw the doc this morning, classic midshaft femur fx. with no patellar involvement. Thanks for all the input.

[Ace844]

Just to clarify, I did ask about previous knee injury and precipitating factors that would account for the knee swelling. She had a previous injury to the knee and stated that it was a little more swollen then normal, but not too bad. There was a decrease in pn. and a significant improvement in sensation. Also, I was having the same thoughts as Rid about quad-muscle spasms and free bone ends moving around. Saw the doc this morning, classic midshaft femur fx. with no patellar involvement. Thanks for all the input.

"EMT,"

Excellent job. It's nice to hear from a colleague who both knows and understands the 'full picture' of their treatment modialities!!! Excellent post!! Good for you for sticking to your guns and having a 'forthright professional discussion' with the doc about this. More than likely it BECAUSE THE PT WAS PLACED IN A TRACTION SPLINT that this aroused his curiosity, and sent 'flags' up in his mind. Remember there are a number of your colleagues for whom this treatment may have never even crossed their mind!!! Even if it did, they may not be confident enough in their abilities to 'follow through' with the correct treatment and thus cause the pt more harm and discomfort!!! So once again, Excellent JOB!!

Out here,

ACE844

[cfaulknor]

Nice job.

[Imagine89]

Seems fine, esp if the hx indicates that the swelling could be an old injury acting up. As long as it didn't cause discomfort, (which it clearly didnt') and as long as you properly assessed the the knee prior to splinting, I think what you did was excellent.