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Patient Assessment
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
All limb fractures require splinting or plaster of Paris application to control fracture movement and hence reduce pain, bleeding, the formation of fat emboli and secondary soft-tissue swelling and damage. In the case of shaft of femur fractures, a traction splint should be used.
Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Apply traction as quickly as possible to reduce the pain and blood loss, and to facilitate movement of the patient during X-ray, which should not be done until after the splint is in place. Use a commercially available Donway™ or Hare™ traction splint, or alternatively use a traditional skin traction device such as the Thomas splint.Get help to apply the splint, which cannot easily be placed alone.
Pre-Hospital and Emergency Trauma Care
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Lone bone fractures, particularly of the femur, can bleed significantly. The damage control approach to fractures is external fixation. The immediate treatment for a patient who is hypotensive from haemorrhage from a femoral fracture is to put traction on the distal limb, pulling the femur into alignment. This not only realigns the bones but also reconfigures the cylindrical nature of the thigh. This has an immediate tamponading effect on the bleeding in the muscles of the thigh. It is frequently necessary to maintain traction with a Thomas or Hare traction splint. Attention should be paid to the distal pulses to be sure that there is continued arterial inflow. If the pulses are absent, an arteriogram should be performed to determine whether there are any injuries to major vascular structures. A determination is then made as to the timing of arterial repair and bony fixation. Re-establishing perfusion to the limb takes priority over fracture treatment.
Early stage IgD multiple myeloma in a 50-year-old man
Published in Baylor University Medical Center Proceedings, 2020
C. Lake Littlejohn, Andrew Whiteley, Marvin J. Stone
The patient had no family history of malignancy or blood disorders. His social history was unremarkable. He was employed as a cafeteria manager. Home medications included lisinopril and recent prescriptions for cyclobenzaprine and ibuprofen. Physical exam revealed an obese middle-aged man lying in bed with a traction splint applied to his right lower extremity. Laboratory studies showed a hemoglobin of 13.6 g/dL, serum creatinine of 0.9 mg/dL, and calcium of 9.2 mg/dL. Blood glucose was mildly elevated, but other laboratory tests, including a complete blood count and comprehensive metabolic panel, revealed values within normal limits. Plain films revealed an acute minimally comminuted fracture of the proximal right femur diaphysis (Figure 1). Computed tomography scan of the right lower extremity showed irregularity of the margins and small adjacent osseous fragments consistent with a pathologic fracture. A focal soft tissue mass was identified within the marrow cavity.