FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 140

Traction stretches the muscles to their normal length and compresses the blood ves-
sels—particularly veins—within them, limiting the bleeding. Compression over the frac-
ture site with a circumferential dressing, such as an elastic bandage, may also help control
bleeding.
Traction is also required to control muscle spasms, which usually begin within an hour
after the fracture, move the bone ends, and can be very painful. Spasms also increase dam-
age to the surrounding muscle.
Traction splints ( Fig. 11-5 ) can be improvised and are commercially available. The
Kendrick® Traction Device and the Sager Splint® are two examples; information about
them is available on the Internet.
Whenatractionsplintistobeapplied,theshoeorbootshouldbeleftinplace,theankle
should be carefully padded to prevent obstruction of the blood supply to the foot, and a
figure-eightbandagesimilartothatusedforsprainedanklesshouldbeplacedovertheboot
and padded ankle. The leg should be gently lifted by pulling on the foot, and the splint
shouldbeslippedintoplaceandsecuredatthegroin.Ahitchslippedunderthefigure-eight
bandage should be looped over the crosspiece of the metal frame and tied. A rod inserted
throughthishitchcanbetwistedtoapplytractionontheleg.Thepullshouldonlybestrong
enough to prevent the foot and leg from sagging when the splint is lifted. Twenty to thirty
poundsoftraction are usually adequate. The hitch may need tobetightened periodically as
the thigh muscles relax and lengthen.
Figure 11-5. Fractured thigh immobilized by a traction splint
Bandages should be used as hammocks to support the leg in the splint, and one bandage
must completely surround the leg to prevent swinging from side to side. The lower end of
thesplintshouldbeelevatedsothatnopressureisontheheel.Thepersonismorecomfort-
able, particularly during a long evacuation, if the knee is flexed five to ten degrees.
Pain in the foot after the splint has been applied indicates the blood supply to the foot
has been impaired. The figure-eight bandage must be disassembled at once and the ankle
more carefully protected. Permanent injury, which may be more crippling than fractures,
can result if circulation is not adequately protected. Such injury is more likely when trac-
tion splinting lasts overnight or longer. In a cold environment, careful attention to circula-
tion is required to avoid frostbite.
Well-equipped rescue groups and wilderness expeditions should probably carry one or
more Kendrick® Traction Devices or Sager Emergency Traction Splints®. The Kendrick