Early application of the Thomas splint for femur shaft fractures in a Level 1 Trauma Unit.

Abstract

AIMS: To measure the compliance of our prehospital service and trauma unit with international guidelines relating to the early application of the Thomas splint in patients with a femur shaft fracture on clinical examination. 

MATERIALS AND METHODS: Level IV retrospective review of clinical and radiological records of patients presenting from 01 January 2012 to 31 December 2012 at a Level 1 Trauma Unit. We included all patients with femur shaft fractures independently of their mechanism of injury. Exclusion criteria were: ipsilateral fracture of the lower limb, neck and supracondylar femur fractures, pathological, periprosthetic and incomplete fractures. The database available for review included demographic information, mechanism of injury, side injured and time when a radiological study (Lodox^® and/or X-ray) was performed. 

RESULTS: We identified 160 fractures. Sixty of these (37.5%) were correctly immobilised with a Thomas splint prior to the first radiological examination being either a Lodox^® or an X-ray. Seventeen fractures (45.9%) out of the 37 fractures not splinted or not correctly splinted at the time of the first radiological exam were then correctly splinted before the second radiological exam. 

CONCLUSION: Only 37.5% of patients presenting to our trauma unit with a femur shaft fracture have a Thomas splint applied before radiological examinations are performed. This deficiency needs to be addressed at all levels of healthcare, i.e. prehospital, peripheral and tertiary hospitals.