Indications for transport immobilization
Temporary fixation is necessary not only for obvious bone fractures, but also for a number of other severe conditions. The main indications include:
- Bone fractures and joint injuries.
- Injuries to major nerve trunks and major blood vessels.
- Crush syndrome (limb crushing).
- Extensive soft tissue wounds.
- Acute inflammatory diseases of the limbs requiring rest (e.g., acute osteomyelitis or acute thrombophlebitis).
Proper fixation helps prevent a closed fracture from becoming open and protects vital organs (spinal cord, brain, blood vessels, nerves, pelvic and thoracic organs) from damage by displaced bone fragments.
Fundamental rules of splinting
Errors during fixation can lead to the development of traumatic shock. To avoid this, the following algorithm must be strictly observed:
- Hemostasis and asepsis. If bleeding is present, a tourniquet or pressure bandage is applied first, followed by an aseptic dressing on the wound itself. Important: the tourniquet must not be covered by bandages securing the splint; it must remain visible for monitoring.
- Surface preparation. Splints are applied directly over the casualty's clothing. If fixation must be done on bare skin, a soft padding (cotton wool, towels, clothing items) must be placed under the rigid structure.
- The rule of joints. To reliably block movement, it is necessary to fixate at least two joints adjacent to the injury site. An exception is a femur injury — in this case, all three joints of the lower extremity (ankle, knee, and hip) are blocked.
- Traction. In closed fractures, gentle axial traction of the limb by its distal part is required before final fixation. In open fractures, traction is unacceptable — the limb is immobilized in the position it assumed after the injury.
- Caution during patient transfer. When moving the casualty onto a stretcher, the assistant must carefully support the injured limb with the splint already applied.
Means of transport immobilization
Both standard (issued) and improvised means are used for fixation.
Standard splints:
- Cramer wire ladder splint: a universal wire structure. Easily molded to take the desired shape. Suitable for arms, legs, and the head; multiple splints can be fastened together.
- Dietrichs splint: a complex wooden structure consisting of telescoping crutches, a plywood sole with metal brackets, and a windlass (stick). Used for femur fractures and injuries of the hip/knee joints. Its main advantage is the ability to create axial traction.
- Yelansky plywood splint: used for the head and cervical spine. Features side panels, an occipital indentation, and oilcloth rolls. Secured with straps to the upper torso.
- Other standard means include pneumatic and plastic splints, as well as vacuum immobilization stretchers.
Improvised means: In an emergency, sticks, skis, and boards are used. Doors unhinged from their frames are often used as rigid stretchers when a spinal fracture is suspected.
Special bandages and slings: Sling bandages (arm bandaged to the torso) or a Desault bandage are used to fix the upper extremities. For neck injuries, a cotton-gauze collar (analogous to a Schanz collar) is used, which snugly embraces the neck, resting on the chest and chin, limiting the mobility of the cervical vertebrae. A cotton-gauze ring is also used for head positioning on a stretcher.
Briefly: answers to topical questions
What complications can occur with improper application of a transport splint?
Improper application of a transport splint can lead to severe local and general complications. The main consequences include:
- Displacement of bone fragments — leads to additional trauma.
- Conversion of a closed fracture into an open one — occurs due to skin perforation by sharp bone edges.
- Damage to vital organs — injury to major blood vessels, nerves, brain, spinal cord, chest, abdominal, and pelvic organs.
- Development of traumatic shock — a consequence of additional soft tissue trauma and increased pain.
- Ischemic disorders — develop when the splint is applied too tightly in the setting of increasing edema.
In what position should the arm be fixed using a Cramer splint for a humeral fracture?
The arm must be fixed in the neutral physiological position ensuring muscle relaxation, with obligatory capture of the shoulder, elbow, and wrist joints. Parameters of correct limb positioning:
- Shoulder joint — abduction of the shoulder by 60° and flexion forward by 30°.
- Elbow joint — flexion at a 90° angle.
- Forearm — neutral position between supination and pronation.
A cotton-gauze roll must be placed in the axillary fossa. The lower end of the splint, along with the forearm and hand, is additionally suspended from the neck using a triangular sling or strap.
How is transport immobilization performed for pelvic bone fractures?
Transport immobilization for pelvic bone fractures is performed strictly in the supine position on a rigid base (spine board) or using a vacuum mattress. The patient is placed in the specific "frog" posture:
- Lower extremities — semi-flexed at the hip and knee joints, with thighs slightly abducted.
- Popliteal region — a roll (made of clothing, a blanket, or a structure of bent ladder splints) is placed underneath to relax the muscles.
The casualty must be strapped to the stretcher to prevent displacement during transport. Vacuum stretchers are considered the most preferred means.
Class and exam questions
Is it permissible to remove the casualty's clothing before applying the splint?
No, the splint must be applied over clothing. If fixation is performed on bare skin, a soft padding made of cotton or fabric must be placed under the splint.
How to apply a splint if a tourniquet is already present on the limb?
The tourniquet must under no circumstances be hidden under the bandage securing the splint. It must be clearly visible for continuous monitoring.
What is the difference between the immobilization of open and closed fractures?
In closed fractures, gentle axial limb traction by the distal part is performed before fixation. In open fractures, any traction is strictly prohibited — the limb is fixed as is.
What else to study on this topic
- Design features and application technique of the Dietrichs splint for traction
- Application of the standard Yelansky plywood splint
- Methodology for applying a Schanz-type cotton-gauze collar
- Specifics of upper extremity fixation: Desault bandage and sling methods
- Algorithm for immobilization and transportation of patients with spinal trauma
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