Transport Immobilization

General rules of transport immobilization

Errors at the evacuation stage can lead to severe consequences. To avoid this, strict rules must be followed:

• Immobilization "as is". Any attempts to reduce a fracture without an X-ray, adequate anesthesia, and special skills will cause harm. The limb is fixed in the position it is in at the time of examination.
• Compression control. It is forbidden to bandage the splint too tightly. As post-traumatic edema increases, tight fixation will lead to critical soft tissue compression and ischemia.
• Temperature regime. In winter, the injured limb must be additionally insulated.
• Auto-immobilization. If standard or makeshift means (boards, branches, cardboard) are unavailable, auto-immobilization is used. The injured leg is bandaged to the healthy leg, and the injured arm is fixed to the torso with a triangular bandage or roller bandage.

Types of standard transport splints

Standard medical supplies are divided into several types depending on their design and purpose:

1. Ladder splints (Cramer splints). Universal wire constructions that can be bent to any anatomical shape. Require preparation: before application, the splint is wrapped with cotton wool and bandage. For reuse, it is covered with oilcloth.
2. Wooden splints. Lightweight, portable, and cheap wooden items. The main disadvantage is that they cannot be molded and fix the segment only in a straight position.
3. Mesh splints. Thin wire rolled into a coil. Low strength, so they are used only for small segments (foot or hand).
4. Thomas splint. A wooden device for immobilizing the femur and hip joint. Includes outer (171×8 cm) and inner (146×8 cm) telescopic bars, a footplate, and a windlass with a cord for traction.
5. Pneumatic (inflatable). Double covers inflated with air (using a pump, from a cylinder, or orally). Disadvantages: risk of losing airtightness if punctured, tissue compression (ischemia), and provocation of venous bleeding while arterial inflow is preserved.
6. Vacuum. Filled with special granules. When air is pumped out with a pump, the structure becomes rigid. Ideal for transport immobilization of the pelvis and spine (in the form of mattresses and stretchers), but their use is limited by high cost.

Upper extremity immobilization

To fix the arm, a molded Cramer splint is most commonly used, supplemented with bandages (Desault, Velpeau, or a sling). A small bolster is always placed in the axillary fossa.

• Humerus and elbow. The splint is applied from the healthy shoulder girdle to the metacarpophalangeal joints. The arm is given a functionally advantageous position: the elbow joint is flexed at a 90° angle, the forearm is midway between pronation and supination, and the hand is extended at the wrist joint up to 45°.
• Forearm. The splint is placed along the outer surface from the upper third of the humerus to the metacarpophalangeal joints. The position of the limb is the same as for a humeral fracture. Additional support with a sling bandage is mandatory.
• Wrist joint and fingers. Ladder, mesh, or wooden splints are used. They are applied along the palmar surface from the elbow to the fingertips. A dense bolster is placed in the palm, giving the hand a position of moderate extension.

Stages of applying a Cramer splint to the arm:

1. Molding the splint to the shape of the limb.
2. Placing the limb and securing the retention cord over the healthy shoulder girdle.
3. Tightly bandaging the splint.
4. Suspending on a sling to unload the shoulder girdle.

Technique for applying the Thomas splint

This design is used strictly for injuries of the femur and hip joint. The most important rule: shoes are not removed before the procedure.

Action algorithm:

1. The footplate is fixed with a bandage to the leg. It should protrude beyond the heel edge by 1.5–2.0 cm to avoid pressure bedsores on the heel.
2. The length of the telescopic bars is selected exclusively according to the patient's healthy leg. The inner bar is measured from the groin, the outer from the axillary fossa. Both bars must extend beyond the sole of the foot by 12–15 cm to provide traction.
3. The selected length is rigidly fixed with special pins on the bars.
4. The inner bar is installed first, resting it against the inguinal region, then the remaining elements are mounted and the windlass is applied.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Technique for applying Desault and Velpeau bandages
• Rules for performing a triangular sling bandage
• Features of using vacuum stretchers in spinal injuries
• Algorithm for auto-immobilization in multiple injuries

Other topics in the section "General Questions of Traumatology and Orthopedics"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.