Anest. intenziv. Med. 2026;37(1):16-21 | DOI: 10.36290/aim.2025.050

Adherence to traction splint use in the initial management of patients with femoral fractures in the prehospital careOriginal Article

Berková J.^{1, 2}, Čermáková M.^{1, 2}, Krenčíková J.², Kaššová J.², Truhlář A.^{2, 3}, Kočí J.^{1, 2}

¹ Klinika urgentní medicíny, Fakultní nemocnice Hradec Králové, Univerzita Karlova, Lékařská fakulta v Hradci Králové

² Zdravotnická záchranná služba Královéhradeckého kraje, Hradec Králové

³ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové, Univerzita Karlova, Lékařská fakulta v Hradci Králové

Objective: This paper evaluates adherence to traction splint use for suspected femoral midshaft fractures in prehospital care, focusing on patients transported to Level I Trauma Center.

Design: Retrospective observational study. Setting: Emergency department, emergency medical service.

Material and Methods: A retrospective analysis utilized datasets from the Level I Trauma Center and the Emergency Medical Service in the period of January to December 2023. Initially, 391 patients were searched in both databases. The study included 46 patients with prehospital traction splint application due to suspected femoral fracture and 8 patients with a femoral shaft fracture without traction splint application. Patients without a confirmed femoral shaft fracture and without applied traction splint and those who died during transport to the emergency department were excluded. The following variables were recorded: age and gender, mechanism of injury, Injury Severity Score (ISS), duration of the prehospital setting, administration of analgesics in the prehospital care, operation treatment within the first 24 hours after the injury, presence of other severe injuries, need for blood transfusion in early management, length of stay in the hospital and mortality. Subsequently, the sensitivity and specificity of a traction splint application in patients with femoral shaft fractures were evaluated.

Results: A total of 54 patients were evaluated, 34 male (63%), median age was 39 years (IQR 26;73), high-energy mechanism of injury prevailed. Injury severity score was 11 (IQR 9;25), 40% of patients were polytraumatized. The duration of prehospital care was 59 min (IQR 47;72 min). Prehospital analgesics were administered to all patients, all polytraumatized patients received early blood transfusion. Length of stay in the hospital was 15 days (IQR 9;26 days). Mortality was 3.7%. Sensitivity of the correct indication of traction splint application in prehospital care in patients with femoral shaft fracture was 92% in our study, specificity 97%.

Conclusion: Currently, a traction splint is a common device used for stabilization of the potential femoral shaft fractures in prehospital settings and in the emergency department. It is important to carefully consider contraindications and femoral fracture level for effective use according to the manufacturer's recommendations for the specific traction splint. The challenge remains the assessment of the fracture level on the prehospital scene. Systematic education significantly influences the recognition and appropriate indication for traction splint application and reflects the high specificity and sensitivity of traction splint application in patients with femoral midshaft fractures in our study.

Keywords: traction splint, femoral shaft fracture, prehospital care, blood transfusion.

Received: August 22, 2025; Revised: October 17, 2025; Accepted: November 7, 2025; Prepublished online: March 10, 2026; Published: April 9, 2026  Show citation