2. • SPLINTS ARE DEVICES USED TO IMMOBILIZE A PARTICULAR PART OF
THE BODY.
• TYPES OF SPLINTS:
• 1. WOODEN SPLINTS – COMMONLY USED
• 2. METALLIC SPLINTS
• 3. PLASTER SPLINTS
• 4PNEUMATIC / INFLATABLE SPLINTS
• 5 MISCELLANEOUS – NEWSPAPERS, CARDBOARDS ETC
3.
4. Thomas Splint
• It was originally described by Hugh Owen Thomas as knee appliance
for ambulant management of chronic inflammation of knee joint.
Thomas’s splint provides excellent support and immobilisation for
transporting the patient
5. • The first variation of the Thomas splint was used for treatment
of tuberculosis affecting the knee. The initial design included a
metal ring, wrapped in leather, fitted around the groin
and attached by metal rods to a smaller ring around the ankle.
Traction would be applied by tightening strips of leather
supporting the leg around a crossbar. This was a simple design
that Thomas believed could be widely accessible and affordable
so that even the poorest patients can benefit from its use.
6. • Across the western front, the splint was adopted and by 1917, it
had become standard issue to army medical teams. Prior to the
introduction of the Thomas splint to the Army, estimates of
mortality from battlefield fractures of the lower extremity
reached 80%. With the splint, mortality rates were reportedly
reduced to as low as 15.6%. This remarkable reduction in
battlefield mortality cannot be attributed solely to the splint, as
medical advances in wound debridement also contributed
improved practice. However, its importance cannot be
understated.
7. Indications
• All Femoral shaft fracture except when there is large wounds in buttock/thigh
which would interfere with fitting of the splint
8. Contraindications
• Injury is close to the knee.
• Injury to the knee.
• Injury to the hip.
• Injury to the pelvis.
• Partial amputation or avulsion with bone separation.
• Distal limb is connected only by marginal tissue.
• Lower leg or ankle injury.
9. PARTS OF THOMAS’S SPLINT
• Proximal padded oval metal ring
• Inner and outer side bar
• Padded ring is set at an angle of 120 degree to the inner side bar.
• The inner and outer side bar are joined together with w piece
• The outer side bar protrudes 2 inches below the padded ring to clear the
prominent greater trochanter
10.
11. CHOOSING THE CORRECT SIZE
• 1. Measure oblique circumference of thigh immediately below Gluteal fold and
Ischial tuberosity. It is taken as the internal circumference of padded ring. In
case of oedema take 2” more than the measured value
2. Measure distance from crotch to heel and add 6-9 inches- this gives length
of the inner side bar
12. • 1. The correct size splint is pushed gently upto the ischial tuberosity while
maintaining a constant traction. Maintain 1 finger gap along the circumference
of the padded ring.
•
2. The splint is applied with MASTER SPLINT in position. The distal splint
must end 2.5 inches above the heel to avoid pressure injury to tendo achilles.
13. MANIPULATION ON THOMAS’S SPLINT
• 1. Manipulation is done when there is loss of bony apposition .
2. If the proximal fragment is abducted – give the traction and abduct the limb
in the splint
3. If the proximal fragment is adducted .the position is improved by traction
alone
4. If the proximal fragment is in flexion – abduct the limb and raising it may
bring the fragment in the position
5. If there is posterior sagging of the fracture site , then increase the padding
in the posterior aspect
14. • FIXED TRACTION IN THOMAS’S SPLINT - Used to maintain the reduction
• SLIDING TRACTION- Traction weight have the tendency to pull the patient
down the bed . Counter traction is given by raising the foot end of the bed .
The upward component of the patient’s body weight provides counter traction.
The amount of elevation is proportional to the traction weight used.
15. COMPLICATIONS AND AFTER CARE
• Pressure sores –
• Proximal – perineal, groin, ischial tuberosity – can be relieved by increasing
the traction.
• Distal – Achilles tendon, over malleoli, under the heel – good nursing and
adequate padding.
