Abstract
Objectives:
To measure compliance with the Trauma Unit guideline relating to the early application of the Thomas splint in patients with a femur shaft fracture on clinical examination.
Design:
Retrospective review of clinical and radiological records of patients presenting from 01 January 2012 to 31 December 2012 at a Level 1 Trauma Unit.
Patients:
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 fractures, pathological, periprosthetic and incomplete fractures. The database available for review included demographic information, mechanism of injury, side injured, surgical procedure and time when a radiological study (Lodox and/or x-ray) was performed.
Outcome measures:
Primary outcome measure was the application of a Thomas splint before the first radiological examination was performed. Secondary outcome measure was the increase in patients immobilized with a Thomas splint before their second radiological examination was performed.
Results:
We identified 160 fractures, 107 (66.9%) had a femur or pelvis x-ray as the first radiological exam. In 44 (41.1%) of these fractures, a Thomas splint had already been applied.
Of the 160 fractures, 53 (33.1%) had a Lodox as first radiological examination. In 16 (30.2%) of these fractures, a Thomas splint had already been applied. The remaining 37 fractures where no Thomas splint was applied prior to the Lodox had been immobilized with either a different type of splint (backslab or Kramer wires) or not immobilized at all. Of these “incorrectly” immobilized or not immobilized fractures, 17 (45.9%) were then correctly immobilized with a Thomas splint prior to the x-ray (x-ray as second radiological exam).
Conclusion:
Out of 160 fractures, 60 were immobilized with a Thomas splint prior to the first radiological examination, corresponding to a 37.5% compliance rate with internal guidelines.
