How to Apply a Thomas Splint

Application of a thomas splint for femur fractures (Source: Jason Wale, Island Health)

History of Thomas Splint:

Welsh Physician Hugh Owen Thomas first described use in 1875.
Really came to use in WWI when Thomas’s nephew Dr. Robert Jones implemented it for field extraction in 1916 . Mortality for lower limb fractures dropped from 80% to less than 20% by 1918 and it is used very much unmodified to this day.

The goal of the splint is to improve patient care for transport by reducing pain, blood loss and secondary soft tissue injury by fracture movement.

Notes:

1) Although it can be applied with traction alone and not analgesia, it is preferable to provide analgesia/sedation. Commonly we use propofol provided a skilled practitioner can be dedicated to airway management.
2) Obese patients can be a challenge to fit properly.
3) The thigh straps should not be too tightly applied at first to allow for swelling and expansion. These should be checked periodically after application to ensure at least one finger can be inserted under strap at all times.
4) Protection of Scrotal/labial tissues is paramount when placing the splint and double and triple checking the placement to avoid impingement is especially important in unconscious or altered patients.
5) Ongoing pharmacologic pain control can be assisted by augmenting the padding on the ring and attending to patient comfort with pillows and positioning over the gluteal and ischial areas as this is more likely to be a source of discomfort for a patient in prolonged traction than the fracture itself if properly reduced and in traction.

For more procedural videos and point-of-care clinical summaries, visit: www.bcemergencynetwork.ca/resource_type/procedural-video