Pivoting Traction Splint
The company known to many (mostly military) EMS providers as the maker of the Reel Splint has just introduced a new traction splint to the market named Pivot-TracTM. There are several features that distinguish this splint from other traction splints.
The most interesting feature of the Pivot-Trac splint is its ability to adjust the angle of the ischial pad. As its name suggests, the ischial pad is easily pivoted and set in place with the same collets that adjust the length of the splint. The angle of the ischial pad can be set from zero to approximately 35 degrees to improve contact with the real contour of the ischium and improve patient comfort. Remember, the hip joint is a ball-and-socket joint that connects at the side of the femur. If you give it some thought, providing the ischial pad nearer to the angle at which it meets the femur is another one of those forehead slappers. Why didn't I think of that?
A question ought to be forming in your mind: "What is the correct angle to set on Pivot-Trac's ischial pad?," The best results occur when the angle parallels the angle of the inguinal crease, that wrinkle of the skin caused by the raising of the thigh, according to the manufacturer. This angle varies with each person. The angle is estimated by the EMS provider on the uninjured leg and is easily set on the Pivot-Trac. You end up with an angle that has the splint longer on the lateral side than the medial side, which will improve patient comfort.
Pivot-Trac intends to improve traction on a broken femur another way also. It decreases the height the proximal end of the femur would be pushed up inside the thigh when traction is applied. Instead of the straight pad that is characteristic of other traction splints, Pivot-Trac's ischial pad is curved to the contour of the leg. Traction splints have been criticized for their risk of elevating the proximal bone end of the fractured femur. The profile of the Pivot-Trac is flatter, with the bars of the splint more on the level with the ischial pad. Combined with the angled contact with the ischium, this design should diminish the possible anterior-posterior displacement of bone ends, according to the manufacturer.
Looking at the other end of the device, the ankle harness completely encircles the ankle with padding and is sized to the patient with a Velcro fastener. Pivot-Trac's design helps prevent screams from your patient during an accidental loss of traction. The tension strap attaches with a hook that has a safety clip to prevent it from disconnecting. Traction is applied with a ratcheting knob that has a secondary locking device to prevent the set amount of traction from being increased or completely released inadvertently. The small drawback to this is that the tension strap is not as quickly extended when setting up the device. Your patient won't complain, though.
The amount of traction to be applied depends on the patient's report of comfort; there is no metering device on the tension knob. Pivot-Trac applies static traction by design, according to the manufacturer. They wanted the splint to provide more traction while the thigh muscles may spasm and less when those spasms release.
There are four movable straps made of polypropylene elastic webbing to stabilize the leg. The straps close with hook-and-loop fasteners. Pivot-Trac straps resist blood and body fluids and can be completely removed for washing without disassembling the splint. The ischial pad is made of closed-cell foam and has plastic end caps to further protect it from blood and pathogens.
Another benefit of the Pivot-Trac is that it requires minimal additional training to use. There is basically one additional step for applying the splint compared to a standard traction device. The additional pivoting step should make the single femur-fractured patient more comfortable for the ride. Pivot-Trac is available in adult and pediatric sizes, costing $219 each.
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