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

[@irfanullahguhar5951]

Best video for Thomas splint. Thanks doctors .. and sorry for the cutting of scrub paint😊

[@christielud]

Great demo!

[@dr.prernamonga1005]

Thank u so much for this dedicated video ! It helped a lot . ❤from 🇮🇳

[@yogarajraj6583]

Thank you so much for this video.

[@dr4utube]

Excellent. Thank you

[@krisnanupigg]

great video very informative x

[@natadodo1564]

Good demonstration

[@alaaelmahdi4951]

Very informative and helpful

[@DrunkDuckXD]

love it

[@deepikaaggarwal5124]

Tqsm ❤️

[@mustafahassan2980]

Thank you so much. AN Mustafa from iraq

[@paolayellowe6887]

Thank you for this video. its been really helpful. and for sacrificing you hair and pants. my question is,if you decide to use weights, how do you know what amount of weight to apply?

[@sharanagoudapatil233]

10% of the body weight

[@dr.smbhargav2502]

@@sharanagoudapatil233 10% of body weight is a blind rule..I do agree with that’s number but if the weight applied is more , it can distract the distal fracture fragment from proximal one & that can delay the healing & union process..& here in this video, they used ADHESIVE skin traction tapes..according to sir JOHN D.M. STEWART ( traction & Orthopedic appliances book) page number 7 of chapter 1, the MAXIMUM weight which can be applied with skin traction is 15lbs (6.7 kgs )..& in case of non-adhesive skin traction, it’s 10lbs ( 4.5 kgs)..please correct me if I’m wrong..thanku ..

[@rakrshbhankur]

Thank you.. we in india don't use adhesive skin traction regularly.. how long wil that skin traction can be used once applied?..

[@EmergencyCareBC]

For the purposes of the Thomas splint it is a temporary measure and should be used for maximum of 24 hours ideally. Skin traction may be used slightly longer for other purposes but for this splint 24 hours should be the limit.

[@haidaraliyu855]

Bro at first you look like Jack bauer

[@dr.rasheed2616]

Toooooo long vedio for simple procedure

[@heathstjohn6775]

Thanks. Very much. (The irritating 'music' isn't necessary).

[@tanialu7499]

its not irritating that's just your preference.

[@tanialu7499]

and it is actually extremely necessary

[@heathstjohn6775]

@@tanialu7499 Hello. Thanks. A "Preference" makes it "Irritating". A "Preference" can makes it not irritating: I agree it's relative. I hope one day the sensible sound of the still air, which has enough confidence and self-possession in itself not to keep whistling, tapping its fingers, or repetitively humming whilst sharing our rooms with us, may be allowed to be our companion again, carry our voices for us, and not be talked over by an attention-seeking vacuity which always suggests either that the speaker thinks they aren't engaging enough in themselves, or that the subject matter has somehow apologetically to insert itself deferentially under the same sound the viewers should rather be listening to on their radios, as it's the same sound, with variations, people listen to everywhere. Music's wonderfu associative ability to stimulate our imaginations has always been one of its greateat pleasures for me. Since the sound in this video, if you don't as I do take care always to avoid it, is now de regueur everywhere, (even in motorway service stations sometimes you aren't allowed to urinate without the same sound coming to your assistance), I wonder more at its popularity. There you are, at home, in your favourite easy chair; you sit down, and press the stereo's Play button: "Thump, thump, thump; tap, tap, tap". A few moments later, you're being reminded of pouring away a latté in the toilets of Junction 4's motorway service station, and when you last applied a Thomas Splint. Two very necessary procedures; but I'd rather close my eyes and be with Strauss, in the Vienna Woods.

[@tanialu7499]

@@heathstjohn6775 I agree with you completely, I agree silence would be a much better alternative as it makes the speaker seem far more confident in that only the sound of their own voice is enough to keep us interested and doesn't need to be accompanied by the incessant and repetitive background music. And i also agree that it is annoyingly everywhere you go, following you with its fidgety movements. But I think that the comment you made, since it is relative and your own opinion, didn't need to be written as it was simply just your own opinion and stating that it wasn't necessary didn't accomplish anything other than perhaps making those who created the video slightly hurt . ( A piece Id rather listen to is the swan by camille saint saens but Strauss is also very nice)

[@heathstjohn6775]

@@tanialu7499 By being called 'Comments', YT seems to be inviting opinion. I'll read any the video's makers want to write. I'll listen to 'The Swan' right now, as it's been years since I've heard it. Thanks.