THOMAS SPLINT - temporary stabilization of a femoral shaft fracture; can be achieved using the Thomas splint apparatus - used

for transport of patients - can provide adequate fracture stability and pain relief until definitive stabilization PROLONGED TEMPORARY TREATMENT - consider other methods of treatment in order to avoid soft tissue complication - e.g., pressure sores, skin blistering under adhesive strip MEDICAL TREATMENT - during immobilization, pharmaceutical thromboembolic prophylaxis is desirable - NSAIDs should not be given due to adverse effects on fracture healing IN CHILDREN - in older children, can be used as a definitive method of treatment 4-6weeks - in younger children, presence of the ring can displace a short proximal fragment DEFINITIVE TREATMENT - in cases where

are contraindications to surgery and/or socio-economic issues

*POSITION supine *Size and length of the Thomas splint use a tape measure circumference of the is measured to establish the size of the inner circumference of the ring of the Thomas splint (cm) - when choosing the Thomas splint to be used, 4cm should be added to the measurement to allow for swelling - the length of the patients leg is measured and 20cm should be added to establish the length of the Thomas splint PREPARATION Tinc Benz Co used on the skin of the leg to improve the adhesion of the adhesive traction strip - on the medical side, beginning @ the groin, Tinc Benz Co is applied down to the ankle - the adhesive is spread on the lateral side from the greater trochanter down to the ankle *APPLICATION OF ADHESIVE TRACTION STRIP 1. the adhesive traction assembly will now be applied. It is important that the material does not stretch lengthwise 2. the counter part of the strip is parallel, to prevent pressure sores forming over the medial and lateral malleoli 3. the backing is removed, and the adhesive strip is applied on the medial side, reaching proximally up to the groin 4. on the lateral side, the backing is removed, and the adhesive strip is applied as far as the greater trochanter. Care is taken to verify that there are no wrinkles in the strip, as they can lead to pressure sore.

*BANDAGE 1. starting four finger-breaths above the ankle, a circular crepe bandage is wound proximally, with moderate tension towards the groin 2. a second, proximal bandage ensures that the adhesive strip is secured as far as the groin *APPLICATION OF THOMAS SPLINT the Thomas splint is applied by passing through the patients leg upward to the groin either the Thomas splint is fitted with slings to support the limbs prior to passing it over the Kramer wire, which must be very well-padded, in order to prevent pressure sores, is placed under the patients leg proximally the support extends to the ring of the splint if a Kramer wire support is used, it should be bent slightly under the patients knee the Kramer wire must be further bent to the angle of the heel, in order to prevent pressure sores under the heels Flannelette bandage slings are used to support the leg in the Thomas splint, whilst also providing support to the Kramer wire to complete the bandaging proximally, it is passed over the ring of the Thomas splint, under the Kramer wire, and it is secured on the lateral side with the reef knot the second and third flannelette slings are applied in the same manner - the second bandage is located behind the knee - the third bandage is located just above the ankle, posterior to the Achilles tendons traction is applied to the fractured femur by tightly tying the cord @ the end of the traction strip assembly to the distal end of the Thomas splint