Quelle attelle de fémur ?

Evaluation of commercially available traction splints for battlefield use

Studer NM et All. J Spec Oper Med. 2014 Summer;14(2):46-55

------------------------------------------------------

L'immobilisation d'une fracture de fémur nécessite idéalement une traction. Les attelles de type thomas-lardenois ne sont pas utilisables en préhospitalier. La classique attelle de Donway n'est pas idéale dès lors que l'on est en combat à pied. Bien que l'intérêt de telles attelles reste discuté (1) , nous disposons à la nomenclature  de l'atelle Faretec CT6. Le document présenté vante de manière très surprenante les qualités de l'attelle de slishman. Certes cette dernière semble plus rapide à poser mais avec un taux d'échec beaucoup plus important. La CT6 reste donc un excellent choix, c'est d'ailleurs ce qui est également dit dans ce document qui parait quelque peu orienté dans ces conclusions. 

------------------------------------------------------

Background: Femoral fracture is a common battlefield injury with grave complications if not properly treated. Traction splinting has been proved to decrease morbidity and mortality in battlefield femur fractures. However, little standardization of equipment and training exists within the United States Armed Forces. Currently, four traction splints that have been awarded NATO Stock Numbers are in use: the CT-6 Leg Splint, the Kendrick Traction Device (KTD), the REEL Splint (RS), and the Slishman Traction Splint (STS).

Objective: The purpose of this study was to determine the differences between the four commercially available traction devices sold to the U.S. Government.

Methods: After standardized instruction, subjects were timed and evaluated in the application of each of the four listed splints. Participant confidence and preferences were assessed by using Likertscaled surveys. Free response remarks were collected before and after timed application.

Results: Subjects had significantly different application times on the four devices tested (analysis of variance [ANOVA], p < .01). Application time for the STS was faster than that for both the CT-6 (t-test, p < .0028) and the RS (p < .0001). Subjects also rated the STS highest in all post-testing subjective survey categories and reported significantly higher confidence that the STS would best treat a femoral fracture (p < .00229).

Conclusions: The STS had the best objective performance during testing and the highest subjective evaluation by participants. Along with its ability to be used in the setting of associated lower extremity amputation or trauma, this splint is the most suitable for battlefield use of the three devices tested