The use of traction splints for hip fractures at the prehospital stage

The Dieterichs splint is a device for immobilizing the lower limb during transport. It was first proposed by the Soviet surgeon Dieterichs, and is still used today because of its convenience and functionality. Similar tires are available from different manufacturers, but they all have a similar design and operating principle.

Author of the article / Site experts Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

Purpose and use of the Dieterichs splint. Immobilization rules.

What do you need to install the tire (tools)?

In addition to the splint, when immobilizing a limb, you will need 2 bandages, scissors and additional bandages and cotton wool for bandages that must be applied to the places where the joints protrude. It is advisable, if the situation allows, to subsequently secure the splint with plaster.

· The process of applying a Dieterichs splint includes many stages, each of which must be approached with the utmost care. Overlay rules:

· First of all, it is important to reassure the patient if possible and explain to him the essence of the upcoming manipulation with his body.

· Cut the clothing along the seam if the clothing is tight to the injured limb, then carefully examine the damage, making sure there is a fracture.

· Apply the inner and outer parts of the Dieterichs splint to the healthy limb, fixing the desired length of the splint.

· Using a figure-of-eight bandage, attach the plantar bar of the splint to the foot of the patient’s injured limb, making sure that the plantar part of the splint protrudes 8-10 cm beyond the plantar part of the foot.

· Insert the outer part of the tire into the metal fastening of the sole bar.

· Place the inner part of the splint in the groin area on the side of the injured limb, pass it through the inner metal eye of the plantar part, and fasten the bridge of the plantar part.

· Place a layer of cotton wool under the bony prominences (ankle, knee joint, greater trochanter and wing of the ilium) to prevent excessive compression and subsequent necrosis.

· Attach the straps from the armpit of the affected limb to the healthy shoulder girdle and at hip level.

· Pass the cord through the hole in the jumper and thus attach the twist stick. By twisting it, create traction on the leg until the crossbars rest against the groin and axillary area.

· Secure the twist stick to the protrusion of the outer tire.

· Fix the splint on the injured limb, wrapping it in a bandage with spiral moves of the bandage, leading from the ankle to the hip joint.

For a hip fracture, the most appropriate transport splint is Dieterichs (1), which is used to immobilize and extend the limb along the axis (2).

– the outer and inner crutches are adjusted along the length of the limb so that the outer crutch rests against the armpit, and the inner crutch rests against the perineum; the lower ends of both extensions should protrude beyond the sole of the foot by 10-15 cm;

– with the help of pins, the extensions are connected to the upper plates through the holes; for secure fastening, the pins can be secured with several rounds of bandage;

– fix the footrest to the sole of the foot (without removing shoes!)

with an 8-shaped bandage, especially securely attaching the rear section of the heel pad to the heel, because this part accounts for the main traction force during traction;

Dieterichs splint : general view (1); view of a patient with a Dieterichs splint applied (2); performing axial traction of the limb using twisting when applying a Dieterichs splint (3).

– lay the outer crutch of the tire along the body, bringing the lower end of the extension through the side eye of the metal bracket of the footrest;

– the crutch stop is fixed in the armpit with a piece of bandage, previously pulled through the upper pair of slits, which is tied on the opposite shoulder;

– lay the inner crutch, passing the lower end through the side ear of the footrest, and the stop of the inner crutch is fixed to the perineum with a bandage pulled through the slits of the plate, the bandage is passed around the thigh in the upper third;

– the lower ends of both crutches are connected to each other by a connecting bar, through the hole of which a double twist cord is passed, and fixed to the footrest bracket. After this, the upper part of the external crutch is fixed to the body with a spiral bandage (use a bandage 10-15 cm wide);

– the inner crutch in the upper third is fixed around the thigh with several rounds of bandage, after which they begin to stretch. Pulling is done manually by carefully pulling the foot and tightening the twist (3). The traction should not be excessive so as not to cause additional pain to the victim;

– cotton-gauze pads are placed between the crutches and bony protrusions;

– the splint is tightly fixed with a bandage, a spiral bandage is applied from the ankles to the axillary fossae.

Transportation rules

If the process of applying a Dieterichs splint to a patient with a hip fracture is completed, then he is taken to the hospital. Doctors should:

Calm the person down and explain what will be done to him.
Give the patient an anesthetic.
Do not unbutton the patient’s clothes or take off his shoes. All actions must be very careful. There is no need to cause unnecessary discomfort to the patient. If the victim is wearing very tight clothing that compresses the injured limb, then it can be cut at the seam.
During transportation, the patient can be given a transport splint. It will help keep the limb in the correct position. But before applying it, cotton wool should be placed on all protruding parts of the body. For fractures, a Dieterichs splint is applied to the joint, ankle, or edge of the ilium. Cotton wool will reduce the risk of the victim developing bedsores and chafing. Remember: now more modernized Dieterichs transport splints are also sold, which also fix the lower limbs. Moreover, it now has a modernized Dieterichs transport splint, which secures the lower limbs, and ribbons.
Stop the bleeding with a compression bandage, tight bandage, or tourniquet. Remember: the lock should not interfere with the removal of the bandage without removing the splint.
Use different bandages to apply a splint or bandage.
Line the base of the metal splint with cotton wool and bandages.
Pull the injured limb slightly forward and secure it in this position. This is usually done in cases where the patient is diagnosed with a closed fracture.
Place a blanket and warm clothes on the injured limb. Usually it is necessary to cover it if the patient is taken to a medical facility during the cold season.
Secure the bandage through the eyelet, but grasping the top of the boot. This way the plantar part will be better secured and will not slip.
In a medical facility, apply a splint to the victim. Moreover, you need to fix the whole body, i.e. starting from the armpits and ending with the lower body. This is the only way to immobilize the injured lower limb.

Remember: if the application of the Dieterichs transport splint is successful, then it will be firmly fixed on the victim.

At the same time, the modernized bandage will remain dry, there will be no pain, the victim’s blood pressure will stabilize, the pulse and breathing will level out. To summarize: the dichterix splint is indeed a very unique device that helps to correctly fix the injured limb and speed up the patient’s recovery process. But it will only be useful if it is applied by an experienced specialist. A splint applied by an ordinary person will have no effect and may even harm the victim. You shouldn't experiment with your health.

Purpose and structure of the device

The Dieterichs splint is a rigid fixator designed to immobilize the lower extremities with simultaneous traction. The main indication for its use is comfortable transportation of victims with fractures. It is applied immediately after an injury when the bones of the thigh or lower leg are damaged to prevent them from moving on the road. Its use is also justified for joint dislocations and other types of injuries that require more detailed diagnosis in a hospital setting.

The structure of the Dieterichs tire consists of several functional parts:

external and internal crutches, which, after fixing the device, will be proportional to the length of the patient’s limb;
footrests - strips on which the foot is placed and fixed;
twist in the form of a stick;
straps - they can be replaced with a bandage.

To immobilize the upper limbs, there is a similar device - Kramer splint. It is also a rigid device and has a similar composition, but it will fix the arm in an anatomically correct position. Its application is indicated for injuries to the bones of the shoulder and forearm, including the radius, ulna, humerus and clavicle.

Principles of transport immobilization

When providing first aid for a fracture, it is important to understand its basic rules.

It is better if specialists are involved in transporting the victim - unskilled actions can cause harm and cause the transformation of a closed fracture into an open one.

Algorithm for applying a splint and transporting patients with a leg fracture:

the splint must cover at least two joints, which are located above and below the fracture site;
it is important to fix the leg in the anatomically correct position or in the one that causes the least pain reaction;
if the fracture is closed, after applying a splint, the bone fragments are tractioned;
if the fracture is closed, the leg is fixed in the position in which it was at the time of injury;
There is no need to remove the victim’s clothes and shoes, but a cloth should be placed under the limb.

While moving the patient onto the stretcher, another assistant should be nearby.

He will support the leg to ensure maximum bone stability. If this technique is followed, the victim can be transported to the hospital safely.

Dieterichs splint technique

For fractures of the lower limb, a splint must be applied before transporting the patient.

This is a mandatory procedure - in other conditions, transportation of victims is prohibited due to the risk of displacement of bone fragments.

To do this, you will need a splint, scissors and two bandages, if the design does not provide special belts for fastening.

Application procedure for fractures of the lower limb:

numb the damaged area;
stop bleeding if necessary;
first, attach the crutches to your healthy leg and measure their required length;
move the crutches to the injured limb (the inner one should reach the groin area, the outer one should reach the armpit);
fasten the upper straps at the hip level and on the shoulder girdle;
using a twist, stretch the limb until the crutches begin to rest on the groin and armpit area;
secure the crutches with straps or a bandage.

The features of applying this device also depend on its structure and material. To prevent rigid wooden or metal structures from injuring bone protrusions, they can first be covered with cloth or cotton wool. The device is adjusted individually for each patient.

Features and contraindications

Despite its versatility and ease of use, the Dieterichs splint has its own characteristics and contraindications. It is important to remember some nuances that will allow the patient to have comfortable and painless movement in transport:

carry out all manipulations only after using painkillers;
wrap cotton wool around all hard surfaces of the tire;
When applying a splint to a boot, it should completely cover the top of the boot.

The device is indicated for use only in cases of damage to large bones of the femur or lower leg.

It is not used for ankle or foot fractures.

The Dieterichs splint, despite the presence of more modern devices and methods, continues to be used for more than 60 years. It remains the most basic and universal method for comfortable transportation of patients with lower limb fractures. When applied correctly, it is possible to minimize the risks of additional damage or displacement of bone fragments along the way and maintain the integrity of healthy tissue.

Contraindications

A diterichs splint for fractures is applied only for medical reasons, because The technique of its application depends on this. The device is indicated to be worn only if the victim has suffered a fracture of the ankle or femur. Moreover, the fracture can be of any degree of complexity. Of course, a Dieterichs splint for a fracture is a useful device, but not all patients can use it. For example, for fractures, a Dieterichs splint is not applied to patients:

having other dangerous injuries in which it simply does not make sense to apply this device;
in a state of severe shock;
who, due to pain, cannot remain in one position for a long time;
who are in a state incompatible with life;
when handling which doctors run the risk of applying the device incorrectly.

Remember: until the doctor arrives, relatives should not apply a transport splint to the victim themselves.

It is best to give the victim a certain position and wait for the doctors. Relatives will not be able to accurately determine the area of damage, so applying a Dieterichs splint for fractures in this case simply does not make sense.

Dieterichs splint technique

Purpose: transport immobilization for hip fracture.

Indications: hip fracture.

Resources: soft pads, bandages, cotton wool; Dieterichs splint, Kramer splint, syringe, scissors, 2 ml 50% analgin, 2 ml 1% diphenhydramine, sterile gloves.

Action algorithm:

1. Lay the patient horizontally and calm him down.

2. Explain the course of the upcoming manipulation.

3. Clean your hands with alcohol and wear sterile gloves.

4. Make an anesthetic 2 ml of 50% analgin, 2 ml of 1% diphenhydramine.

5. Examine the site of injury.

6. Check for a fracture or dislocation.

7. Give the limb an average physiological position.

8. Take a Kramer splint with a length of -120 cm and a width of -11 cm.

9. Place the end of the splint (120x11) on the foot of the patient’s healthy limb, from the toes to the heel.

10. Bend the heel at a right angle (90 0).

11. Place the splint along the back of the lower limb to the lower back.

12. Secure the plantar part of the splint with an 8-shaped bandage to the plantar surface of the foot (do not take off your shoes!).

13. Secure the outer part of the splint so that it starts at the armpit and protrudes 8-10 cm beyond the plantar surface of the foot.

14. Insert it into the metal eyelet of the sole of the tire.

15. Lay the inner part of the splint along the inner surface of the limb from the perineum to the plantar surface of the foot - 8-10 cm.

16. Pass it through the inner metal eyelet of the sole.

17. Place a cotton pad under the bony prominences (ankle, knee joint, greater trochanter and wing of the ilium) to prevent compression and the development of necrosis.

18. Secure the splint to the lower leg, thigh, abdomen, and chest using circular motions of the bandage.

19. Pull it out using a twist and place it on the protrusions of the outer part of the tire.

20. Remove gloves and dip into disinfectant solution.

Application of a medical pneumatic splint (MPS)

Purpose: transport immobilization for limb fractures

Indication: fracture of the upper and lower limbs.

Resources: tire bag.

Note: The tire is made of transparent plastic film and consists of the following elements: a two-layer sealed film, a zipper, a valve device with a tube for pumping air into the chamber; ShMP is available in packages of three types according to size: 1- for the hand and forearm; 2 – for the foot and lower leg; 3 – for the knee joint and hip.

Algorithm of actions:

– Make the patient sit facing you, calm him down.

– Explain the course of the upcoming manipulation.

– Clean your hands with alcohol and wear sterile gloves.

– Make an anesthetic 2 ml of 50% analgin, 2 ml of 1% diphenhydramine.

– Examine the site of injury.

– Check for a fracture or dislocation.

– Place the limb in an average physiological position.

– Remove the tire from the bag.

– Unfold the splint and carefully move it under the injured limb.

– Open the valve of the air supply device by turning the tube counterclockwise.

– Inflate the tire with a pump until it is firm (or using a pedal pump).

– Close the valve by turning the tube clockwise.

Note: – at a pressure in the chamber of 40-45 mmHg, the tire acquires the rigidity necessary for transport immobilization;

– the splint does not interfere with blood circulation in the injured limb;

– characterized by quick application and good X-ray permeability.

The level of mastery of practical skills is assessed using a five-point system:

2 “unsatisfactory” – unable to perform practical skills;

3 “satisfactory” – performs practical skills, but makes significant errors in the methodology of execution and details, has not reached the recommended level;

4 “good” – has practical skills in its fundamental principles and at the recommended level, but allows minor inaccuracies;

5 “excellent” – has high quality and full practical skills at the recommended level or higher.

Date added: 2015-02-05; ; ORDER A WORK WRITING

The use of traction splints for hip fractures at the prehospital stage

Traction splints are means for immobilizing fractures, which, unlike conventional splints, provide an element of traction for the damaged limb segment. They are most widespread in the immobilization of diaphyseal fractures of the femur.

The traction element when fixing a femoral shaft fracture offers the following advantages compared to conventional splinting:

More pronounced analgesic effect. The femur is one of the largest bones in the skeleton. The muscle mass surrounding it is also the most powerful compared to other segments of the limbs. In the case of a fracture of the femoral diaphysis, the pain syndrome is caused by the pressure on the tissue of sharp fragments of the femur created by the muscles. When traction is created, the pressure of fragments on the tissue decreases, which leads to a pronounced reduction in pain.
Reduced blood loss. With a closed diaphyseal fracture of the femur, blood loss can reach from 1 to 3 liters. This is largely due to the ability of the intermuscular spaces of the thigh to accommodate large amounts of blood. With traction, the volume of intermuscular spaces is reduced, which ultimately leads to a decrease in blood loss. This is also facilitated by the fact that fixed fragments during traction are less likely to damage nearby blood vessels.
Preventing nerve damage. This is also associated with fixation of fragments and reducing the pressure of their sharp edges on surrounding tissues.

These largely theoretical conclusions and assumptions have allowed traction splints to become widespread in emergency medicine.

Historically, the first traction splint was developed by John Hilton in 1860 and then modified in 1875 by Hugh Owen Thomas, who used it to treat a patient with tuberculosis of the knee, and whose name it eventually received. Jones (Robert Jones) introduced the use of the Thomas splint into the practice of military field surgery during the First World War. Since the 50s, in many countries, traction tires have been included in the mandatory list of equipment for ambulance teams. To date, the application of a traction splint has become the standard of prehospital care for isolated diaphyseal femoral fractures in many countries, in particular the USA and Great Britain.

All modern traction splints have a common operating principle: first, emphasis is placed on the perineal area using a half-ring (as on a Thompson splint) or in some other way, and then the limb is pulled beyond the foot area. After stretching, the splint is additionally fixed throughout.

HARE TRACTION SPLINT

Developed by Glen Hare in the 60s and is a further development of the Thompson tire. It is a frame telescopic structure of adjustable length with soft transverse inserts. After manual stabilization of the fracture and installation of the required length of the structure (on the healthy limb), the splint is carefully placed under the victim’s limb. The proximal end of the splint with a stop is fixed with a sling at the level of the upper third of the thigh. Next, a fixing device for the foot is applied and traction is performed using a tensioner with a stopper. The optimal force, according to the technique, should be about 10-15% of the patient's weight, or about 15 pounds (6.8 kg). Another criterion will be a significant reduction in pain noted by the patient himself. The final stage is additional fixation of the limb to the splint along the length using fabric elements and fixation of the patient on the board-stretcher. The disadvantages of the splint include the impossibility of using it for fractures in the area of the proximal third of the femoral diaphysis, since in such cases the proximal stop of the splint can put pressure on the area of the fracture line. In case of a hip fracture in childhood, the use of an adult version of the splint is also impossible. There are special versions of this splint for use in pediatric practice.

SAGER EMERGENCY TRACTION SPLINT

Developed in the 70s by Joseph Sager and Antony Borshneck. It is a telescopic structure placed on the inner surface of the injured thigh. The proximal end rests on the perineal area and is shaped similar to a crutch or the butt of a gun. At the distal end of the structure there is a tension device with a lever and a scale in pounds. The amount of tension generated by this tire is similar to the Hare tire. After traction of the foot, the splint is additionally fixed along its length with cuffs with textile fasteners. Typically, such a splint is somewhat less comfortable for the victim, and if displaced during transportation, it can cause additional injury to the external genitalia. Its positive qualities include the ability, if necessary, to perform simultaneous traction on both feet in case of a bilateral hip fracture.

KENDRICK TRACTION DEVICE and CT-EMS

Due to its compactness and low weight, this type of tire has become widespread in the equipment of doctors working in backcountry conditions (climbing on foot to peaks not equipped with mechanized means of ascent with further descent on skis or snowboards along unprepared slopes. - editor's note) - in ski patrollers, in base mountaineering camps, etc. Consists of a folding rod consisting of several segments, the number of which can be adjusted in length, a foot grip with a tension sling and an adjustable sling loop for fixing the splint in the upper third of the thigh, as well as elastic cuffs for fixing the splint for. The splint is quite simple and convenient, compact when carried and quickly applied.

Its further development was the CT-EMS (Carbon Traction Emergency Medical Service) tire, which differs from its predecessor by a carbon fiber rod and a roller tensioner operating like a 4:1 chain hoist. The weight of such a tire is no more than 500 grams.

IMPROVISED TRACTION TIRES

In addition to standard versions of traction tires, there is also a technology for improvised production from scrap materials. It largely repeats the principle of operation of CT-EMS, only pieces of fabric can be used instead of slings, a pole, ski or trekking pole can be used instead of a barbell, and for additional fixation of the limb, either a blanket (as in the picture) or a polyurethane mat (as in the title photo) can be used ). The traction is done using a pull cord, similar to a chain hoist. One study compared standard traction splints and improvised designs in terms of patient comfort and found no significant differences between them.

DIETERICHS TIRE

It would be unfair not to mention the traction splint, which has become widespread in domestic traumatology. Developed back in the 30s of the 20th century by the domestic surgeon M. M. Diterichs for transport immobilization for hip fractures, it is still used for its intended purpose. The fundamental difference from other types of splints is the fact that traction is carried out with emphasis simultaneously on the perineal area (similar to Sager) and on the axillary area on the affected side. If there are contraindications to traction, this splint can be successfully used as a standard one, without traction. Despite its age, this type of splint is still used in the prehospital stage for hip fractures as part of military field surgery. Other traction tires, except for the Dieterichs tire, are not widespread in our country.

What is the scope of application of such a variety of traction tires? There is only one indication for applying such a splint - an isolated fracture of the femoral diaphysis. Contraindications for applying traction include a concomitant fracture of the pelvis, a fracture or dislocation in the area of the knee or ankle joint, a fracture of the tibia, in other words, any other fractures in the line of traction. Traction is also contraindicated for proximal or distal femur fractures. Other contraindications include an open hip fracture with bone fragments visible in the wound, severe osteoporosis, and increased pain when a splint is applied. In all these cases, conventional immobilization is indicated - the application of a standard fixing splint or a traction splint without traction.

POSITION OF EVIDENCE-BASED MEDICINE

It would be unfair not to notice that in recent years an increasing number of articles and discussions have appeared that, to one degree or another, question the advisability of using traction splints in the prehospital stage. There are several reasons for this:

Situations that absolutely require the application of a traction splint are quite rare. Abarbanell conducted an analysis of 4,513 ambulance calls in 2001 within one locality. A total of 16 of them were due to injury to the middle third of the thigh. In only five cases did paramedics diagnose a femoral shaft fracture. A traction splint was applied in only two cases. In other cases, traction was not performed for the following reasons: one had contraindications - a proximal femoral fracture, another patient was transported in a comfortable position, and the third experienced severe pain when trying to apply a traction splint. Thus, this device is intended to help provide assistance only in case of one isolated injury, but, according to regulations, it must be available always and everywhere.
Another problem is that most ambulances are adapted to transport a patient no more than 2 meters tall. The patient, fixed on a stretcher with a traction splint applied, has a large length, which significantly complicates transportation in an ambulance or in a helicopter.
Applying a traction splint takes a significant amount of time and can delay the transportation of the victim to a medical facility, and also distracts attention from possible more significant injuries (chest injury, traumatic brain injury).
The traction splint has many contraindications, in particular, the presence of other injuries (dislocations or fractures) of the limb. Very often it is not possible to identify them during a pre-hospital examination, and a traction splint is applied, for example, against the background of an existing but undetected pelvic fracture.
The traction splint itself, the purpose of applying which is to protect nerves and blood vessels from additional trauma, under certain uncontrolled circumstances (for example, marginal damage by fragments of great vessels) can lead to their damage.

But still, the most important argument forcing us to reconsider the existing standards of care is that the feasibility of using traction splints and their advantages over standard fixing splints are not confirmed by the relevant evidence base. There are several studies that have shown a greater reduction in pain with traction splints compared to conventional splints. However, the benefit of their use in assessing mortality or complication rates has never been proven. Despite many years of experience in the use of such splints by ambulance teams, only a few studies on this topic are found in the literature, and descriptions of the advantages given in emergency medicine textbooks are nothing more than logical reasoning, not supported by an evidence base. Currently, most authors agree that traction splints may be the treatment of choice in certain situations, but new randomized clinical trials are required to confirm their benefits over standard immobilization. And perhaps in the near future we will witness a turning point when traction splints will either strengthen their position as the “gold standard” for fractures of the femoral shaft, or, having not proven their advantages over simpler and more affordable splinting, will take their place in the museum of the history of emergency medicine.

Sources:

Kwon YH, Kahwaji CI. EMS. Traction splint. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jun 15.
Mistovich JJ, Karren KJ, Hafen BQ. Prehospital Emergency Care. Prentice Hall; 2009.
McEvoy D, Bleidher J, Moore G, Anderson P. Wilderness Medicine. Aerie Backcountry Medicine; 2010.
Runcie H, Greene M. Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or Not to Use? That Is the Question. Wilderness Environ Med. 2015;26(3):305-11.
Robinson PM, O'meara MJ. The Thomas splint: its origins and use in trauma. J Bone Joint Surg Br. 2009;91(4):540-4.
Schimelpfenig T, Safford J. NOLS Wilderness Medicine. Stackpole Books; 2006.
Weichenthal L, Spano S, Horan B, Miss J. Improvised traction splints: a wilderness medicine tool or hindrance?. Wilderness Environ Med. 2012;23(1):61-4.

Device

The author of the device is a Soviet surgeon, whose name it received as its name. It was actively used during the Second World War. Transport immobilization with a Dieterichs splint was one of the main procedures for fractures in that ancient time, and it is still widely used today.

The undeniable advantage of such a device is that it is capable of stretching and immobilizing the injured leg at the same time. In some difficult cases, for example, in case of serious damage to the hip bones, transporting and moving the victim without using a splint is strictly prohibited.

The Dieterichs splint consists of a pair of sliding wooden slats - short and long, the size of which can be adjusted (depending on the person’s height). The oval crossbars of the upper ends are covered with elastic soft fabric - for painless support in the perineum and armpit. A special transverse board connects their lower ends. A hole is made in it, with the help of which the limb is pulled out: a special sole-platform is attached to the foot with bandages.

Dieterichs splint application

When is such a procedure necessary? It can be used for all levels of tibia or femur fracture. The technique of applying a Dieterichs splint is not overly complicated, but subsequent rehabilitation depends on the quality of its implementation. A long bar is placed on the outer surface of the thigh, starting from the armpit itself, and a short part on the inner surface of the thigh. The outer part of the splint is secured with wide belts in the lumbar and chest areas, then the straps are fixed on the lower leg and thigh.

The planks are equipped with transverse struts for support. A special sole is bandaged to the foot. The stop with a hole is hinged on the inner bar of the tire: a fixing cord is passed through this hole. The latter is twisted to tension after applying a splint, which is attached to the body using soft bandages. Anesthesia must be administered before application. Important! If a multiple fracture has occurred, in which the bones of the ankle, foot and ankle joint are simultaneously damaged, the application of a Dieterichs splint is contraindicated.

Overlay Rules

It is important not only to apply the splint correctly, but also to choose it wisely. The device must:

Be strong, lightweight, securely fix the damaged joint.

Remember: the Dieterichs splint is used for patients with a fracture of the hip, knee, ankle or femur.

Do not cause discomfort to the victim, provide free access to the problem area.
Hold the problematic part in a position comfortable for the patient.
Be simple, easy to use, multifunctional.

Moreover, when applying it, you should take into account the following simple rules:

Do not place the device directly on bare skin. It is placed on clothing and gauze. Therefore, the joint is padded with a cotton or gauze bandage.
The length of the bars is measured along the healthy leg in accordance with the height of the victim.
It is advisable to give the leg a comfortable position.
A diterichs splint for a fracture of the femur or femur is securely fixed to the problem area. They fix it with bandages.
When an arm is broken, the injured limb is fixed with a scarf or braid.
A sterile bandage is applied to the wound, and then the limb is immobilized.
If there is bleeding from the wound, then it should first be stopped. This can be done using a tourniquet or a pressure bandage. In this case, the limb is numbed and a bandage is applied to it.
In the cold season, a warm blanket is placed on the limb.

Remember: the patient is given pain medication. And for complex fractures of the femur (for example, simultaneously the ankle joint, foot bones, ankle), the Dieterichs splint is not used.

Video tutorial

And if a person with an injured arm still has questions about how to properly apply a fixation device, then he should watch a video on this issue located on the Internet. Moreover, you can study not only videos, but also reviews on them. It is in reviews that people often talk about the nuances of applying the device, possible errors and ways to overcome them.

Principles of transport immobilization

Any representative of medicine should be well aware that incorrectly performed fixation can cause additional trauma. Instead of benefit, it can cause harm: for example, insufficient fixation of a closed fracture can aggravate it, turning it into an open one. To prevent this from happening, the Dieterichs splint should be applied in case of a fracture in compliance with the following principles:

An assistant should hold the injured limb when shifting the victim.
The victim's clothes are not removed.
Reduction of fragments in open injuries is not performed.
Before completing immobilization for a closed fracture, it is important to slightly stretch the limb along the axis.
The splint covers at least two joints (sometimes three).

Necessary tools

To immobilize an injured limb, doctors should have on hand:

diterichs tire;
sterile bandages;
medical gauze, cotton wool;
sterile syringes, needles.
a solution that will be administered to the patient as an anesthetic. You can use “Baralgin”, “Promedol”, “Fentanyl”;
stretcher. It is on them that the victim must be taken to a medical facility;
comfortable scissors.

Remember that while applying a splint, the patient may:

experience severe pain from the injury, fear;
see your wound and be even more afraid;
see heavy blood flowing from the wound;
faint, lose a lot of blood;
experience traumatic shock;
lose the ability to move normally, especially severely reduced mobility in the injured limb;
introduce an infection into an open wound;
have injuries other than a fracture.

Therefore, doctors should constantly talk with the victim. This will help prevent him from developing one of the symptoms described above.

Overlay Features

If the victim is wearing boots, then the fixing bandage should securely cover the boot. When immobilizing a boot by the sole, it can slide down with the plantar part of the device itself. The splint usually protrudes beyond the foot by a distance of about 15 cm. It is securely fixed to the body.

Elastic pads made of cotton wool and gauze should be placed under the tops of the side flaps of the crutches, and if the patient’s shoes are soft, they will also be needed in the ankle area. To make the fixation more reliable, a plywood or ladder splint with pads in the area of the Achilles tendon and knee cavity is placed under the pelvis and back of the leg. The splint itself, if circumstances permit, can be reinforced with plaster rings. To prevent displacement of fragments and sagging of the tibia, it is advisable to additionally use a Kramer splint.