Paediatric Fracture

Question 1

Indications for Use of the triangular bandage sling in suspected upper limb fracture

Answer 1

• Forearm injuries, e.g. fractured radius/ulnar/wrist—standard arm sling.
• Upper arm and hand injuries—high arm/St John sling.
• Clavicle and shoulder injuries—collar and cuff sling.

Question 2

Indications for CT6

Answer 2

• Middle third femur fractures, including compound.
• Upper two-third tibia fractures, including compound.

Question 3

Contraindications for CT6

Answer 3

• Knee or ankle/foot trauma: May increase pain and worsen other injuries.

Question 4

Precautions for CT6

Answer 4

Pelvic trauma: Pelvic splinting is a higher clinical priority than splinting of limb factures. Traction splints may
apply pressure on the pelvis in order to achieve traction, potentially worsening an injury. Legs should be
realigned as part of open book fracture management. Splinting can still be used in pelvic trauma/fracture though anatomical splinting may be better depending on pelvic injury and severity.
* Realign long bone fractures in as close to normal position as possible.
* Open fractures with exposed bone should be irrigated with a sterile isotonic solution prior to realignment and
splinting.

Question 5

Indications for Use of formable splint in limb injuries

Answer 5

Radius/ulna injury.
* Humerus injury.
* Lower leg/knee injury.
* Ankle injury.

Question 6

Use of formable splint in limb injuries Contraindications

Answer 6

Nil

Question 7

Use of formable splint in limb injuries Precautions

Answer 7

Consider the use of a traction splint for leg fractures unless contraindicated.

Question 8

Signs used to identify a potential fracture

Answer 8

□ Pain
□ Irregularity
□ Loss of movement
□ Swelling
□ Deformity
□ Unnatural movement
□ Crepitus
□ Tenderness

Question 9

Outline the main purpose of splinting in fracture management, including traction splints such as the CT-6.

Answer 9

Splinting aims to prevent the movement in the joints and bones above and below fracture sites. This prevents the bone ends from moving and creating additional injuries to the internal tissue, muscle, vessels or nerves. A traction splint such as a CT-6 splint can effectively apply tension and draw the bone ends back into alignment or into near alignment greatly reducing pain and minimising further bleeding into the tissues.

Question 10

What are the indications and contraindications for the CT-6 Splint

Answer 10

Indications
□ Middle third femur fractures
□ Upper two third tibia fractures
Contraindications
□ Knee or ankle / foot trauma

Question 11

Outline the pre-preparation for CT6

Answer 11

1. Ensure patient has appropriate analgesia prior to and
   during splinting of fracture.
2. Reassure and inform patient of the traction splint
   procedure.
3. Ensure all pockets are carefully checked and objects
   removed to avoid pressure areas.
   Note: be aware of potential needle stick injury when
   searching pockets.
   Prepare limb
4. Expose and align the patient’s leg whilst maintaining
   support.
5. Remove footwear.
6. Dress all wounds. If the patient has an open fracture,
   irrigate thoroughly with sterile water or normal saline prior
   to dressing wound.
7. Palpate distal pulse and mark its location.
8. Check capillary refill, colour, warmth, movement and
   sensation.
9. When resources allow, manual traction should be applied
   to the injured leg until the CT-6 is fully applied.
   Align leg and remove footwear
   Check colour and movement
   Prepare CT-6 traction splint
10. Undo both elastic cinch straps.
11. Remove splint from bag, grasping the adjusting block.
12. As the splint is removed from the bag, hold it at shoulder
    height and shake gently, allowing the tubes to hang and
    intersect.
13. Manually connect any unlinked sections.
14. Straighten any straps as required.