Prehospital Trauma Compendium: Management of Suspected Femoral Shaft Fractures – A Position Statement and Resource Document of NAEMSP

Emergency medical services (EMS) clinicians encounter patients with suspected femoral shaft fractures due to both blunt and penetrating trauma. Traction splinting is commonly used by many EMS systems on the premise that it might reduce the perceived risk for hemorrhage and can help reduce pain. It has been called into question whether femoral shaft fractures are truly causative of hemorrhagic shock. Additionally, traction splinting has been associated with iatrogenic injuries, especially if applied to patients with co-morbid lower extremity and pelvic injuries. The application of a traction splint is also an infrequent EMS intervention, raising concerns about skill decay and maintenance of competency. Non-traction splinting, or static splinting, is also a therapeutic option in the field management of suspected femur fractures. Because the benefits of traction splinting versus static splinting of suspected femur fractures in the EMS setting are uncertain, the National Association of EMS Physicians (NAEMSP) performed a review of the evidence regarding EMS management of femoral shaft fractures and developed the following recommendations and summarization of the evidence.