Thomas Splint - An Overview

Introduction:

The Thomas splint, a staple in emergency departments and orthopedic units worldwide, originated from the pioneering work of Hugh Owen Thomas in 1875. Despite its age, this device has remained largely unaltered since its inception, initially crafted to rectify lower limb deformities. Its evolution into a pivotal instrument for managing lower limb trauma stems from its simplicity, effectiveness, and user-friendly design, garnering widespread acclaim. Revolutionizing the treatment of injuries sustained during the First World War, this splint played a pivotal role in reducing mortality rates from a staggering 80 to 90 percent.

What Is Thomas Splint?

In the early 1865s, the inaugural Thomas splint emerged, primarily for alleviating knee ailments such as tuberculosis (severe infection of the lungs) through prolonged immobilization and rest. Its initial application evolved significantly during World War I, propelled into prominence by Jones, Thomas's nephew, particularly within military medical units.

Originally fashioned with a metal ring enveloped in leather encircling the groin region, connected via metal rods to a smaller ankle ring, the splint's architecture underwent refinement for managing lower limb fractures.

Notably, its original rendition facilitated traction, delicately pulling on the leg, achieved through tightening leather strips supporting the leg around a central crossbar. Moreover, including a raised shoe pattern on the distal ring and an uninjured limb's shoe empowered patients to ambulate while donning the splint, enhancing both mobility and comfort during treatment.

What Are the Advantages of Thomas Splint?

Advantages of the Thomas Splint:

• Accessibility and Simplicity: Featuring a straightforward design, the Thomas splint offers easy access, making it ideal for utilization in diverse settings, including underserved rural areas and small towns. Its uncomplicated structure renders it particularly advantageous for pediatric cases, ensuring efficient use across various demographics.

• Enhanced Surgical Access: The splint facilitates surgical intervention by providing ample access for cleaning compound injuries, improving overall case management. Patients experience comfortable transport with the splint, ensuring stability during movement, thus enhancing their surgical outcomes.

• Reduced Mortality Rates: The Thomas splint substantially decreases mortality rates associated with limb injuries by halving the necessity for blood transfusions. Furthermore, it mitigates the risk of pulmonary complications, leading to better patient prognosis and outcomes.

• Stabilization and Injury Prevention: Effective in stabilizing injured limbs, the splint minimizes the risk of exacerbating injuries during transportation, thus ensuring safer transfer to medical facilities.

• Management of Open Wounds: Specifically beneficial for fractures complicated by open wounds, the Thomas splint allows for daily inspection and treatment of wounds without enclosing the limb fully, promoting optimal wound care and healing.

• Noninvasive Design: As a noninvasive support mechanism, the Thomas splint delivers effective support without necessitating invasive procedures, prioritizing patient comfort and safety throughout the treatment process.

• Rapid Application: In emergency scenarios, the splint can be swiftly applied, enabling prompt stabilization and treatment of limb injuries, thereby improving patient outcomes.

What Are the Indications for Thomas Splint?

Indications for Use:

• Primary indications involve lower limb fractures, especially those of the femur, showcasing Thomas's splint's efficacy in providing stabilization and support during recovery. Moreover, its applicability extends to fractures involving the knee and upper tibia, demonstrating its versatility in addressing various lower limb injuries.

• The Thomas splint is recommended for all thigh bone fractures, barring instances where substantial upper thigh or buttock wounds impede proper splint fitting, ensuring optimal immobilization and management of fractures.

• Additionally, it finds utility in cases featuring extensive wounds in the fleshy portion of the thigh, providing a supportive framework while accommodating wound care needs, thereby aiding in the comprehensive management of injuries.

• Particularly in severe fractures surrounding the knee joint or upper segment of the shinbone, the Thomas splint proves beneficial by offering stability and support, contributing to enhanced patient comfort, and facilitating effective treatment interventions.

What Is the Procedure Involved in Thomas Splint?

Within the Thomas Splint ensemble lies the following:

• A framework adorned with a fittingly sized ring.

• Splint straps are numbered either three or five.

• A non-adhesive skin traction kit.

• A protective hoop strap cover.

• Tongue depressors.

• An array of tapes, including micropore tape or elastotape.

• Bandages for secure wrapping.

• Wool for pressure alleviation.

• A pair of scissors.

The steps involved are:

• First and foremost, the physician must thoroughly brief the patient on the upcoming procedure. Given that a Thomas splint can induce discomfort, administering adequate anesthesia, such as a femoral nerve block, is imperative to ensure patient comfort. Additionally, meticulous preparation of the splint and carefully selecting the appropriate size are crucial steps to prevent any potential delays during the application process.

• The splint consists of two distinct parts: the shorter side, which is positioned medially, and the larger side, designed to be placed on the outer thigh, featuring a metal oval ring at its apex. It is essential to secure the straps to the splint precisely, creating a supportive cradle-like structure for the leg to rest comfortably.

• Robust manual traction is administered with the foot in a dorsiflexed position (upward flexion of the foot). When applying skin traction, extending evenly from both sides of the leg is crucial, with the padded portion positioned beneath the sole. Maintaining a 1.57-inch gap between the traction and the foot allows for adequate plantar extension (foot extension downwards).

• The skin traction bandage containing a traction chord must envelop the leg from both sides, leaving the knee and fibula head uncovered by the bandage. This precautionary measure minimizes the risk of compression on the peroneal nerve.

• Once the Thomas splint frame is positioned, it should snugly fit into the groin area and rest firmly against the ischial tuberosity, commonly known as the "sit bones." This ensures proper alignment and stability of the splint.

• The splint frame is skillfully fastened using a bandage, ensuring that the knee and fibula head remain unobstructed. Following this, the traction cords are meticulously tightened around the W-shaped structure at the base of the splint, securing them firmly in place.

• Next, a tongue depressor is carefully inserted between the cords and twisted several times to generate traction. Simultaneously, thorough checks are conducted on the foot's color and movement.

• The foot is gently raised using supportive pillows, ensuring comfort and stability, before proceeding to capture an X-ray image for further evaluation.

What Are the Disadvantages of Thomas Splint?

Disadvantages include:

• Utilizing a clove hitch (a type of knot) to apply traction with the Thomas splint posed a drawback: excessive force or prolonged duration could jeopardize blood circulation to the foot.

• The practitioner must exercise caution and awareness when applying traction with the splint, as increased force can exert additional pressure on the perineal tissues located between the genitals and the anus. Such pressure may result in a severe complication known as perineal pressure necrosis, potentially leading to significant health complications.

• Tailored for femur fractures, the Thomas splint's efficacy might not extend to other fracture types or injuries, warranting caution in its application.

• Discomfort or pain may ensue for patients subjected to the Thomas splint, exacerbated by improper adjustment or swelling around the fracture vicinity.

Conclusion:

Despite 156 years having elapsed since its inception, the enduring legacy of the Thomas splint persists as a staple in medical practices globally. Renowned for its efficacy, the Thomas splint maintains its prominence in military settings, proving indispensable in addressing the exigencies of battlefield trauma. Its versatility shines through in managing open and closed femoral fractures, particularly when operational constraints impede swift patient transport. While iterations have emerged over time, the quintessential simplicity and efficacy of the original Thomas splint endure, cementing its status as a cornerstone in femoral fracture management.