Everything about the Thomas Splint

Courtesy: Sameer Qureshi, Consultant Orthopaedic Surgeon, The Young Orthopod Channel

 

THOMAS’S SPLINT

It was originally described by Hugh Owen Thomas as knee appliance for ambulant management of chronic inflammation of knee joint. Thomas’s splint provides excellent support and immobilisation for transporting the patient

INDICATIONS

• All Femoral shaft fracture except when there is large wounds in buttock/thigh which would interfere with fitting of the splint

PARTS OF THOMAS’S SPLINT

• Proximal padded oval metal ring
• Inner and outer side bar
• Padded ring is set at an angle of 120 degree to the inner side bar.
• The inner and outer side bar are joined together with w piece
• The outer side bar protrudes 2 inches below the padded ring to clear the prominent greater trochanter

CHOOSING THE CORRECT SIZE

1. Measure oblique circumference of thigh immediately below Gluteal fold and Ischial tuberosity. It is taken as the internal circumference of padded ring. In case of oedema take 2” more than the measured value
2. Measure distance from crotch to heel and add 6-9 inches- this gives length of the inner side bar

APPLYING A THOMAS’S SPLINT

1. The correct size splint is pushed gently upto the ischial tuberosity while maintaining a constant traction. Maintain 1 finger gap along the circumference of the padded ring.
2. The splint is applied with MASTER SPLINT in position. The distal splint must end 2.5 inches above the heel to avoid pressure injury to tendo achilles.

FIXED TRACTION IN THOMAS’S SPLINT

• Used to maintain the reduction

SLIDING TRACTION

• Traction weight have the tendency to pull the patient down the bed . Counter traction is given by raising the foot end of the bed . The upward component of the patient’s body weight provides counter traction. The amount of elevation is proportional to the traction weight used.

MANIPULATION ON THOMAS’S SPLINT

1. Manipulation is done when there is loss of bony apposition .
2. If the proximal fragment is abducted – give the traction and abduct the limb in the splint
3. If the proximal fragment is adducted .the position is improved by traction alone
4. If the proximal fragment is in flexion – abduct the limb and raising it may bring the fragment in the position
5. If there is posterior sagging of the fracture site , then increase the padding in the posterior aspect

COMPLICATIONS AND AFTER CARE
Pressure sores –

• Proximal – perineal, groin, ischial tuberosity – can be relieved by increasing the traction.
• Distal – Achilles tendon, over malleoli, under the heel – good nursing and adequate padding.