title: Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or Not to Use? That Is the Question.
abstract: OBJECTIVE
  To determine the incidence of femur fractures in mountain rescue in England and Wales. To investigate the attitudes of rescuers toward the use of femoral traction splints. To review the literature for evidence on the use of traction splints in prehospital medicine and test the hypothesis that femoral traction splints reduce morbidity and mortality in patients with a fractured femur.
  
  
  METHODS
  The Mountain Rescue England and Wales database was searched for cases of suspected fractured femur occurring between 2002 and 2012, a questionnaire was sent to all mountain rescue teams in England and Wales, and a literature review was performed. Relevant articles were critically reviewed to identify the evidence base for the use of femoral traction splints.
  
  
  RESULTS
  Femur fractures are uncommon in mountain rescue, with an incidence of suspected femur fractures on scene at 9.3 a year. Traction splints are used infrequently; 13% of the suspected femur fractures were treated with traction. However, rescuers have a positive attitude toward traction splints and perceive few disadvantages to their use. No trials demonstrate that traction splints reduce morbidity or mortality, but a number describe complications resulting from their use.
  
  
  CONCLUSIONS
  Femur fractures are rare within mountain rescue. Traction splints may be no more effective than other methods of splinting in prehospital care. We failed to identify evidence that supports the hypothesis that traction splints reduce morbidity or mortality. We advocate the use of a femoral traction splints but recognize that other splints may also be appropriate in this environment.
authors.affiliation: North Cumbria University Hospitals NHS Trust, Emergency Department (Dr Runcie), and Emergency Medicine (Mr Greene), West Cumberland Hospital, Whitehaven, UK. Electronic address: harriet.runcie@gmail.com.
authors.forename: Harriet
authors.initials: H
authors.lastname: Runcie
authors.affiliation: North Cumbria University Hospitals NHS Trust, Emergency Department (Dr Runcie), and Emergency Medicine (Mr Greene), West Cumberland Hospital, Whitehaven, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Greene
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D005264:Femoral Fractures / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009017:Morbidity; D009051:Mountaineering; D018635:Rescue Work / Q000706:statistics & numerical data; D013165:Splints / Q000706:statistics & numerical data*; D014143:Traction / Q000706:statistics & numerical data*; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
keywords: femoral fracture; prehospital care; splints; traction; wilderness medicine