Early versus delayed application of Thomas splints in patients with isolated femur shaft fractures: The benefits quantified.
OBJECTIVE
To investigate and quantify the clinical benefits of early versus delayed application of Thomas splints in patients with isolated femur shaft fractures.


METHODS
Level IV retrospective clinical and radiological analysis of patients presenting from January to December 2012 at a Level 1 Trauma Unit. All skeletally mature patients with isolated femur shaft fractures independently of their mechanism of injury were included. Exclusion criteria were: ipsilateral fracture of the lower limb, neck and supracondylar femur fractures, periprosthetic and incomplete fractures. Their clinical records were analysed for blood transfusion requirements, pulmonary complications, surgery time, duration of hospital stay and analgesic requirements.


RESULTS
A total of 106 patients met our inclusion criteria. There were 74 males and 32 females. Fifty seven (54%) patients were in the 'early splinted' group and 49 patients (46%) were in the 'delayed splinted' group (P>0.05). The need for blood transfusion was significantly reduced in the 'early splinted' group (P=0.04). There was a significantly higher rate of pulmonary complications in the 'delayed splinted' group (P=0.008). All other parameters were similar between the two groups.


CONCLUSIONS
The early application of Thomas splints for isolated femur fractures in non-polytraumatised patients has a clinically and statistically significant benefit of reducing the need for blood transfusions and the incidence of pulmonary complications.
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland. Electronic address: svenhoppe@gmail.com.
Sven
S
Hoppe
Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
Marius Johann Baptist
MJ
Keel
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Orthopaedic Surgery, CHUV, University of Lausanne, Switzerland.
Nicolas
N
Rueff
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa.
Issadig
I
Rhoma
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa.
Stephen
S
Roche
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa.
Sithombo
S
Maqungo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000628:therapy*; D006801:Humans; D007103:Immobilization / Q000295:instrumentation* / Q000379:methods; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D013165:Splints; D013997:Time Factors; D014143:Traction / Q000295:instrumentation*; D014193:Trauma Centers; D016896:Treatment Outcome
Blood loss; Complications; Femur shaft fractures; Outcome; Thomas splint; Traction splint