The Thomas’ splint: Application and patient care
Introduction
Splints and traction remain a part of modern day orthopaedic care. The Thomas' splint, originally known as the Thomas' Bed Splint, is a long leg splint extending from a ring at the hip/groin area to beyond the foot and was named after its developer, Hugh Owen Thomas (1834–1891), a Welsh orthopaedic surgeon (Flynn, 2018). He first described the splint for use with deformities of the lower limb in 1876. The design of the splint has changed little since its first use to treat tuberculosis of the knee and, later, to treat femoral shaft fractures during the First World War where it also facilitated transport of the injured from the battle field (Robinson and O'Meara, 2009). Some redesigned splints with similar principles have become available over the last few years, but these have not yet been formally evaluated for effectiveness and safety.
The Thomas' splint was described in detail by Stewart and Hallett (1983) who explain that it is of a relatively simple design that aims to immobilise the limb and consists of a padded metal ring (either continuous or with an opening and a strap and buckle on the lateral side) covered with soft leather which is attached to an angled bar that extends down the length and both sides of the leg. The bar is usually angled over the hip at the greater trochanter and the two side bars join in a “W” shape at the foot (see Fig. 1). The ring is available in different sizes to enable it to fit appropriately around the patients' groin (over the ischial tuberosity) and across the gluteal fold (or sulcus) and the side bars are made in differing lengths (or are telescopic in newer designed splints). This enables the splint to fit the patient as closely as possible but means that orthopaedic units need to keep a number of different sized traditional splints in stock. This can be problematic since they take up considerable storage space and modern practice means that Thomas’ splints are not used as often as they once were, although still in regular use in many units.
Section snippets
Indications for use
In modern day orthopaedic practice, the Thomas' splint is most commonly used with either skin or skeletal traction to provide immobilisation for proximal third and mid shaft femoral fractures, especially for children and adults whose injuries cannot be managed by other means. The application of lower limb skin extensions and traction is detailed by Duperouzel et al. (2018). The Thomas’ splint is occasionally used without traction as a resting splint and some patients with femoral dislocations
Care of traction apparatus and equipment
It is important that any practitioner who is caring for a patient with a Thomas' splint with or without traction has the knowledge and skills to provide competent, safe and appropriate care. It is necessary to understand the reason for the traction being applied and the rationale for the associated care. There are some specific elements of care to be provided to the patient with a Thomas’ Splint which will be discussed here. Further detail about the general principles of traction can be found
Measuring for the splint and preparing for application
It is essential that the splint ring fits correctly (Fig. 1) and is neither too tight nor too loose, as this renders the splint ineffective and leads to pressure ulcers under the ring. To ensure the correct fit for the splint and to minimise the pain of moving the affected limb, measurements should be taken from the unaffected limb, although it is important to account for swelling to the affected limb. If using a traditional version of a Thomas' splint with either a complete or split ring and
Care of the patient with Thomas’ splint
The ring of the Thomas' splint is a significant potential cause of pressure injury because of its contact with the patient's skin where it can lead to both pressure and friction. The traditional Thomas' splint ring or half-ring is usually covered in soft leather, and glycerine (“saddle”) soap or an alternative softening preserving cream for treating leather should be used to maintain suppleness and softness and prevent cracking, drying or roughness of the leather. Care of the ring should be
Conclusion
Although the Thomas' splint is used much less than it would have been in the 19th and 20th centuries it remains an important option in the treatment of both adults and children with lower limb injuries where other options are not advisable. It is essential that the practitioner has the knowledge and skills to effectively measure for and prepare the splint, as well as care for the patient with particular attention to skin care under the Thomas’ splint ring and recognition of any developing
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