Special Operations Forces Medical Handbook

8-33

Procedure: Common External Traction Devices

18D Skills and Training Manual, Reviewed by LTC Winston Warme, MC, USA

When: When a casualty has a fracture of the lower limb that needs traction to reduce the fracture,
stabilize and align it. Apply the correct amount of traction to the extremity without causing further injury
to the patient.

What You Need: Moleskin, elastic bandage, felt pads or cotton, stockingette, rope or cord, a spreader
bar, soap, water, a razor and blades.

What To Do:

1. Inspect the skin of the lower extremity to determine the scope of injury.


2. Check the pulse in the lower extremity to ensure blood circulation.
   NOTE: If none, assess the neurovascular status before, after, and at intervals during the procedure. If
   pulses continue to be absent, continue with this task and evacuate as soon as possible.


3. Wash the lower extremity.


4. Shave the leg.


5. Pad the bony prominences of the leg (medial/lateral malleolli and fibular head) to prevent injury.


6. Apply moleskin to the medial and lateral aspects of the leg to protect the skin from breakdown.


7. Apply a long piece of stockingete from the medial roximal tibia to the lateral proximal tibia, leaving a
   loop below the foot. Attach the spreader bar to the stockingette, in line with the long axix of the
   extremity. Secure the stockingette to the limb with an elastic bandage.
   a. If stockingette is not available, improvise with rope, torn clothing or belts.
   b. The spreader bar can be a stiff branch, a canteen cup with a hole drilled in the center, or an
   unopened abdominal bandage taped to the device.


8. Align the rope over a pulley or pivot point with tension in line with the long axis of the extremity.


9. Attach five pounds of weight to the construct. More may be needed.
   CAUTION: The device used to attach the weight to the extremity must not be so tight that it restricts the
   blood flow. The force applied by the weight must NOT exert uneven pressure that would cause skin
   necrosis.
   NOTE: Add additional weight until the patient experiences relief of pain. The relief will often be dramatic
   by adding as little as two or three pounds. Reduce the weight over the following days as the muscle
   spasm (that the traction device is designed to overcome) diminishes.


10. Perform a postreduction examination of the extremity to evaluate the following:
    a. Reduction efficacy.
    b. Neurovascular status.
    CAUTION: Pain may indicate the possibility of compartment syndrome. Re-examine the patient frequently
    for this complication (see Procedure: Compartment Syndrome Management).


11. Check the pulse in the extremity hourly.


12. Record the procedure.

What Not To Do:
Do not add too much weight.
Do not constrict the limb, which restricts blood flow and causes necrosis.

Procedure: Bladder Catheterization

CAPT Leo Kusuda, MC, USN

What: Straight catheterization through urethra to drain urinary bladder.

When: When patient is unable to void or is having frequent (q 15-20 minute) voiding, suggestive of poor