Prehospital Trauma Compendium: Management of Suspected Femoral Shaft Fractures – A position statement and resource document of NAEMSP
Creators: name: Lyng, John W.
name: Corsa, Joshua G.
name: Nawrocki, Philip S.
name: Raetzke, Brad D.
name: Nackenson, Josh
name: Bosson, Nichole
Publisher: name: Taylor & Francis
Year: 2025
Subjects: subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Cell Biology
subject: Genetics
subject: Biotechnology
subject: Science Policy
subject: Developmental Biology
subject: Inorganic Chemistry
subject: FOS: Chemical sciences
subject: Hematology
subject: Infectious Diseases
subject: FOS: Health sciences

description: Emergency medical services (EMS) clinicians encounter patients with suspected femoral shaft fractures due to both blunt and penetrating trauma. Traction splinting is commonly used by many EMS systems on the premise that it might reduce the perceived risk for hemorrhage and can help reduce pain. It has been called into question whether femoral shaft fractures are truly causative of hemorrhagic shock. Additionally, traction splinting has been associated with iatrogenic injuries, especially if applied to patients with co-morbid lower extremity and pelvic injuries. The application of a traction splint is also an infrequent EMS intervention, raising concerns about skill decay and maintenance of competency. Non-traction splinting, or static splinting, is also a therapeutic option in the field management of suspected femur fractures. Because the benefits of traction splinting versus static splinting of suspected femur fractures in the EMS setting are uncertain, the National Association of EMS Physicians (NAEMSP) performed a review of the evidence regarding EMS management of femoral shaft fractures and developed the following recommendations and summarization of the evidence. Hemorrhagic shock from femoral shaft fractures is uncommon. EMS clinicians should carefully evaluate for other sources of shock in the hemodynamically unstable trauma patient with suspected midshaft femur fracture(s). EMS clinicians must recognize the challenges in accurately identifying femoral shaft fractures and associated comorbid injuries involving the pelvis and distal extremities. EMS clinicians may use either static or traction splinting to immobilize suspected femoral shaft fractures. Traction splinting carries contraindications, additional risks, and technical complexities that are not present with static splinting.
Static splinting may be the preferred method of immobilizing midshaft femur fractures in the prehospital setting.EMS clinicians should not use traction splints unless they have reliably assessed for and reasonably excluded the presence of distal femur fractures, knee joint disruption, and co-morbid ipsilateral lower extremity or pelvic fractures. Static splinting may be the preferred method of immobilizing midshaft femur fractures in the prehospital setting. EMS clinicians should not use traction splints unless they have reliably assessed for and reasonably excluded the presence of distal femur fractures, knee joint disruption, and co-morbid ipsilateral lower extremity or pelvic fractures. EMS clinicians should manage pain associated with suspected femur fractures.
EMS clinicians should immobilize suspected femoral shaft fractures using either static or traction splinting devices or other means to help reduce movement and control pain in adult and pediatric patients.Analgesic medications should be administered to patients with femoral shaft fractures in the prehospital setting whenever they are within the scope of practice and available to EMS clinicians.Regional anesthesia interventions may have a role in the prehospital treatment of femoral shaft fractures when used by appropriately trained EMS clinicians, but widespread adoption of these interventions in the prehospital setting is not yet supported by existing evidence. EMS clinicians should immobilize suspected femoral shaft fractures using either static or traction splinting devices or other means to help reduce movement and control pain in adult and pediatric patients. Analgesic medications should be administered to patients with femoral shaft fractures in the prehospital setting whenever they are within the scope of practice and available to EMS clinicians. Regional anesthesia interventions may have a role in the prehospital treatment of femoral shaft fractures when used by appropriately trained EMS clinicians, but widespread adoption of these interventions in the prehospital setting is not yet supported by existing evidence. EMS clinicians should transport patients with suspected midshaft femur fractures who also meet other triage criteria of the the National Trauma Triage Guidelines to a major trauma center. Transport via air-based EMS may be appropriate in select circumstances. EMS physicians play an important role in developing curricula and leading quality management programs to both ensure that EMS clinicians are properly trained in the recognition and management of femoral shaft fractures and that interventions for femoral shaft fractures are performed appropriately, safely, and effectively.