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Background: Austere fracture immobilization equipment and techniques are often overlooked, with few studies critically evaluating the process. The purpose of this study was to evaluate current austere splinting techniques and equipment used for lower extremity fractures while field testing a new 1-step spray-on foam splint. Methods: This is a prospective analysis of austere splinting techniques. A cadaveric model with a distal third tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (structural aluminum malleable [SAM] splint, 6-in. ACE wrap) while being critically evaluated. The specimens were also immobilized with a 1-step in-situ foam splint. Results: Twenty-one military Special Operations medical personnel participated. Each participant was observed and scored by a single orthopedic foot and ankle surgeon using a Likert scale based on 10 splinting criteria. Standard splinting resulted in an average score of 32.2 (range, 5-50), with significant deficiencies in fracture traction (1/5), fracture motion (2.9/5), protection of neurovascular structures (3/5), and soft tissue manipulation (3/5). The average time to completion was 203 seconds, with 1 splint failure. The spray-on foam splinting technique yielded a significantly higher score of 48.5 while completing the task significantly faster (68 seconds), with no failures. Conclusion: Special Operations medical personnel demonstrated success in immobilizing a complex fracture with standard techniques in a cadaveric model. However, testing demonstrated the inherent inability of the SAM splint to provide longitudinal traction while simultaneously allowing excessive fracture motion and potential injury to the soft tissues. In comparison, our spray-on foam proof of concept technique eliminated motion by allowing an in situ application with adequate rigidity. Clinical Relevance: This experiment included a likert scale to critically evaluate splinting techniques and equipment. It reliably tested standard splinting equipment and a 1-step in-situ foam splint for distal third tibia-fibula fractures.

Category: Trauma Introduction/Purpose: Improved body-armor and mine resistant vehicles have improved battlefield survivability, but now nearly 50% of casualties have a musculoskeletal extremity injury. The purpose of the current study was to evaluate current SAM splint techniques utilized for a distal Tib/Fib fracture verse a new one-step spray on foam immobilization technique. Methods: A cadaveric model with a distal third combined tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (SAM splint, 6in Ace wrap). The test group immobilized the injury with a one-step in-situ spray on foam splint. Results: Twenty-one military Joint Special Operations Command (JSOC) medical personnel (11 Medics, 4 PAs, 6 Physicians) participated with an average of 7.7 years as a provider and 25.4 months deployed in a combat theater. Each participant was observed and scored by a single orthopedic foot and ankle surgeon using a Likert scale based on 10 splinting criteria. Standard SAM splinting resulted in an average score of 32.2 (range, 5-50), with significant deficiencies in fracture traction (1/5), fracture motion (2.9/5), protection of neurovascular structures (3/5), and soft tissue manipulation (3/5). The average time to completion was (203 sec), with one splint failure. The spray on foam splinting technique yielded a significantly higher score of 48.5 while completing the task significantly faster at 68 sec with no failures. Conclusion: JSOC medical personnel demonstrated overwhelming success in immobilizing a complex extremity fracture with a SAM splint. Testing demonstrated the inherent inability of the SAM splint to provide longitudinal traction while simultaneously allowing excessive fracture motion and potential injury to the soft tissues. In addition, our spray-on foam proof of concept technique eliminated motion and provided traction by allowing in-situ application with adequate rigidity.

Category: Ankle Introduction/Purpose: Following lower extremity surgery patients are often required to utilize assistive devices in order to perform activities of daily living. As technology and assistive devices continue to improve, providers are faced with selecting a device that is safe while providing high patient satisfaction and a quick return to actives. The purpose of the current study was to compare physical exertion and subject preference between a hands-free single crutch and standard axillary crutches in foot and ankle patients. Methods: A prospective, randomized crossover study was performed using 35 orthopedic foot and ankle patients from within one treatment facility. Each participant had demographic data and heart rate recorded. The patients were then randomized to an assistive device. All participants completed a 6-minute walk test (6MWT); immediately following each 6MWT heart rate, self-selected walking velocity (SSWV), perceived exertion using OMNI Rating of Perceived Exertion (OMNI-RPE) and perceived dyspnea using Modified Borg Dyspnea Scale was obtained. The patients then completed another 6MWT using the other assistive device and was asked the same questions. After completing both 6MWTs participants were asked which assistive device they would prefer to use. Results: A total of 35 patients were included with a median age of 32-year-old. The hands-free crutch was preferred by 86% of participants. Regression analysis was used to test if factors such as gender, height, weight, BMI predicted patient preference of iWalk vs. Crutch. None of these factors were found to be significant. Student t-tests and ANOVAs were performed separately for dyspnea, fatigue ratings, distance (meters) and heart rate between iWalk and crutch all were found to be significant (p