Sager Splint User`s Manual
Contents
1. Cleaning Instructions Software Goods and Stainless Steel M anu Klenz i e Sodium Dodecylbenzine Sulfonate and Coconut Diethylthanolamide Effective manual washing of heavily soiled washable surfaces medical instruments counters glass and plastic surfaces Directions 1 ounce Manu Klenz to 1 gallon water Stainless Steel 70 Alcohol solution or above instructions Foam Rubber Precise Hospital Foam Cleanser Disinfectant 1 2 or other comparable product Sager Emergency Traction Splints 31 SAUER Emergency Traction Splints Appendix A Practical examination for use by Sager Emergency Traction Splints students Includes test paper student exercises and a certificate for successful candidates 32 Sager Emergency Traction Splints SAUER Emergency Traction Splints Practical Examination Sager Emergency Traction Splints Name Student i d Date Course Questions 1 25 2 points each 1 If elevation of a femur fracture is desired the only method to truly elevate the femur above the level of the heart is O Use an ischial pad traction splint with tripod Trendellenberg positioning of the patient Position patient on spine board with head elevated Place patient in side position with fracture site up 2 What isthe best method of preventing external rotation of a fractured femur C Apply an ischial pad splint with tripod which binds the foot of the injur2. Emergency Traction Splints Quantifiable Dynamic Traction The Spring within the Inner Shaft of a Sager splint is dynamic It continuously reacts to changes in the amount of muscle spasm The amount of pain felt by the patient is in part related to the amount of muscle in spasm as well as the degree of spasm This is why a fractured Femur typically results in much more pain than a fractured Humerus The application of traction upon the muscle tires it and pulls it out of spasm and consequently relieves much of the patient s pain It also restores the cylindrical shape of the leg and in the process increases tissue pressure within the thigh which inhibits further blood loss It is interesting to note that blood loss of 1000 1500 c c is not uncommon with Femoral fractures The type of traction applied when using Sager Emergency Traction Splints is called Quantifiable Dynamic Traction Quantifiable means that the amount of traction applied is measurable in pounds or kilograms Dynamic means that the amount of traction or pull on the fracture site is automatically adjusted in relation to the degree of muscle spasm Thus a correct and safe amount of traction is always achieved The Spring within the Inner Shaft of a Sager splint is dynamic It continuously reacts to changes in the amount of muscle spasm For example if Someone accidentally jostles a stretcher on which a patient is lying the muscles around the
3. 14 6 cm 1 2cm 12 In the intact human limb a positive tissue pressure is established because the Fascia muscle sheath forms a which maintains its shape due to the internal support of the femoral bone O Circle Cylinder O Ellipse Sager Emergency Traction Splints 35 SAUER Emergency Traction Splints 13 The most important action of applying traction to a fractured femur in a patient who is hypovolemic and or is developing shock from multiple injuries is O Align the fragments C Pain relief Prevent damage to nerve and vascular structures O Minimize blood loss 14 The various modes for traction can be divided into three broad groups Which is the safest for prehospital care Continuous traction weight and pulley Static traction drum and crank Dynamic traction spring traction 15 Manual traction by a first responder or paramedic falls in the category of dynamic traction It has one serious drawback as Well as one serious limitation These are d O The drawback of unknown traction D r1The limitation of human endurance C O Increased force with time d O Over extension occurs e Forces decrease with time LC and D and B and E and D 16 The Sager Form III Articulating Base and Cushion functions in the same manner as a Hare Splint Reel Splint C Thomas Full Ring or true Half Ring C AIl of the above 36 Sager Emergency Traction
4. 304 Paramedic applying Sager 5301 Super Sager Form III Single on a 5 9 adult male Close up of Model 304 Super Sager Form III Bilateral demonstrates the Sager s unique ability to fit inside air transport units If the patient fits the Sager fits All Sager Traction Scales display traction in pounds and kilograms Sager Emergency Traction Splints 15 PL CUI Emergency Traction Splints Section Four Features advantage and benefits Will fit patients ranging from a 4 year old to an adult well over 2 m 7 feet in height With the Sager s unique design the patient s weight is not a problem in application For infants model S300 Sager Infant Bilateral is available 16 Sager Emergency Traction Splints Feature Quantifiable Dynamic Traction SAUER Emergency Traction Splints Advantage Designed to continuously show the exact amount of safe quantifiable traction applied with no possibility of overtraction Permits documentation of the traction force applied a plus for medical and legal purposes The dynamic function permits the traction to decrease automatically and appropriately as the spasm releases Benefit Reduces further trauma and pain Increased patient comfort Safe Paramedic use Continuous overtraction never occurs Traction is variable as the spasm decreases traction decreases Patients always have the right amount of safe traction Universal
5. Sager Splints mate perfectly with Anti Shock Trousers inside and out If the patient fits the Sager Fits Models S304 and 5204 Sager Emergency Traction Splints 27 SAUER Emergency Traction Splints 8 Sager Splints provide medial and lateral splinting and traction as well as prevention of internal and external rotation Is this less desirable than posterior splinting No not at all One might consider posterior splinting as most desirable if one was transporting a patient without the use of a basket spine board and or stretcher This never happens so why provide posterior support on a device that requires posterior support to be effective Remember Ischial Pad Traction Splints must have a firm support beneath them in order to work and not slip off the Ischial Tuberosity Example It is difficult to apply these devices in snow Time motion studies clearly reveal an economy of time decrease of unnecessary steps decreased movement of the patient and a decrease in morbidity moving the patient from the place of injury to the hospital when a Sager Splint is used Immobilization is better using a Sager Splint if the patient has a proximal fracture of the femur which is the most common type of femoral fracture Sager s splinting system works well with a Spine board or stretcher Sager Splints also work well with Minto Breakaway Flats Minto Breakaway Flats have been uniquely designed to complement the wide range of
6. one size fits all bth to 99th percentile models 304 and S301 Fits an adult or child No delay in application while searching for the right sized splint One 1 bilateral Sager Splint has four 4 times the potential of other splints Straight In line Traction Anatomically and physiologically proven to ensure superior alignment no fear of malalignment Promotes rapid recovery with fewer complications No pressure against the Sciatic Nerve Articulating Base amp Cushion Bends laterally for seating and exacting conformance to the Ischial Tuberosity Increases the comfort and safety of the patient Traction never slips no matter what patient position is assumed Compared to other splints provides the least amount of pain or movement when applying the splint Containment within the Body Silhouette models 304 204 Does not extend beyond the feet of an adult Ideal for use in enclosed areas No problem closing ambulance doors or transporting patients in stokes baskets If the patient fits the Sager fits Rapid One Person Application Frees second attendant for other patients or procedures Does not require constant monitoring Less patient manipulation and therefore less pain and discomfort More time for patient evaluation and care Applied in any position Can be applied prior to moving patients from dangerous locations Promotes increased patient s
7. There is less chance of cutting off circulation with the Sager alleolar Harness ankle harness because it is applied above the alleoli of the ankle away from the posterior Tibial and Dorsalis Pedis Arteries These arteries are deep in the ankle at the site of application of the Sager M alleolar Harness e The Sager Malleolar Harness is quick and easy to apply e The Sager Malleolar Harness is now copied and used by almost all splint manufacturers e The traditional triple and quadruple type harnesses used with Ischial Pad Traction Splints are applied lower over the foot directly over the Dorsalis Pedis and posterior Tibial Arteries at the location in the foot where they are most superficial and most susceptible to pressure or injuries Cross section of the ankle above the Malleoli at the site of pressure and traction of the Sager alleolar Harness Note that the arteries are protected from compression at the M alleoli of the Ankle Diagram of lower limb Anterior and Posterior view of the lower limb at the site of the Sager M alleolar Harness Note that at the front of the leg the Dorsalis Pedis Artery is located deep in the anterior Ankle and is protected from compression except on the top of the foot At the back of the leg the posterior Tibial Artery is protected from compression A because It is located between the Fibula Back of Leg Front of Leg and Achilles Tendon Sager Emergency Traction Splints Dorsalis
8. a single carry case Super Sager Form Ill Combo Pac 2 Model S300 4 1 x 300 Infant Bilateral and 1 x 304 Form III Bilateral Both units store in a single carry case Model 5300 Super Sager Infant Bilateral Model 301 Super Sager Form Ill Single Model S304 Super Sager Form Ill Bilateral Super Sager Combo Pacs are Great value Low Price Ideal for Training Institutes Contact your Authorized Sager Distributor for details Sager Emergency Traction Splints 19 PL CIIM Emergency Traction Splints Section Five Sager components The splint proper is manufactured from 303 stainless steel Sager Form 111 Series Articulating Base is comprised of Dupont s Crastin Polyester Resin The Form III Shaft Cushion is manufactured from Closed Cell CPE Chlorinated Polyethylene Foam The S300 s outer shaft is encased in a vinyl form fitting cover All Sager Splints come complete with all components and accessories required for use including 20 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Sager Emergency Traction Splints have six 6 basic components These consist of Carrying Case The Carrying Case has been designed to provide easy access and storage of all Sager components and accessories The Super Sager Form IIl Combo Pac Carry Case has been designed to store both Adult Child amp Infant Sager models all in one convenient case Splint Proper The Splint Proper consists o
9. anatomical and medically engineered splints sold on the world market today Remember one Bilateral Sager Splint The Sager Splint is the only splint that provides bilateral splinting capabilities and quantifiable dynamic traction One splint can treat either an adult or child with one or two fractured femurs Ischial Pad Traction Splints require the purchase of four splints to have the range of use of one Sager Splint Moreover you will always know how much traction you have applied e Solution Have your hospital join the increasing number of progressive hospitals nationwide who use Sager Splints exclusively for in hospital and service exchange use 6 Are Sager Emergency Traction Splints comfortable to wear Do they press against male and female genitalia To date no significant complaint of discomfort due to pressure from the Perineal Cushion has been recorded When patients do complain there has always been some aspect of the application technique of the splint that has been overlooked Remember Trials using a Sager Splint in practice situations should be undertaken with the patient wearing loose shorts and jeans so that natural genital mobility can take place This is important for both male and female trainees candidates e n real life situations clothing of course should be opened cut and or removed as part of the evaluation process of the patient e The Ischial Perineal Cushion should be placed snugly in the late
10. fracture site may go into a more intense spasm and therefore produce more discomfort for the patient The situation would also produce an increase in the amount of traction perhaps even to the point of 30 pounds the amount could be determined from the reading the traction scale The subsequent Increase in traction would quickly act to relieve the increase in muscle spasm Another and more common experience is that as the initial amount of traction acts upon the muscle spasm the spasm reduces in intensity You should notice a concomitant DECREASE in the amount of traction registered on the traction scale This is both normal and desirable as it acts as a safety mechanism to prevent unnecessarily high amounts of traction being applied It indicates that the muscle spasm and patient discomfort are being reduced Close up of traction being applied to a patient Summary Sager Emergency Traction Splints provide the best mode of traction for field use on fractured Femurs They provide safe traction via their specially calibrated stainless steel spring Sager Splint s also indicate the exact amount of traction force applied and have a dynamic feature that safely varies with the amount of muscle spasm 14 Sager Emergency Traction Splints SAUER Emergency Traction Splints Sager Traction Wheel M odel 5300 amp 5301 Close up of Sager Traction Pulley Wheel and Scale Close up of Sager Traction Handle and Scale Model
11. in real time was made comparing Sager Emergency Traction Splints with the Hare Traction Splint Range of force acting on the Femur with Sager Traction Splints was 0 2 105 Forces acting on the Femur using a Hare Traction device varied from 12 71 Ibs Splint Traction Force Acting On Femur Hare Splint on a supine patient no thigh strap applied No traction Varies 5 1 to 25 Ibs Hare Splint on supine patient thigh strap applied No traction Varies 6 8 to 27 7 Ibs Hare Splint on supine patient thigh strap applied 15 Ibs traction Varies 6 4 to 29 8 Ibs Hare Splint on supine patient thigh strap applied Patient moved to a Semi Fowler s position 15 Ibs traction Varies 8 8 to 48 Ibs Hare Splint on supine patient thigh strap applied Patient moved to a sitting position 15 Ibs traction Varies 20 0 to 71 0 Ibs Hare Splint on supine patient thigh strap applied Patient lifted and carried 15 Ibs traction Varies 3 1 to 34 9 Ibs Hare Splint on supine patient thigh strap applied Patient moved to three quarter prone position 15 Ibs traction Varies 5 0 to 27 Ibs Sager Emergency Traction Splints A complete copy of the preliminary report Load Cell Study Forces acting on an intact Femur with Hare Traction Splint and Sager Emergency Traction Splint is available on request Reprinted with permission from A G Borschneck M D Load Cell Study using a Sager Spli
12. of Sager s anatomically correct Ischial Perineal Cushion 3 Adult and Pediatric Ischial Pad Splints side by side Note how the ischial pads are the same height 4 2 2 7 1 r y 8 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Summary Sager Emergency Traction Splints are the most anatomically correct traction splints available on the world market today They apply countertraction against the Ischial Tuberosity medial to the Shaft of the Femur in a manner consistent with the original Thomas Full and Half Ring Splints This is the same manner of traction and countertraction applied to patients in operating room theatres undergoing surgical reductions and splinting As with surgical procedures Sager s application of traction avoids point pressure on the Sciatic Nerve and related vascular structures in the critical Proximal Third of a Femoral Fracture This same feature makes the Sager indicated for treatment in 93 of all Femoral fractures Sager Splints also avoid the pitfalls of rope weight and pulley traction as well as the hazards associated with drum and crank arrangements They provide gentle quantifiable traction that is dynamic in nature As such the Sager s revolutionary design permits graded reduction of the traction force as the muscle spasm decreases and the leg length increases The Quantifiable feature enables First Respon
13. patient sizes including over sized patients Will the elasticized Leg Cravats straps used with Sager Splints be harmful if applied directly over the fracture site No The limb is immobilized by traction helping to bring the fractured bones into alignment The three elasticized straps splint the leg further immobilizing it and at the same time help to decrease the blood loss at the fracture site 10 Sager Splints provide dynamic traction in pounds and kilograms What happens if the calibrated sping breaks 28 In over twenty five 25 years of use there has never been an instance of the spring breaking Sager Emergency Traction Splints SAUER Emergency Traction Splints Ask Your Authorized Sager Distributor about these additional Minto Products Sized and Shaped For Today s EMS Needs Minto Breakaway Flats provide the perfect solution to inter hospital and intra hospital transport They feature a pull out Center Strap that allows the flat to break into two 2 pieces The flat can then be easily removed from underneath the patients sides without moving the patient The hinged frame assembly allows for tilting the flat into a Semi Fowler s position head elevated for ease in patient care The same feature enables convenient carrying and storage of flats Crews no longer have to waste time waiting to retrieve their transport system The flat s unique design enables crews to retrieve the flat immediately after pa
14. the above 6 When a Sager Splint is properly applied the structures used and pressed on are the same as those Used and pressed on when riding a stationary bicycle C Used and pressed on when riding a unicycle C Used and pressed on when riding a mountain bike Used and pressed on when straddling a fence O AIl of the above 7 The purpose of elasticized Leg Cravats is to C Splint the leg C Further immobilize the leg C Help decrease the blood loss at the fracture site of the above 34 Sager Emergency Traction Splints SAUER Emergency Traction Splints 8 The traditional ankle harnesses used with ischial pad splints are applied Above the M alleoli of the ankle away from the Posterior Tibial and Dorsalis Pedis arteries Directly over the Dorsalis Pedis and Posterior arteries Over the Posterior Tibial but not over the Dorsalis Pedis artery 9 n the case of massive fractures of the pelvis which type of traction splints are contraindicated C Sager Emergency Traction Splints LJ Hare Traction Splints Donway Traction Splints Ferno Traction Splints C Reel Traction Splints of the above 10 The Ischial Tuberosity isastructurethatis to the shaft of the femur Superior O Inferior C M edial O Lateral 11 Cat Scan studies reveal that the Ischial Tuberosity protrudes a maximum of cms below the level of the shaft of the femur 110 12 cm 16 8cm
15. 1 Super Sager Form Ill Single Button Latch Operation Application of Model 301 Super Sager Form III Single Leg Traction Splint is similar to that of its bilateral cousin M odel 304 However the unilateral nature of the 301 requires that when positioning the Splint the Traction Pulley Wheel be placed on it s side and towards the injured limb To accomplish this the 301 Outer Shaft must be disconnected from the Articulating Base and Cushion Simply press the Button Release Latch and rotate the Splint until the Traction Cable is on the same side as the fractured Femur Reconnect the Outer Shaft to the Articulating Base and Cushion Follow the easy application stages of Position Set and Secure to complete the operation Students take note During operation of the Sager Splint always pull the cable parallel to the shaft of the Splint To avoid damage to the cable do not dangle the Splint by the Malleolar Harness ankle harness Do not let the cable snap back to the zero position Release Rotate Reconnect Press Button Release Latch Rotate splint so that the Traction Pulley Wheel is on the same side as the injured limb Reconnect the Outer Shaft to the Articulating Base and Cushion Sager Emergency Traction Splints 3 PL CIIM Emergency Traction Splints Section TWO Anatomy and physiology The human Pelvis is a closed bony ring that is strong and massively constructed It is the foundatio
16. 800 642 6468 330 222 2313 Fax 530 222 0679 E Mail MINTORD aol com www sagersplints com PL CIIM Emergency Traction Splints Section One Instruction guidelines The following lecture guidelines were developed to assist ALS and BLS Instructors in their endeavor to introduce Sager Emergency Traction Splints to students participating in EM T and Nursing Paramedic programs These guidelines are only intended for use as a basic reference tool Please defer to federal state and local medical protocol for definitive analysis and guidelines Sager Emergency Traction Splints 1 SAUER Emergency Traction Splints Introduction To Sager Emergency Traction Splints Introduce the S304 Super Sager Form Ill Bilateral the 5301 Form III Single and the S300 Sager Infant Bilateral Emergency Traction Splints to the class using your training samples Have the class review the training video The Science Of Traction Splinting Application Guidelines for Super Sager models 5304 Form Ill Bilateral S301 Form III Single and 5300 Infant Bilateral Provide handouts of 1 Sager Form III User s Handbook models 5304 5301 amp 5300 2 Why Traction Reprint from J EM S 3 Traction Force Challenge Trials using a Sager Splint in practice situations should be Reprint from EM S M agazine undertaken with the 4 Emergency Orthopedics The T TS Extremities Reprint patient wear ng loose 5 Important Economical sh
17. Ischial Pad splints are contraindicated in the treatment of Proximal Third Fractures and thus are only indicated for treatment of M id Shaft Fractures roughly 996 of all Femoral Fractures A major concern relating to Proximal Third Femoral Fractures is the proximity of the Sciatic Nerve The Sciatic Nerve exits the Pelvis behind the Femoral Head and lies along the Postero M edial edge of the Shaft of the Femur Improper traction splinting of Proximal Third Fractures may result in unnecessary nerve injury These concerns do not apply to Sager Splints because of the unique design of the Ischial Perineal Cushion iliac Crest Proximal third Pelvis Femur And The Sciatic Nerve N of Femur Overhead Projection 2 Femoral Shaft Sciatic Nerve Ischial Tuberosity continued overleaf Sager Emergency Traction Splints 7 SAUER Emergency Traction Splints Consider the anatomy of the Pelvis and Femur In an AP view the Ischial Tuberosity is located about the distance from the mid line to the Femur In a lateral view the Ischial Tuberosity s lower edge is no more than to 1 below the Shaft of the Femur A true Thomas Full Ring or Half Ring Splint properly sized can reach up to press against the Ischial Tuberosity medial to the Shaft of the Femur while the bottom of the ring is well below the lower edge of the Femoral Shaft Ischial Pad splints although often referred to as half ring splints are not
18. Pedis Artery Muscle Fibula Posterior Tibial Artery Flex Hallucis Longus Gastrocnemius Muscle and Achilles Tendon Achilles Tendon Posterior Tibial Artery Tibia Extensor Hallucis Longus Tendon Exterior Digitorum Longus Extensor Digitorum Brevis Dorsalis Pedis siat becomes superficial here PL CIIM Emergency Traction Splints 2 Isthere a danger that external rotation of the fractured femur can occur using a Sager Splint No not when the Sager Splint is properly applied and the Pedal Pinion figure8 strap With Ischial Pad Splints is used to bind the feet together External rotation of a fractured femur can and does happen using Ischial Pad Traction Splints that have the foot end raised on atri pod cannot bind the feet where the feet cannot be bound together together unless the good leg is raised also 3 Is elevation of the foot much better for prevention of leg congestion and swelling Any elevation of the injury and the limb distal to it can be helpful but look at the facts e Most Ischial Pad Traction Splints in use today elevate the foot seven 7 inches The hip may not be elevated at all or at most be elevated one 1 to two 2 inches If the foot is the injured part there may be some improvement in drainage and a decrease in congestion and swelling of that foot However this does nothing for the drainage of the injured femur In order to take advantage of elevation one would have
19. SAUER Emergency Traction Splints Instructor s Manual J M Fikes BSN MSN A G Borschneck M D Edited By A L Borschneck BA NL CIIM Emergency Traction Splints Table of contents Instruction Guidelines 1 The Anatomy amp Physiology Of Fractures 2 Mechanism Of Action 3 Features Advantages amp Benefits 4 Sager Components 5 Questions amp Answers 6 Contraindications amp Cleaning Instructions 7 Practical Exam Student Exercise Appendix A Additional Handouts Handouts User s Handbook Why Traction Traction Force Challenge Emergency Orthopedics The Extremities Important Economical Considerations These Are The Facts USA ICD9 Projections Suggested Reading Overhead Projections For more information on Sager Emergency Traction Splints visit our world wide web site at www sagersplints com Minto Research amp Development Inc Manufacturer s of Sager Emergency Traction Splints and other quality medical products SAGEIC js a registered trademark of Minto Research amp Development Inc Authors Jerald M Fikes BSN MSN Director Emergency Services Mercy Hospital Redding CA Anthony G Borschneck M D Redding CA Editor Anne L Borschneck AA BA 1998 2004 mm um m mmm m E VJ Research amp Development Inc Minto Research amp Development Inc 20270 Charlanne Drive Redding CA USA 96002 9223 Tel 1
20. Splints SAUER Emergency Traction Splints 17 The Sager Form III Articulating Base and Cushion bends laterally for seating and exacting conformance to the O Inner thigh O Ischial Tuberosity C Symphysis Pubis 1 Groin 18 The American Academy of Orthopedic Surgeons recommends gentle traction for a fractured femur on an adult patient which is 115 pounds per leg 1 30 pounds per leg O 15 kilograms per leg You pull traction until the patient gets relief 19 Sager s dynamic function enables the traction to as the spasm releases O Maintain C Decrease C Increase 20 The Sager Form III series splints will fit a patient ranging in age from a 6 year old to an adult over 7 feet in height 3 year old to an adult over 7 feet in height 4 year old to an adult over 6 feet in height 4 year old to an adult over 7 feet in height 21 Sager traction splintsareindicatedfor percent of femoral fractures 1100 175 193 19 Sager Emergency Traction Splints 37 SAUER Emergency Traction Splints 22 Ischial Pad traction splints are indicated for _______ percent of femoral fractures 175 REE about 78 About 9 23 Bleeding to some degree is a common problem with fractured femurs The average amount of blood loss is 1 1000 c c 11500 c c 1 3000 c c 11500 3000 c c 24 The amount of pain felt by a patient with a fractured femur is in partrelated
21. culating Base and Cushion bends laterally for seating and exacting conformance to the Ischial Tuberosity 18 The American Academy of Orthopedic Surgeons recommends gentle traction for a fractured femur on an adult patient which is 15 pounds per leg 19 Sager s dynamic function enables the traction to Decrease as the spasm releases 20 The Sager Form III series splints will fit a patient ranging in age from a A 4 year old to an adult over 7 feet in height 21 Sager traction splints are indicated for percent of femoral fractures 93 22 Ischial Pad traction splints are indicated for About 9 percent of femoral fractures 23 Bleeding is a common problem with fractured femurs The average amount of blood loss is 1500 c c 24 The amount of pain felt by a patient with a fractured femur is in part related to the amount of Amount of spasm 25 The Sager S300 Infant Bilateral Emergency Traction Splint has been designed to reduce the risk of All of the above 40 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Student Exercise Sager Emergency Traction Splints Parts identification place the correct number by the part 1 Splint Proper 2 Shaft Cushion 3 Leg Cravat Kit 4 M alleolar Harness Set 5 Abductor Bridle 6 Pedal Pinion 7 Articulating Base and Cushion Carrying Case 9 Traction Handle and Scale 41 Sager Emergency Traction Splints SAUER Emerge
22. ddition spasm of the Psoas and Piriformis M uscles acting on the Proximal fragment of the Femur may cause a flexion abduction and external rotation deformity Skeletal relationship between the Pelvis and Femur in AP position Note that the Ischial Tuberosity is half the distance from mid line to Femur fig2 Ischial Tuberosity and Femur are on the same plane Note how the Ischial Tuberosity protrudes no more than 1 2 cm Sager Emergency Traction Splints Y2 Distance SAUER Emergency Traction Splints Application of Traction Application of traction breaks the spasm and eliminates much of the pain It also causes alignment of the bone fragments and subsequent increased tissue pressure This reduces and controls bleeding and shock and prevents further nerve vascular and tissue damage It is clear that properly applied traction and immobilization of a fractured Femur helps control shock and reduces mortality The traction needed to break the spasm of muscles associated with a fractured Femur is a product of thetraction force and the length of time it is applied A very large traction force only needs to be applied a short while for muscle fatigue and relaxation of the spasm to occur Large traction forces generally in excess of 30 to 50 pounds can in some cases control spasm in a few seconds However there is a risk with this mode of traction It may result in nerve vascular muscle and soft tissue injury as well as ove
23. ders for the first time ever to document the traction force applied a definite plus for medical legal purposes Safe traction splinting is a science based on a comprehensive understanding of human anatomy and physiology Sager Emergency Traction Splints are the embodiment of this science They are constantly evolving in an attempt to bring the latest scientific advancements to the field of traction splinting Each unique feature not only represents an increase to the comfort and safety of patients but an advantage to the application of traction by First Responders In the ever changing world of medical science one thing remains constant Sager Emergency Traction Splints are the most advanced lower limb traction device ever Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Cadaver Study Comparison Between Sager Emergency Traction Splints Aparat And Ischial Pad Traction Splints A traction and alignment comparison between the Sager Emergency Traction Splint and the Hare Traction Splint was made on a Cadaver with an exposed Intertrochanteric Femur fracture M alalignment was observed when the Hare Traction Splint was applied Acceptable alignment occurred with application of a Sager Emergency Traction Splint Sager Emergency Traction Splints provide countertraction against the Ischial Tuberosity medial to the Shaft of the Femur whereas Hare Traction Splints provided countertraction against the Ischia
24. ed limb C Bind the feet together on the transport stretcher c Properly apply a Sager Splint which utilizes a Pedal Pinion figure 8 strap to bind the feet together Immobilize patient on board 3 Sager Emergency Traction Splints feature Quantifiable Dynamic Traction Among other things this feature enables first responders to Measure traction in pounds or kilograms Document the traction force applied C Reduce the risk of continuous overtraction C AIl of the above Sager Emergency Traction Splints 33 PL CUI Emergency Traction Splints 4 You have a 6 6 tall patient with a fractured femur needing transport in a Stokes basket Which of the following features and benefits are most critical to the patient Choose only one revolutionary manual ratchet traction mechanism CO Straight in line traction O Quantifiable Dynamic Traction traction handle and scale 1A handy tripod C Both unilateral and bilateral splinting capabilities O Exclusive unilateral splinting capabilities only O Articulating Base and Cushion C Containment within the body silhouette 5 The advantages and benefits of a single rescuer being able to apply a Sager Splint are Frees second attendant for other patients and procedures Less patient manipulation and therefore less pain and discomfort time for patient evaluation and care c Does not require constant monitoring and adjustments of
25. f the Ischial Perineal Cushion and Saddle Base Articulating base amp cushion the Outer and Inner Telescoping Shafts the Cross Bar Harness Traction Scale and Traction Handle or Traction Pulley Wheel The Form Ill Articulating Base and Cushion enables anatomically and physiologically correct countertraction to be applied against the bony structures of the Pelvis These structures include the Ischial Tuberosity Ischial Ramus Pubic Ramus Pubic Symphysis and Mons Pubis These hard points ensure fail safe countertraction no matter what the patient s position may be The Articulating Base and Cushion bends laterally for seating and exacting conformance to the Ischial Tuberosity It is interesting to note that Sager s Ischial Perineal Cushion provides the same safe and secure mode of support as a bicycle seat continued overleaf Sager Emergency Traction Splints The Carrying Case The Abductor Bridle Thigh Strap The Splint Proper The Leg Cravat Kit The Pedal Pinion Figure Eight 8 Strap The Malleolar Harness Set Ankle Harnesses m Model 304 Super Sager Form III Bilateral Components Articulating Base and Cushion 21 SAUER Emergency Traction Splints The Outer and Inner Shafts act as the splint and also contain the traction mechanism The Shaft Cushion which covers the length of the outer shaft provides added comfort and cushioning The outer shaft includes a Button Latch at t
26. he distal end that acts as a one way lock The splint may be lengthened and locked by simply pulling on the Inner Shaft In order to decrease the splint s length the Button Latch must be lifted to allow retraction of the Inner Shaft thus shortening the splint s length The Cross Bar provides the point of attachment for the Ankle Harnesses and the Traction Handle Wheel provides controlled safe secure quantifiable dynamic traction to the injured limb s Sager s Traction Scale displays the amount of traction that has been applied enabling the Operator to document the exact amount of traction applied It should be noted that constant traction fatigues leg muscles in spasm allowing the reduction of bone overlap to ensure leg lengthening and alignment Abductor Bridle The Abductor Bridle thigh strap is used to bend and hold the Ischial Perineal Cushion laterally for seating and exacting conformance to the Ischial Tuberosity alleolar Harness The Malleolar Ankle Harness is designed to attach around the patient s Ankle above the medial and lateral Malleoli The harnesses are marked Left and Right to indicate the appropriate placement and use Each harness has Comfort Cushions that can be folded into place to accommodate the various sizes of Ankles or leg wear Leg Cravat Kit Sager s Leg Cravat Kit consists of three 3 elasticized straps These straps have been specially designed to spread equal tension when applied over the e
27. ized Leg Cravats is to All of the above 8 The traditional ankle harnesses used with ischial pad splints are applied Directly over the Dorsalis Pedis and Posterior arteries 9 In the case of massive fractures of the pelvis which type of traction splints are contraindicated All of the above 10 The Ischial Tuberosityisastructurethatis to the shaft of the femur Medial 11 Cat Scan studies reveal that the Ischial Tuberosity protrudes a maximum of cms below the level of the shaft of the femur 1 2 cms 12 Inthe intact human limb a positive tissue pressure is established because the Fascia muscle sheath forms a which maintains its shape due to the internal support of the femoral bone Cylinder 13 The most important action of applying traction to a fractured femur in a patient who is hypovolemic and or is developing shock from multiple injuries is Minimize blood loss Sager Emergency Traction Splints 39 PL CIIM Emergency Traction Splints 14 The various modes for traction can be divided into three broad groups Which is the safest for prehospital care Dynamic traction spring traction 15 Manual traction by a first responder or paramedic falls in the category of dynamic traction It has one serious drawback as well as one serious limitation These are a and b 16 The Sager Form III Articulating Base and Cushion functions in the same manner as a Thomas Full Ring or true Half Ring 17 The Sager Form III Arti
28. l Tuberosity below the Shaft of the Femur Pressure up against the Femur with the Hare mechanism creates pressure and possible injury on the Sciatic Nerve and other intervening soft tissue structures This does not occur with Sager Emergency Traction Splints fig 8 Intertrochanteric Femoral Fracture with Sager Emergency Traction Splint in place with 15 Ibs of traction Note alignment of l m fracture occurs and pressure on critical structures below the Femoral Shaft is absent 1 Proximal Femur Greater Trochanter 2 Distal Femoral Shaft ie Foot end fig 9 Intertrochanteric Femoral Fracture with Hare Traction Splint in place with rope 15 Ibs weight and pulley for traction Note Femur is pushed up into malalignment and Sciatic J Nerve and Vascular structures are pushed up 7 Foot end into fracture site 1 Proximal Femoral Fragment externally rotated 2 Distal Femoral Shaft 3 Approximate site of Sciatic Nerve A complete copy of the preliminary report Cadaver Study Comparison between Sager Emergency Traction Splints and Ischial Pad Traction Splints is available on request Reprinted with permission from A G Borschneck M D 10 Sager Emergency Traction Splints SAUER Emergency Traction Splints Load Cell Study Forces Acting On An Intact Femur With Hare Traction Splint Abstract and Sager Emergency Traction Splint A Load Cell Study documenting forces acting on the Proximal Femur
29. n for the Torso and provides support for the lower limb attachment and locomotion It is shaped so that the Ischial Tuberosity forms a platform for sitting in an upright position This occurs because the Ischial Tuberosity is the most distal part of the pelvis When the legs are flexed anteriorly all the weight of the body can rest unencumbered on the Ischial Tuberosities seeoverhead projection 1 Photograph of accident victim with intact left leg and fractured right femur Note leg shortening and enlargement of right thigh 4 Sager Emergency Traction Splints SAUER Emergency Traction Splints Each Tuberosity is medial to the shaft of the Femur and is located half the distance between the midline Symphysis Pubis and the Femoral Shaft They form the base line of the Uro genital triangle which slopes anterior and cephelad The external Genitalia in both sexes are attached at the apex of the Uro genital triangle and because of this both sexes can sit straddling seats and saddles without discomfort or injury The largest muscle mass in the human body is located surrounding the length of the Femur When fracture of the Femur occurs it can result in e Laceration of arteries veins and nerves at the site of the fracture e Severe muscle spasms resulting in Bone fragment overriding deformity and shortening of the limb e Decreased tissue pressure resulting in further bleeding and shock as well as severe pain In a
30. ncy Traction Splints Student Exercise Answer Key Sager Emergency Traction Splints Parts identification 1 Splint Proper 2 Shaft Cushion 3 Leg Cravat Kit 4 Malleolar Harness Set 5 Abductor Bridle 6 Pedal Pinion 7 Articulating Base and Cushion Carrying Case 9 Traction Handle and Scale 42 Sager Emergency Traction Splints 9 y21easay sui DU 3u2 udo PASC 9 upJesse JO gt popes IHE uonninsu JEP uo opnu sna Aq pepee Sag UBLUCIINDS SIU Jo SSN SUOIEIIL HSID pue SJUSBLLEJINDSI Jeppy pue IE E20 Sau s3urjds UOIIDEAL pes JO asn oua ui suoneuLuexe y UM pue eped uyog seu Fey SPE sur UO TPPRLUOD LO DOLD squids uone Pr
31. nt shows a maximum force of 1 2 Ibs acting on the femur with the patient in any position 11 PL CIIM Emergency Traction Splints Cat Scan Study The Ischial Tuberosity protrudes at most 1 2 cm below the level of the shaft of the Femur Reprinted with permission from A G Borschneck M D Survey Radiograph of CAT SCAN Study through Pelvis and upper Thigh of adult male Note male Genitalia is not interposed between Sager s Ischial Perineal Cushion splint cushion and the Ischial Tuberosity Cross Section Cut 21 of CAT SCAN Survey of adult male Note Ischial Tuberosity is a structure medial to the Shaft of the Femur and protrudes at most 1 2 cm below the level of the Shaft of the Femur 1 2cm Survey Radiograph of adult female CAT SCAN Study of the Pelvis and Femur fig 13 Cross Section through Cut 21 of CAT SCAN Study Note Ischial Tuberosity is a medial structure in relation to the Shaft of the Femur The Ischial 12cm Tuberosity protrudes at most 1 2 cm below the Shaft of the Femur 12 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Section Three Mechanism of action When a patient suffers a fractured Femur the large muscles surrounding the bone react by going into spasm and thereby splint the fracture site The pain alerts the patient to the injury and also prevents further movement of the limb which may worsen the injury Sager Emergency Traction Splints 13 SAUER
32. ntire surface area The largest strap will be placed around the patient s upper Thigh Do not be concerned about applying this strap over a fracture site Once traction has been applied the Bone ends will be drawn into near normal alignment and natural splinting takes place The strap provides further splinting in conjunction with the splint shaft and the patient s other leg The remaining straps will be applied around the patient s knees and around the patient s shins just above the ankle harnesses Pedal Pinion The Pedal Pinion figure eight 8 strap is applied around the Ankles and Feet to prevent internal or external rotation of the distal parts of the fractured Bone It also provides additional splinting Note as with any device that uses hook and loop fasteners the Cravats may engage on carpet unless care is taken during application When you insert the Cravats under the knee the HOOK half of the Velcro fastener faces UP on the end of the Cravat being inserted The LOOP half of the Velcro fastener therefore will trail and face DOWN and will not stick to the carpet 22 Sager Emergency Traction Splints Probe lens view of the Outer and Inner Shaft s of Sager model 5304 SAUER Emergency Traction Splints Section SIX Questions and answers Sager Emergency Traction Splints 23 1 24 PL CIIM Emergency Traction Splints What advantage is there to using Sager s revolutionary alleolar Ankle Harness e
33. orts and jeans so that Considerations 6 These Are The Facts 7 USA ICD9 Projections 1997 natural genital mobility can take place e Demonstrate the application of the 304 and or 301 on a volunteer from the class If available demonstrate the application of the S300 on a pediatric volunteer or mannequin A practical exam has been provided for your convenience Demonstrate the correct application Have each class member practice with the splint s until they demonstrate to you that they have mastered its use in accordance with the application instructions Ask if there are any questions regarding the use of Sager Splints and address of Sager Splints these in accordance with the provided instructional materials and state local ee medical protocol If you are unsure of the answer to a question record it and 1 person application contact your local or state education service for the answer in under 2 minutes Split the class into three equal groups Have one group write the written test one group practice with the splint s and one group take the practical test Rotate through the groups until each student has 1 practiced with the splint 2 demonstrated they can apply it correctly and 3 taken the written exam e Mark the written exam Students who fail the written exam should review the material and retake the exam 2 Sager Emergency Traction Splints SAUER Emergency Traction Splints Model S30
34. r extension of bone fragments Gentle traction the amount of pull required to accomplish this traction will vary but rarely exceed 15 pounds This is gentle traction and the least amount of force necessary is the amount that should be employed American Academy of Orthopedic Surgeons Emergency Care and Transport of the Sick and Injured Third Edition George Banta Co Inc 1981 San Antonio TX pg 142 Skeletal Comparisons Between Sager And Hare fig 3 Hare Ischial Pad Splint Angle of malalignment is 51 degrees Sager Emergency Traction Splints provide near perfect alignment fig 5 Typical x ray radiograph of fractured femur with Sager Traction alignment traction force 12 Ibs 6 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Safe Traction Safe traction for field use should be traction in a known amount prescribed by protocol or a medical consultant It should also be traction that is dynamic in nature using a resilient member that permits graded reduction of traction force as the muscle spasm decreases and leg length increases It should avoid the pitfalls of rope weight and pulley traction which is a constant and unrelenting force that can result in over extension of the bone elements This method is more conducive to a hospital environment where it can be monitored at length under the care and supervision of an Orthopedic or other M edical Consultant Static traction a
35. ral perineal area against the thigh and the Ischial Tuberosity and then strapped into place before applying traction Few people male or female complain about discomfort when sitting or riding on a bicycle The structures used and pressed on in this situation are the same as those used when wearing a Sager Splint 26 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints 7 What advantage is there to using a Sager Splint with Anti Shock Trousers Sager Splints are so versatile that Anti Shock Trousers can be applied over the leg of a patient wearing a Sager Splint just as easily probably easier than on a patient not wearing a splint at all After the Sager is applied the patient s fractured femur is stabilized and it becomes easy to clothe a patient in an Anti Shock garment Remember e The shaft of the splint is closely applied to the medial side of the thigh and the Ischial Perineal Cushion is located so that it lies in the perineal opening of the Anti Shock garment e Since the splint is closely applied to the leg there is excellent contouring of the pressure bladder of the trouser around the shaft of the splint and over the leg The possibility of tenting between the shock trouser and the splint shaft is so small that it becomes negligible schial Pad Traction Splints are irregular in shape and poorly conform to the shape of a patient s leg when Anti Shock trousers are applied fig 24
36. s provided by drum and crank arrangements should also be avoided The traction is not quantifiable and most importantly can be completely lost if leg spasm stops and the limb lengthens This traction force exists only for a set length between points of traction and countertraction It also necessitates constant monitoring and resetting of traction leading to further distraction of bone elements and or needless increase in pain In addition uneven forces in lifting and carrying or simply moving a patient can double or triple the forces against the injured limb This drawback is commonly associated with most Ischial Pad splints that promote the use of static traction arrangements Common Femoral Fractures Versus Splinting Systems In 1997 the projected potential of U S Femoral Fracture hospital admissions totaled 474 551 USA ICD9 Projections Internet Of these Proximal Third Fractures accounted for 84 or 399 484 of total hospital admissions while M id Shaft Fractures accounted for 996 or 41 012 of all admissions Together these two fracture types amounted to an estimated 93 of all hospital admissions The remaining 796 34 055 of fracture types indicates traction not needed or contraindicated Sager Emergency Traction Splints are indicated for treatment in all Proximal Third and M id Shaft Fractures In other words in 1997 alone Sager Splints had the capability and potential to treat 93 of all projected Femoral Fractures Conversely
37. tability Less pain less possibility of further injury Compact and Lightweight Weighs 3 pounds Will fit in most backpacks Sager Emergency Traction Splints Ready for use 17 SAUER Emergency Traction Splints M odel Advantage Benefit 5304 Super Sager Form Ill Bilateral Has the ability to treat an adult or child You always have the correct splint to treat with one 1 or two 2 fractured Femurs the wide variety of Femoral fractures Universal has four 4 times the function of Ischial Pad Splints Economical Quick application Treats unilateral fractures on Less equipment to carry an adult or child 5300 Super Sager Infant Bilateral Only splint on the world market that is Pediatric patients receivethe same care designed to treat children from birth to as an adult the correct equipment six 6 years of age sized for a child No risk of overtraction and its detrimental effects to Epiphyseal growth centers Knee Edema and excessive distraction of bone ends 1996 Guidelines for Pediatric Equipment and Supplies deemed pediatric extremity splints as essential for all BLS and ALS Ambulance units Annals of Emergency Medicine Dec 1996 No 28 p 699 701 18 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Other model combinations Super Sager Form Ill Combo Pac 1 Model S300 1 1 x 300 Infant Bilateral and 1 x 301 Form Ill Single Both units store in
38. tient transfer Think of them as the patient transfer system you won t leave behind Minto Breakaway Flats have been in use throughout North America since 1985 They are available in two 2 distinct sizes and shapes and have been designed to meet the needs of today s Emergency Medical Services e Model B101 Standard Flat Sets the standard of quality patient care for adults and everyday use e Model B104 Maxi Flat Constructed from extra heavy duty materials to support the oversized patient Without a doubt there s a Minto BREAKaway Flat to meet your needs Minto Breakaway Flat model B101 Standard Flat Minto Breakaway Flat model B104 M axi Flat Constructed from extra heavy duty materials for the oversized patient Weight capacity of 1 000 pounds when lifted equally on all sides Sager Emergency Traction Splints 29 PL CIIM Emergency Traction Splints Section Seven Contraindications and cleaning All operators should receive full and proper initial and refresher instruction sessions from a qualified person on detailed use of this equipment and regarding the particular situations in which it should be used 30 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Indications Sager splints are indicated for use on Proximal Third and M id Shaft femoral fractures Contraindications for the use of tractions splints for femoral fractures A fracture of the Pelvis occurring with a frac
39. to raise the foot ankle approximately twenty two 22 inches in order to raise the femoral injury above the level of the heart However even this extreme elevation will not raise the injury above the level of the patient s heart when the fracture is at the proximal end of the femur Ischial Pad Traction Splints cannot raise femurs above the level of the heart therefore this minimal elevation is of no value It can also be detrimental If elevation of the fracture site is desired trendellenberg positioning of the patient should be considered This is the only method to truly elevate the femur above the level of the patient s heart mA D VAL i Lew If elevation of the fracture site is Su pen desired Trendellenberg positioning of the patient is the more appropriate course of action Sager Emergency Traction Splints 25 PL CIIM Emergency Traction Splints 4 Are Sager Splints contraindicated in the case of massive fractures of the pelvis Yes but so are all traction splints including Ischial Pad Traction Splints since they also i i can compress and deform the Ischial Tuberosity which is part of the pelvis and subject Ischial Pad and Half Ring to movement Splints require the 5 Why should I purchase a Sager Splint when some hospitals in my area purchase of four splints to utilize Ischial Pad Traction Splints and can exchange splint for splint have the range of use of Sager Splints are the most advanced
40. totheamountof Amount of blood loss Degree of Angulation Anesthesia of the part Amount of spasm 24 The Sager 300 Infant Bilateral spint h has been designed to reduce the risk of Overtraction C Knee edema O Injury to Epiphyseal growth centers All of the above 38 Sager Emergency Traction Splints PL CIIM Emergency Traction Splints Practical examination Answer key Sager Emergency Traction Splints if elevation of the femur fracture is desired the only method to truly elevate the femur above the level of the heart is Trendellenberg positioning of the patient 2 What is the best method of preventing external rotation of a fractured femur Properly apply a Sager Splint which utilizes a Pedal Pinion figure 8 strap to bind the feet together 3 Sager Emergency Traction Splints feature Quantifiable Dynamic Traction Among other things this feature enables first responders to All of the above You have a 66 tall patient with a fractured femur needing transport in a Stokes basket Which of the following features and benefits are most critical to the patient Choose only one Containment within the body silhouette 5 The advantages and benefits of a single rescuer being able to apply a Sager Splint are All of the above 6 When a Sager Splint is properly applied the structures used and pressed on are the same as those All of the above 7 The purpose of elastic
41. true half ring splints Ischial Pad splints are really only a slightly dished padded bar at right angles to the Femoral Shaft of the Femur The bars pads are usually elevated on pedestals that can range in height from 1 to 3 high the same adult elevations are seen in pediatric models sadly they have not been resized for pediatric patients In order to hook onto the Ischial Tuberosity and provide countertraction these bars pads must push up on the Femoral Shaft resulting in a undesirable malalignment of the injured Limb This malalignment is exaggerated in pediatric patients Conversely Sager s Ischial Perineal Cushion was designed to impinge on the Ischial Tuberosity medial to the Shaft of the Femur and thus provide the same action as a Thomas Full Ring Splint By design the Sager is anatomically and medically engineered to avoid pressure against the Proximal Third of the Femur and the Sciatic Nerve Currently revised Ischial Pad splints are also offered on the market These devices are actually Ischial Pad splints turned on their sides While the devices attempt to imitate Sager Splints they fall short on a number of critical points For example the perineal cushion does not conform to the Perineum and as well the device is still subject to the pitfalls of static traction as it continues to promote the use of drum and crank static traction arrangements As importantly the device is unable to replicate the function and performance
42. ture of the Femur is generally a contraindication for the use of a traction splint of any type A Sager Emergency Traction Splint is not contraindicated when M AST Trousers are used to immobilize the fractured Pelvis In this situation Sager Splints may be applied over M AST Trousers if treatment of the fractured Femur is indicated or desired Sager s traction is quantifiable and gentle and will not disrupt or move Pelvic bones immobilized by M AST Trousers Supracondylar fractures of the distal end of the Femur are contraindicated because traction can cause anterior rotation of the distal bone fragment forcing the sharp fractured bone end down into the Popliteal Artery and Nerve These fractures should be splinted as found Compound fractures of the Femur with bone fragments sticking through the skin may be a contraindication Guidelines by local protocol or instructions by a M edical Consultant should be followed Fractures of the Ankle and Foot are also contraindicated Pressure from the ankle harness and from traction is not therapeutic The indications and contraindications listed above are only intended as a basic reference tool Please defer to federal state and or local protocol for definitive analysis and guidelines Warning All Operators should receive full and proper initial and refresher instruction sessions from a qualified person on detailed use of this equipment and regarding the particular situations in which it should be used
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