Sager Traction Splint Application

Sagar Traction splint application is included in this California-based EMT program as it satisfies the requirements for long bone immobilization for National NREMT registration while introducing an additional skill with equipment found in many BLS ambulances. It is not required for skills verification for California Registration.

Sager Splint

Sager splints provide unipolar traction. One steel rod sits between a patient's legs and applies traction from the ankle with counter pressure directed onto the ischial tuberosity. Sager splint sits between the leg against the ischial tuberosity, so it is more effective for proximal femur fracture than hare splint. Also, one Sager splint can be used for a bilateral femur fracture. However, there is an increased risk of damage to the genitalia as the splint can move from the initial ischial tuberosity placement during transport. Sager traction splint can measure the actual traction applied on the gauge. The optimal traction is roughly 10% to 15% of a patient's body weight. Only go to 30 lbs for bilateral fractures.

Position

Position the Sager between the patient’s legs, resting the ischial perineal cushion (the saddle) against the ischial tuberosity, with the shortest end of the articulating base towards the ground. In the case of a unilateral fracture, the splint should be placed in the perineum on the side of the injury. In bilateral fractures, excluding pelvic trauma, the side with the greatest degree of injury should be the side of placement.

Strap

Apply the ischial strap as high around the upper thigh of the fractured limb as you can. Push the ischial perineal cushion gently down while at the same time pulling the ischial strap laterally under the patient’s thigh. This will seat the lower end of the cushion comfortably against the ischial tuberosity. Tighten the ischial strap lightly.

Size

Lift the spring ratchet to extend the inner shaft until the crossbar rests 1" beyond the patient’s heels.

CMS Check

Assess neurovascular state of the patient. Note the absence or presence of distal pulses, check for sensation and motor function.

Attach

Position the malleolar (ankle) harness just above the ankle(s). Fold down the number of cushions needed to allow the ankle strap to be velcroed snugly in place at the ankle above the medial and lateral malleoli. This should be tight enough to pull without slipping past the ankle, but not so tight that it impedes blood flow. Ensure that the tension adjustment buckle for the ankle strap is facing laterally.

Slide the lower strap of the ankle harness through the anchor point on the cross bar and adjust the tension strap on the ankle harness to engage the ankle harness tightly against the crossbar.

Applying Tension

With your thumb pull the ratchet up so that it does not "click" and send shock through the patient's injury during adjustment, and grasp the black shaft. With your other hand, grasp the red traction handle and gently extend the inner shaft until the desired amount of traction is recorded on the traction scale. It is suggested to use 10% of the patient’s body weight per fractured femur up to 7kg (15 pounds) for each leg. If bilateral fractures are present – the maximum amount would be 14kg (30 pounds).

Securing

At the hollow of the knees, gently slide the large elastic thigh strap through and gently work it upwards to the thigh, repeating with the smaller straps to the knee and ankle level, taking care to to minimize lower and mid-limb movement.

Check the upper ischial strap at the upper thigh making sure it is not too tight, but snug and secure, then firmly secure the elastic bands.

Secure the feet with a figure of 8 strap around both feet.

Recheck the CMS status of the patient's feet. Note the absence or presence of distal pulses. Patient is now ready for transport.

Indications

A suspected or obvious isolated fracture of the midshaft femur is an indication for traction splint. If there are other fractures in the foot or ankle traction may not be effective, because traction splints require support on strap sites to be able to apply traction.

Contraindications

Fractures of ankle or foot Partial amputation or avulsion with bone separation while only marginal tissue connects the distal limb.

Relevant knowledge pages

CMS recheck