SAGER: Traction Splinting A Midline Femur Fracture
/What is a Sager Splint?
A Sager splint, also known as a traction splint, is a medical device used to immobilize and align a fractured or injured leg. It is designed to reduce pain and swelling by applying traction to the leg, pulling the bone fragments back into alignment. The splint consists of two main components: the splint itself, which is a long, narrow rod that extends from the foot to the groin, and the traction mechanism, which is attached to the foot end of the splint.
An advanced first aider applies a Sager splint to a patient with a broken femur. The patient is lying on their back and the first aider is wearing white gloves and kneeling beside them.
The splint is typically made of aluminum or carbon fiber and is lightweight and easy to transport. It is designed to be adjustable to fit a variety of leg sizes and can be quickly and easily applied in emergency situations. The traction mechanism is usually a ratcheting system that allows the medical professional to control the amount of traction being applied to the leg. This mechanism can be adjusted to achieve the desired amount of traction and can be released easily if necessary.
The amount of pressure applied is weighed in pound with a rule of thumb being 10% of the patients body weight for a maximum of 15 pounds per femur fracture or 30 pounds for a bilateral femoral fracture.
Sager splints are used for femoral shaft fractures, which are fractures that occur in the middle of the thigh bone. These types of fractures can be serious and require immediate attention. Sager splints are effective at immobilizing the affected leg, reducing pain and swelling, and realigning the bone fragments.
What causes a femur fracture?
Femur fractures can occur due to a variety of mechanisms of injury (MOI), with high-energy trauma and direct impact being the most common causes.
High-energy trauma, which involves a significant amount of force, can be caused by car accidents, falls from a height, sports injuries, and other incidents that involve significant force. The femur can break due to the impact of the force or due to bending or twisting of the bone.
Direct impact to the thigh bone, such as a blow from a heavy object or a fall onto a hard surface, is another common MOI that can cause a femur fracture. This can occur in industrial accidents or during contact sports. In both cases, the force applied to the femur is greater than the bone's ability to absorb it, causing the bone to break.
It's important to note that the severity of the femur fracture can vary depending on the MOI and the angle of impact.
How serious is a broken femur?
A femur break, particularly a bilateral femur fracture, can be a serious and potentially limb-threatening injury. The femur is the longest and strongest bone in the human body and is responsible for supporting the weight of the body and facilitating movement. When the femur is fractured, it can cause significant pain, swelling, and deformity of the affected leg.
One of the most significant dangers of a femur break is the potential for the femoral artery to be compromised by a bone fragment. The femoral artery is a large blood vessel that runs through the thigh and supplies blood to the lower leg and foot. If a bone fragment from a femur break punctures the femoral artery, it can lead to internal bleeding, which can be life-threatening if not treated promptly.
In addition to the danger of internal bleeding, a femur break can also result in nerve damage, muscle damage, and compartment syndrome. Compartment syndrome occurs when pressure within a muscle compartment builds up, which can cause damage to the nerves, blood vessels, and muscles in the affected area. If left untreated, compartment syndrome can lead to permanent damage or loss of function in the affected limb.
Indications and contraindications
Indications:
Femoral shaft fractures:
Sager splints are commonly used to immobilize and align femoral shaft fractures, which are fractures that occur in the middle of the thigh bone. Bi-lateral or single femur fractures.
Contraindications:
Open fractures:
A compound or open fracture is a type of bone fracture where the broken bone pierces through the skin.
In a compound fracture, the exposed bone can be seen or felt through the wound in the skin, and there may be visible bleeding, swelling, and/or deformity at the site of the injury. If the skin over the fracture is broken or torn, the Sager splint should not be applied as it can cause further damage or infection.
Injuries on the effected leg:
If the patient has any other associated injuries, such as ankle or fib tib fractures, a Sager splint may be contraindicated. Additionally, if the patient has a knee injury, such as a dislocated knee, a Sager splint may not be appropriate as it can exacerbate the injury. It's important to carefully evaluate the patient with a thorough rapid body survey to rule out injuries that may effect application.
Life threatening injuries:
If a patient has a life-threatening injury, the priority is to rapidly transport the patient to a medical facility for appropriate treatment. In such cases, immobilization with a Sager splint may not be the best course of action, as it can take time to properly apply the splint, and rapid transport may be necessary to save the patient's life.
It's important to remember that in cases of multiple injuries or life-threatening injuries, the priority is to save the patient's life, life over limb. While a femur fracture can be a serious and potentially limb-threatening injury, other injuries may take precedence over the fracture.
Proper application
Assuming that the patient has been assessed and a Sager splint is deemed appropriate, the medical professional or advanced first aider will follow the steps outlined in the previous response to properly apply the splint. Proper application of a Sager splint requires medical training and should only be done by trained professionals. Here are the general steps involved in applying a Sager splint:
Assessment of the patient's injury:
Before applying a Sager splint, the medical professional should assess the patient's injury to determine if it's the right tool for the job. A physician should evaluate indications and contraindications.
Patient in a supine position:
Once it's been determined that a Sager splint is necessary, the patient should be placed in a supine position.
Remove clothing from effected area:
Any clothing that obstructs the affected leg should be trauma stripped to ensure proper placement of the Sager as well as to check for compound fractures.
Placement of the Sager:
The Sager splint should be placed on the affected leg, positioning the ankle and foot in the appropriate spot. The splint should be placed with the traction component of the device facing the foot.
Securing the splint to the leg:
The splint should be secured to the leg with straps or bandages, ensuring that it is snug but not too tight. This will help to keep the splint in place and provide the necessary support.
Application of traction:
The traction component of the Sager splint should be applied, pulling the leg gently and steadily until the desired amount of traction is achieved. This will help to reduce pain and swelling and realign the bone fragments.
Pulse, sensation, and movement check:
The medical professional should check the patient's pedal pulse, sensation, and movement in the affected leg to ensure that the splint is not causing further damage or obstruction.
Training
Sager splints are orthopedic devices that are commonly used to immobilize femoral shaft fractures. They can help to stabilize the fracture and prevent further damage to the leg or other parts of the body. However, the proper application of a Sager splint requires specialized training and should only be done by trained medical professionals or advanced first aiders.
At Delta Emergency Support Training, we provide in-depth advanced first aid classes that cover a variety of topics, including the proper application of a Sager splint.
