Konig KNLEDFLDRL10W User manual

Instructor’s Manual
Model SX404; Sager Extreme Compact Bilateral
Models; S301 Form III Single, S300 Infant Bilateral,
S304 Form III Bilateral, Super Sager Combo
Pacs #1 and #2, and the MINTO FRACTURE KIT
J. M. Fikes, BSN, MSN •A.G. Borschneck, M.D.•Edited By: A.L. Borschneck, BA

Table of contents
Section One:
Instruction guidelines 1
Section Two:
The anatomy and physiology of fractures 4
Section Three:
Sager’s Application for splinting femoral fractures 13
Section Four:
Sager’s features, advantages and benefits 23
Section Five:
Sager® components 27
Section Six:
Sager® Questions and answers 30
Section Seven:
Contraindications and cleaning 36
Section Eight, Appendix A:
Practical exam/Student exercise for the S300 & 400 Series Splints 38
Section Nine:
The Minto Fracture Kit (MFK) 50
Section Ten: Appendix B:
Practical exam/Student exercise for the
The Minto Fracture Kit (MFK) 59
Additional Handouts
Handouts:
User’s Handbook, Why Traction,
Traction Force Challenge,
Emergency Orthopedics: The Extremities,
USA ICD9 Projections,
Suggested Reading,
Power Point presentation and/or overhead projections
For more information on Sager® Emergency Traction Splints,
visit our world wide web site at: www.sagersplints.com
Minto Research & Development, Inc.
Manufacturer’s of:
Sager® Emergency Traction Splints, Minto®Fracture Kit (MFK) and
other quality medical products.
is a registered trademark of Minto Research & 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
Minto Research & Development©1998 - 2010
Minto Research & Development, Inc
20270 Charlanne Drive
Redding, CA, USA, 96002-9223
Tel: [phone]
530. 222. 2373
Fax: [phone]
E-Mail: [email protected]
www.sagersplints.com

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 and the Minto Fracture Kit to
students participating in EMT 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 and the Minto Fracture Kit 1

Introduction to Sager® Emergency Traction Splints:
Introduce the (SX404) Sager Extreme Compact Bilateral, (S304) Sager Form III Bilateral, the
(S301) 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 Sager models SX404 Sager Extreme Bilateral, S304 Form III Bilateral, S301 Form III Single and
S300 Infant Bilateral”.
•Demonstrate the application of the SX404, S304 and/or S301 on a volunteer from the
class. If available, demonstrate the application of the S300 on a pediatric volunteer
or mannequin.
•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 these
in accordance with the provided instructional materials (and state/local medical
protocol). If you are unsure of the answer to a question record it and contact your
local or state education service for the answer.
•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.
•Mark the written exam. Students who fail the written exam should review
the material and retake the exam.
Provide handouts of:
1Sager Extreme User’s Handbook (model SX404)
2Sager Form III User’s Handbook (models S304,S301, & S300)
3Why Traction (Reprint from JEMS)
4Traction Force Challenge (Reprint from EMS Magazine)
5Emergency Orthopedics: The Extremities (Reprint)
6Important Economical Considerations
7These Are The Facts
8USA ICD9 Projections (1997)
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.
A practical exam has
been provided for
your convenience.
Demonstrate the
correct application
of Sager® Splints —
1 person application
in under 2 minutes!
2Sager® Emergency Traction Splints and the Minto Fracture Kit

Application of Model S301, Sager Form III Single Leg Traction Splint is similar to that of its
bilateral cousin — Model S304. However, the unilateral nature of the S301 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 S301 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.
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.
Model S301, Sager Form III Single Button Latch 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.
Sager® Emergency Traction Splints and the Minto Fracture Kit 3
1
2
3

4Sager® Emergency Traction Splints and the Minto Fracture Kit
Section Two:
Anatomy, physiology and
treatment of femoral fractures
The human pelvis is a closed bony ring that is
strong and massively constructed. It is the
foundation 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.
(Review PowerPoint tutorial overview)

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:
•Laceration of arteries, veins and nerves at the site of the fracture.
•Severe muscle spasms resulting in Bone fragment overriding,
deformity and shortening of the limb.
•Decreased tissue pressure — resulting in further bleeding and
shock, as well as severe pain.
In addition, spasm of the Psoas and Piriformis Muscles 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.
Ischial Tuberosity and Femur are on the
same plane. Note how the Ischial Tuberosity
protrudes no more than 1-2 cms.
(PowerPoint #2)
Sager® Emergency Traction Splints and the Minto Fracture Kit 5
fig 1
fig 2

Comparative 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 the traction 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 over-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
Hare Ischial Pad Splint. Angle of
malalignment is 51 degrees.
Sager® Traction Splints provide
near perfect alignment.
Sager’s Near-perfect alignment when applied.
(PowerPoint #3)
6Sager® Emergency Traction Splints and the Minto Fracture Kit
fig 4
fig 3
fig 5

fig 6
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 Medical Consultant.
Static traction, as 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 Mid Shaft Fractures accounted for 9% or 41,012
of all admissions. Together, these two fracture types amounted to an estimated 93% of all
hospital admissions. The remaining 7% (34,055) of fracture types indicates traction not
needed or contraindicated.
Sager Emergency Traction Splints are indicated for treatment in all Proximal Third and Mid
Shaft Fractures. In other words in 1997 alone, Sager® Splints had the capability and potential
to treat 93% of all projected Femoral Fractures. Conversely, Ischial Pad splints are
contraindicated in the treatment of Proximal Third Fractures, and thus are only indicated for
treatment of Mid Shaft Fractures (roughly 9% 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-Medial 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.
Pelvis, Femur and the Sciatic Nerve
(Overhead Projection #3)
(PowerPoint #3)
Sager® Emergency Traction Splints and the Minto Fracture Kit 7

Consider the anatomy of the Pelvis and Femur. In an AP view, the Ischial Tuberosity is located
about half the distance from the mid-line to the Femur. In a lateral view, the Ischial Tuberosity’s
lower edge is no more than 1⁄2” 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 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 13⁄4” to 31⁄2” 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 exagerated 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.
Adult and Pediatric Ischial Pad Splints — side by side.
Note how the ischial pads are the same height — 31⁄2”
at the highest point and 21⁄2” at the lowest point.
8Sager® Emergency Traction Splints and the Minto Fracture Kit
fig 7

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 repair. 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 Responders (for the first time ever) to document the
traction force applied — a definite plus for medical legal purposes!
Sager® Emergency Traction Splints and the Minto Fracture Kit 9

Abstract:
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. Malalignment 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 Ischial 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.
Intertrochanteric Femoral Fracture with
Sager® Emergency Traction Splint in place
with 15lbs. of traction. Note alignment of
fracture occurs and pressure on critical
structures below the Femoral Shaft is absent.
1. Proximal Femur Greater Trochanter
2. Distal Femoral Shaft.
Intertrochanteric Femoral Fracture with Hare
Traction Splint in place with rope, 15lbs.
weight and pulley for traction. Note Femur is
pushed up into malalignment and Sciatic
Nerve and Vascular structures are pushed up
into fracture site.
1Distal Femoral Shaft
2Proximal Femoral Fragment externally rotated
3Approximate site of Sciatic Nerve.
(PowerPoint #5)
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 and the Minto Fracture Kit
Cadaver Study: Comparison between Sager® Emergency Traction Splints
and Ischial Pad Traction Splints.
fig 8
fig 9

Abstract:
A Load Cell Study documenting forces acting on the Proximal Femur 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 lbs. Forces acting on the Femur
using a Hare Traction device varied from 12 - 71 lbs.
Splint Traction Force Acting On Femur
Hare Splint on a supine patient
—no thigh strap applied. No traction Varies 5.1 to 25 lbs.
Hare Splint on supine patient
— thigh strap applied. No traction Varies 6.8 to 27.7 lbs.
Hare Splint on supine patient
— thigh strap applied. 15 lbs. traction Varies 6.4 to 29.8 lbs.
Hare Splint on supine patient
— thigh strap applied. Patient moved
to a Semi-Fowler’s position. 15 lbs. traction Varies 8.8 to 48 lbs.
Hare Splint on supine patient
— thigh strap applied. Patient moved
to a sitting position. 15 lbs. traction Varies 20.0 to 71.0 lbs.
Hare Splint on supine patient
— thigh strap applied.
Patient lifted and carried. 15 lbs. traction Varies 3.1 to 34.9 lbs.
Hare Splint on supine patient
— thigh strap applied. Patient moved
to three quarter prone position. 15 lbs. traction Varies 5.0 to 27 lbs.
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® Splint shows a
maximum force of 1.2 lbs.
acting on the femur with
the patient in any position.
Sager® Emergency Traction Splints and the Minto Fracture Kit 11
Load Cell Study: Forces acting on an intact femur with Hare Traction Splint
and a Sager® Emergency Traction Splint.
1Study conducted using a Sager S304 Form III Bilateral Emergency Traction Splint

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
1-2cms. below the level of the Shaft of the Femur.
Survey Radiograph of adult female CAT SCAN Study
of the Pelvis and Femur.
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
Tuberosity protrudes at most 1-2cms. below the
Shaft of the Femur.
(PowerPoint #5)
12 Sager® Emergency Traction Splints and the Minto Fracture Kit
CAT SCAN Study: The Ischial Tuberosity protrudes at most 1-2 cms. below the
level of the shaft of the Femur.
Reprinted with permission from A.G. Borschneck, M.D.
fig 10
fig 11
fig 12
fig 13
1-2 cm
1-2 cm

Sager® Emergency Traction Splints and the Minto Fracture Kit 13
Section Three:
Mechanism of action and
Sager’s application for
splinting femoral fractures
When a patient suffers a fractured femur, the large
muscles surrounding the bone react by going into spasm
which causes severe pain. Traction splinting prevents
further injury and breaks the spasm which eliminates the
major source of pain.

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 Humerous.
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 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 on 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 and the Minto Fracture Kit
Quantifiable, Dynamic Traction™, mechanism of action. The spring within the inner
shaft of a Sager® Splint is dynamic. It continuously reacts to changes in the amount
of muscle spasm.
fig 14

Close-up of Sager® Traction (Pulley) Wheel
and Scale. (Sager® models S300 Infant
Bilateral and S301 Form III Single)
Close-up of Sager® Traction Handle and Scale.
(Sager® models SX404 Compact Bilateral and
S304 Form III Bilateral)
Paramedic applying Sager® S301 Form III
Single on a 5’9”adult male.
Close up of Model S304 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 and the Minto Fracture Kit 15
fig 15
fig 16
fig 17
fig 18

16 Sager® Emergency Traction Splints and the Minto Fracture Kit
Important: Follow these additional
steps to ensure correct assembly and
usage of Sager Extreme Compact
Bilateral Traction Splints. Note: the
Security Sliding Lock should be applied
after traction is applied to the patient
and the yellow indicator is visible. On
short, light-weight people, the yellow
indicator might not be visible if the
Traction Bar does not extend out of
the Outer Tube. If the Lock is applied
before inserting the Traction Bar into
the Outer Tube, the range of travel
will be limited.
Important: Traction Assembly Packing
and Folding Procedure! To refold the
inner-traction splint shaft (traction tube)
and place in Carrying Case, grasp the
traction tube with thumb against Hinge
Tab. Push Hinge Tab, as you would to
turn on a flashlight, while gently pulling
the solid bar. When solid bar stops then
fold keeping the bar and tube in
alignment.
Warning: Failure to follow Manufacturer’s
Assembly Instructions and Packing
Procedures may result in damage to
the splint and/or hinder the
application of the splint. Minto
Research & Development, Inc. is not
responsible for incorrect assembly
and/or usage of the splinting device.
All Operators should receive full and
proper initial/refresher instruction
sessions from a qualified person on
detailed use of this equipment and
regarding the particular situations in
which it should be used. Please defer
to federal, state, and/or local protocol
for definitive analysis and guidelines.
Attention: Read first – prior to application
Traction Tube
Hinge Tab
Grasp traction tube, placing
thumb against the hinge tab
Solid Bar
Hinge Tab
Grasp traction tube, placing
thumb against the hinge tab
Then fold while keeping the
bar and tube in alignment
Traction TubeSolid Bar
Model SX404 Sager® Extreme Compact Bilateral
Security Sliding Lock
1. Slide the Security Sliding Lock over hinge of the Inner Shaft
and cover the yellow indicator with the red knob.
2. Lock down by tightening the red knob.
Traction Assembly and Folding Procedure
Diagram 1
Traction Tube
Diagram 2
Traction Tube “pull away from the traction Tube…”

Sager® Emergency Traction Splints and the Minto Fracture Kit 17
Rapid one person assembly and application. The splint can be
assembled and applied in under 2.5 minutes. To assemble the splint,
simply unfoldand secure into place. The Sager®splint has a unique
semi-attached design that ensures that no major parts will be lost
or incorrectly assembled.
Training application sheet #1: Model SX404 traction splint.
1 Remove and unfold the outer shaft assembly. 2 Remove, unfold and lock the inner shaft assembly. 3 Insert inner shaft assembly into the outer shaft
assembly. Splint is ready to apply.
Position:
aPosition the Sager® Splint between the
patient’s legs, resting the the saddle
against the ischial tuberosity, with the
shortest end of the articulating base
towards the ground.
Set:
bFold down the number of comfort
cushions needed to engage the ankle
above the medial and lateral malleoli.
cUsing the attached hook and loop
straps wrap the ankle harness around
the ankle to secure snugly.
dPull control tabs to engage the ankle
harness tightly against the crossbar.
Apply Quantifiable, Dynamic
Traction™. Grasp the padded shaft of
the Sager® Splint with one hand and
the red traction handle with the
other; gently extend the inner shaft
until the desired amount of traction
is recorded on the traction scale.
Secure:
eAdjust the thigh strap at the upper thigh making sure it is not too tight, but snug
and secure, then firmly secure the tensor cravats.
fApply the figure 8 strap around the feet to prevent rotation. Note the absence or
presence of distal pulses, check for sensation. Patient is now ready for transport.
(PowerPoint #9-11)

Step 1 Position
Position the Sager® SX404 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. Apply the
abductor bridle (thigh strap) around the upper thigh of the fractured limb. Push the ischial
perineal cushion gently down while at the same time pulling the thigh strap laterally under
the patient’s thigh. This will seat the lower end of the cushion comfortably against the
ischial tuberosity. Tighten the thigh strap lightly. Lift the spring clip to extend the inner
shaft on the SX404 until the crossbar rests adjacent to the patient’s heels.
Step 2 Set
Note the absence or presence of distal pulses, check for sensation. Position the malleolar harness
(ankle harness) beneath the heel(s) and just above the ankle(s). Fold down the number of comfort
cushions needed to engage the ankle above the medial and lateral malleoli. Using the
attached hook and loop straps wrap the ankle harness around the ankle to secure snugly. Pull
control tabs to engage the ankle harness tightly against the crossbar. Apply Quantifiable
Dynamic Traction™. Grasp the padded shaft of the SX404 with one hand and the red traction
handle with the other; 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). At the hollow of the knees, gently slide the large
tensor cravat through and sizzer it upwards to the thigh, repeating with the smaller cravats
to minimize lower and mid-limb movement.
Step 3 Secure
Adjust the abductor bridle (thigh strap) at the upper thigh making sure it is not too tight, but
snug and secure, then firmly secure the tensor cravats. Apply the pedal pinion (figure 8
strap) around the feet to prevent rotation. Note the absence or presence of distal pulses, check
for sensation. Patient is now ready for transport.
Warning: All Operators should receive full and proper initial/refresher instruction sessions from
a qualified person on detailed use of this equipment and regarding the particular situations
in which it should be used.
(PowerPoint #9, 11)
Training application sheet #2:
For model SX404 Traction Splint.
18 Sager® Emergency Traction Splints and the Minto Fracture Kit