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.

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 elastic leg cravat through and upwards to the thigh repeating with the smaller cravats to minimize lower and mid-limb movement.

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 elastic leg 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.

Contraindications for traction splints:
All traction splints of any kind are contraindicated in the case of fractured Pelvises unless the Medical Consultant indicates otherwise, or a MAST Trouser has been applied – in which case a Sager Splint can be applied over the MAST Trousers. Supracondylar fractures of the Knee and Ankle fractures are also contraindicated. The 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.

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Recommended traction amount:
How much traction should I apply? Apply the amount of traction recommended by your medical consultant, or that required by protocol. For adults, the American Academy of Orthopedic Surgeons recommends gentle traction to a maximum of 7kg (15 pounds) per fractured Femur [14kg (30 pounds) for a bilateral fracture]. A general rule of thumb is 10% of the patients’ body weight per fractured Femur. For example; if a patient weighing 45kg (100 pounds) has a single fracture, the appropriate amount of traction would be 4 1/2kg (10 pounds). If that same person has a bilateral fracture, 9kg (20 pounds) would be estimated. The Sager S300 Splint is designed to register a maximum of 7kg (15 pounds) of traction. For infants and children, the maximum per fractured Femur would be 3 1/2kg (7 1/2 pounds), 7kg (15 pounds) for bilateral fractures.