Question: Are there contraindications for sager applications?

 Thanks for the question. The intent of the ASKMAC website was originally to address issues that relate to the Advanced Life Support Patient Care Standards and areas that traditionally require oversight by Regional Base Hospital Programs. It is interesting that a large percentage of ASKMAC questions actually pertain to the Basic Life Support Patient Care Standards (BLS PCS). Despite this, we have endeavored to answer all questions that are brought to this forum.

As for your question relating to sager application, this is not our area of expertise similar to other devices a paramedic may utilize. As such we have reached out to our college colleagues for their advice.

Here is the answer from the manufacturer with the following contraindications:

• A fracture of the pelvis occurring with a fracture of the femur
• Supracondylar fractures of the distal end of the femur
• Compound fractures of the femur
• Fractures of the ankle and foot

Reference: (2014). Sager Emergency Fracture Response System. Retrieved April 23, 2014 from http://www.sagersplints.com/pages/home.html.

Here is the answer from Fanshawe College who provides initial education for some paramedics in the region:

During initial education we reference several sources of information for students regarding the guidelines, precautions and contraindications of this traction splint.

1. The BLS Patient Care Standards has references in several areas to traction splint in general with the recurring guideline to "weigh the application time for traction splints at the scene against the need for rapid transport." BLS PCS Appendix 91: Trauma Care - Pearls. Clinically it makes sense to apply a traction splint to a stable patient with an isolated single femur splint on the scene. However in the setting of bilateral femur fractures or multi-system trauma the Paramedic is encouraged to apply the traction splint enroute to the lead trauma centre or appropriate local facility.

2. The MOH EHS Equipment Manual (page 93) includes the following precautions:

iv) in the event of groin injury, the splint may be applied to the outside of the leg. v) The elderly may not tolerate traction well, especially if there is a pre-existing condition such as arthritis or joint tenderness"

3. The manufacturer's instructor manual for the Sager Traction Splint (page 36) offers the following contraindications:

A fracture of the Pelvis occurring with a fracture of the Femur is generally a contraindication for the use of a traction splint of any type.

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.

Fractures of the Ankle and Foot are also contraindicated. Pressure from the ankle harness and from traction is not therapeutic.

Compound fractures of the Femur with bone fragments sticking through the skin may be a contraindication. Guidelines by local protocol or instructions by a Medical Consultant should be followed.

Our teaching regarding compound femur fractures is to use the traction splint without applied traction to stabilize the long bone fracture if possible.

The BLSPCS Extremity Injury - Bone/Joint regarding management advises:

2 ii. Prior to splinting leave protruding bone ends as found; if ends remain visible after manipulation/in-line traction, cover ends with extra dressings and/or padding. Upon arrival, advise receiving staff that protruding bone ends were retracted during splinting (where applicable).

The SWORBHP Medical Council would advise paramedics to review their service policies as with any equipment they are supplied as well as follow the Basic Life Support Patient Care Standards from the MOHLTC.

BLS,Miscellaneous

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