Medial versus lateral splinting.

One of the most commonly asked questions posed to us at Minto Research & Development, Inc. in the last few years is whether or not Sager Splints® can be placed and utilized on the outside of the leg. The general consensus and argument for this type of placement is that other splints utilize the outside (lateral side) of the leg. This begs the question… why not the Sager?

Sager Splints® were designed to be used in the same manner as that used in orthopedic operating theatres when open reduction and splinting is needed to treat a fractured femur. The splint is placed against the ischial tuberosity medial to the shaft of the femur. This avoids pressure on the sciatic nerve as well as other vascular and soft tissue structures. It also provides the safest mode for reduction of the fracture.

An evaluation of the Sager Splint® or any other traction device applied to the outside (lateral side) of the leg revealed the following:

1. Use of a sling either medial to, on, or lateral to the ischial tuberosity on the inside of the leg and attached to a splint on the outside of the leg requires the sling to stretch across the groin to the lateral position of the splint.
2. The sling crosses the femur at an angle of about 135 degrees which may create a lateral vector of
force which may deform the fracture site.
3. The track of the sling crosses directly over the femoral artery on the anterior thigh and directly below the track of the sciatic nerve as it crosses the head of the femur and tracks down along the
medial posterior border of the femur.
4. Applying traction with a sling may impair the circulation of the femoral artery and can create pressure on the sciatic nerve on the underside of the femur.
5. More than 75% of all femoral fractures occur in the proximal third. Lateral pressure in this area may cause bone splinters to impale soft tissue structures – nerves, vascular, tissue, etc.
6. With use of a sling there is no direct point of countertraction against the ischial tuberosity medial to the shaft of the femur. A direct point of countertraction creates optimum alignment of the fracture.
 

Fig 1.

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Sager Form III Traction Splints (models S301 and S304) have a patented Articulating Base and Cushion which bend laterally for seating and exacting comformance to the ischial tuberosity. The Sager’s base has two main functions:

1 To flex the articulating base of the perineal cushion laterally to seat on the ischial tuberosity.

Click image to enlarge

2 To hold the ischial perineal cushion in the lateral perineum (with a force of about 1 pound).

Most perineal examinations and procedures can be performed with the splint in place – without compromising the comfort and safety of the patient. Some medical consultants and/or federal, state or local protocols may include lateral application of Sager Splints®. They do so at their own discretion. Minto’s recommendation is that Sager Splints be applied medial to the shaft of the femur according to the manufacturer’s guidelines specified in Sager User Handbooks. For further information on application procedures, please visit our website at: www.sagersplints.com and download the instructional manual of your choice, or call 1.800.642.6468

Click to enlarge

Click to enlarge

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