A traction and alignment comparison between the Sager Emergency Traction Splint and Hare Traction Splint (representative of all Ischial Pad Splints) was made on a cadaver with an exposed intertrochanteric femoral fracture. Malalignment was observed when the Hare Ischial Pad Traction Splint was applied. Acceptable alignment occurred with the 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 the Hare Traction Splint provided countertraction against the ischial tuberosity below the shaft of the femur. Pressure up against the femur with the Hare Ischial Pad creates pressure and possible injury on the sciatic nerve and other intervening soft tissue structures. This does not occur with Sager Emergency Traction Splints.

Preliminary Report

A 70 year old, 5'8" male cadaver weighing approximately 145 pounds was used for this investigation. The body was placed in a supine position and a incision along the tensor fascia lata was made extending from the right anterior superior illiac spine to approximately 8cm above the Knee joint. Sharp dissection was carried down to visualize the proximal third of the femur. Muscle and fascial tissue was then retracted so that an intertrochanteric fracture could be made with a bone chisel. Once the fracture line from the greater to lesser trochanter was made, force was applied from the lateral side resulting in full separation of the proximal and distal fragments.

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The Sager Emergency Traction Splint was applied to the fractured femur following the manufacturer's recommendations. Countertraction with the Ischial Perineal Cushion was seated against the ischial tuberosity medial to the shaft of the femur and a traction force of fifteen (15) pounds was applied by the harness at the ankle. A photograph was then taken demonstrating the position and positive alignment of the proximal and distal fragments. No splint pressure was noted against the fracture site.

After removal of the Sager Splint, an Ischial Pad Traction Splint (Hare Splint) was then applied following the manufacturer's recommendation. Countertraction with the splint was applied against the ischial tuberosity by lifting the fractured limb and sliding the splint into position. The splint's "Pad" rests against the ischial tuberosity below the shaft of the femur. The associated thigh strap was not applied. Fifteen (15) pounds of traction was then applied by the harness at the ankle. In order to provide the same fifteen (15) pounds of traction available/noted on the Sager Traction Scale, the foot end of the Ischial Pad Traction Splint was modified by removing the Ratchet Traction Mechanism and replacing it with a rope, pulley and fifteen (15) pounds of weight.

A photograph was then taken demonstrating the Pad pressure under the femur - pushing the femur up and forcing it out of alignment. Structures under the shaft of the femur, at the site of the intertrochanteric fracture are at risk because of pressure from the Ischial Pad, which forces them against the fracture site.

Significant Anatomy

In the supine human, the lateral view of the pelvis and femur indicates that the ischial tuberosity protrudes below the shaft of the femur between one (1) to two (2) cms. The sciatic nerve and its blood supply lie below and slightly medial to the femoral shaft. In addition, posterior to the intertrochanteric region of the femur, one notes the origin of the vastus lateralis muscle, inferior gluteal vessels, posterior cutaneous nerve, quadratus femorus muscle and over this, the Gluteus Maximus Muscle. All or any part of these structures are at risk by simply applying the Ischial Pad Type Splint to a patient with an intertrochanteric fracture. When the Thigh Strap is applied to secure the Ischial Pad up against the ischial tuberosity, the potential for damage is compounded.

Summary

Ischial Pad Splints are contraindicated for traction and splinting of femoral fractures when the fracture of the femur is in the proximal third of the bone. It is next to impossible to place the Ischial Pad against the ischial tuberosity without causing pressure up on the shaft of the femur and without creating additional, unnecessary injury to intervening structures.

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