Sager splints are used to literally pull a fractured femur back into alignment. Doing so requires that enough tension be placed on the splint to overcome the natural elasticity of the muscles of the upper thigh. For the purposes of EMS, 10% of the patient's weight should be used, up to a maximum of 15 pounds (or 7 kg). When pulling traction, it is imperative that counter-traction be placed on the main body of the splint to avoid insufficient extension of the limb and under-traction. Another item to be thoughtful of is lifting the ratchet if possible so that it does not "click" on every hole; these clicks may be painful to the patient. Once traction is pulled to the desired amount, the ratchet may be released into the appropriate hole and the traction handle may be released slowly. If inadequate counter traction was applied, the splint will have moved away from the patient's groin and will slip back into place, effectively reducing the amount of true traction applied. Remember, the splint must be tight against the patient in order to provide traction; this will not be comfortable but will aid in providing significant relief.

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