SAGER SPLINT Candidate Name: _________________________________________ Date: ______________________

Examiner Name and Signature: _________________________________________________________

Time Started: __________ Time Ended: __________ Points: _____/13 PASS/FAIL (Circle One)

Points Possible Points Awarded
Directs application of manual stabilization of injured leg 1
Exposes extremity and removes shoe and sock 1
Directs application of manual traction (must be applied before elevating leg if necessary) 1
Assesses motor, sensory, and distal circulation in the injured extremity 1
Adjusts splint to proper length 1
Positions splint between patients legs, cushion against gorin and secures groin strap. 1
Secures ankle hitch properly 1
Extends the splint, providing approximately 10% of the patient’s body weight in traction. (Max 15 pounds for single leg or 30 pounds bilateral). 1
Positions/secures support straps 1
Re-evaluates proximal/distal securing devices 1
Reassesses motor, sensory, and circulatory functions in injured extremity 1
Secures patient to long backboard to immobilize hip 1
Secures splint/legs to long backboard to prevent movement 1

                                         Points Possible: 13                    Total Points Awarded_______________

Critical Criteria

____ Loss of traction at any point after it is assumed

____ Failure to apply manual traction before evaluating leg

____ Did not reassess motor, sensory, and circulatory functions in injured extremity

____ Foot is excessively rotates or extended after splinting

____ Final immobilization failed to support leg or prevent rotation of injury

Notes: ____________________________________________________________________________________________


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