Cramer splint: application technique, ladder splint, for fracture, indications for use

The Kramer splint is one of the standardized transport methods for emergency immobilization of fractures, which are produced on an industrial scale. There are many ways to ensure reliable fixation of bones when they are damaged, but the Kramer splint has several significant advantages. First of all, it is the lightness and strength of the structure. Aluminum alloy in combination with steel helps to bend the structure into the required shape, while it can easily maintain the given shape. More information about the types of injuries this type of fixation and application technique can be used for will be described in the next article.

Features of using the Kramer tire

Healthcare professionals know several principles that must be followed to correctly, effectively and quickly apply a transport splint. They help not only reduce the time for fixation, but also make it more accurate and reliable. So, there are several rules:

If fixation of a limb is necessary, it is recommended to model the shape and length of the splint on a healthy limb. This will help avoid pain for the patient, as well as complications from additional manipulations of the damaged area.
Proper fixation should include immobilization of two healthy adjacent joints to the site of the lesion. This will help not only securely secure the splint, but also ensure complete rest for the limb.
In an emergency situation, when it is not possible to place an additional layer of fabric between the grille and the skin, it is recommended to apply the splint directly to the clothing. If you have soft fabric (scarves, blankets, etc.) you can use them as a backing. Healthcare workers use soft pads on exposed skin made from cotton wool wrapped in gauze. This ensures softness and protection from damage to soft tissues.
After fixing a broken leg, it should maintain a straight position.

Structure of the structure

This design is a modern analogue of the wooden Dieterichs device. Characteristics of the medical device:

Outwardly it looks like a small ladder.
It is a design of gratings made of wire. An aluminum alloy is used, thanks to its lightness and flexibility, you can fix a broken limb in an optimal position. The ladder bends perfectly in any direction.
The internal jumpers are made of steel, which guarantees rigid fastening.
The outer part is covered with a cover made of gauze, bandage, cotton wool or fabric. This protects the patient from the cold when coming into contact with the device in winter.

For fixation, strong belts are used, as well as available materials: gauze, bandages, fabric.

Indications for use

The Kramer ladder splint has many indications for use, as it is universal and easy to model in emergency conditions:

Fractures of the cervical spine, severe traumatic brain injuries.
Bone damage and joint dislocations of the upper and lower extremities.
Fractures and dislocations of the pelvic bones.
Injuries such as ligament ruptures, damage to large vessels and nerve pathways. Also severe frostbite, massive burn injuries to soft tissues.

Important! The Kramer splint is only a temporary measure until admission to a specialized medical facility. After a complete diagnosis and an accurate diagnosis, it is replaced with a permanent option (for example, a plaster cast).

Overlay technique

There is a general algorithm for applying the Cramer splint technique, which medical workers are guided by. Compliance with it helps to focus on the speed and efficiency of fixation of fractures of varying complexity (open and closed, with and without displacement). This is what it looks like:

First of all, it is necessary to individually model the shape of the tire. This operation is performed on a paired healthy limb, in order to avoid additional trauma in the form of displacement of fragments, ruptures of blood vessels, etc.
It is necessary to maintain the correct physiological shape of the limb to minimize the load on adjacent muscle groups.
As a rule, tires come with an oilcloth cover, which helps reduce friction when in contact with exposed skin. However, if you don’t have one, you need to make a fabric backing for the fixing structure with your own hands.
Shoes and clothing are not removed from the victim only if the fracture is closed. In case of open wounds and bleeding, clothing must be cut and access to the site of soft tissue injury. Use available antiseptics to disinfect the wound and apply a sterile bandage.
In sub-zero temperatures, the leg along with the tire should be covered as much as possible with a warm blanket. Cold metal can damage your skin.

Depending on the individual case, the application technique varies. This will be discussed in more detail later in the article.

Application for a shoulder fracture

In case of injury to the shoulder joint, the algorithm for correctly applying a Kramer splint is as follows:

It is necessary to apply a splint previously modeled on the healthy arm from the healthy shoulder joint, which runs along the entire shoulder girdle.
After placing the fixation structure on the problem shoulder, it goes down along the entire forearm to the very tips of the fingers.
It is necessary to place a lining of fabric and cotton along the length of the splint to avoid injury.
It is necessary to bend the arm at the elbow joint at an angle of 90º, and along the outside of the forearm, fix the splint with a bandage to the hand. In this case, it is necessary to direct the hand approximately 30º relative to the body, placing a thick and soft cushion under the injured shoulder.
After these operations, it is necessary to apply a simple tape bandage with support on the healthy shoulder. The soft garter should go under the wrist of the problematic hand.

In case of injury to the bones of the forearm, you should adhere to the following recommendations:

Again, the application is preceded by modeling on the paired healthy limb. The elbow also bends at a right angle.
The length of the splint is located along the entire hand and forearm, ending at the level of the second third of the shoulder.
To ensure that wearing does not cause discomfort, you need cotton pads under the elbow, as well as at the level of the wrist and palm. Fabric is placed throughout the entire splint if this area of the arm is open.
From the outside, along the entire length, it is fixed with a bandage, and then tied with a scarf, the tie of which falls on the neck. The entire forearm is located on a wide edge.

Application of a device for lower limb injury

The peculiarity of applying a cramer splint for a fracture of the lower limb is that not one, but three fragments of a fixation structure are needed. Depending on the exact location of the damage, their length and modeling method vary. So, how to properly apply a transport splint for a broken leg bone:

You need three fragments of the splint, which will be located below and on the sides of the shin. The lower one runs along the entire length of the foot to the upper third of the thigh. At the level of the foot, they bend according to its shape. In the popliteal region it is kept straight, and a soft cotton-gauze roll is placed under the knee.
From the outer edge of the leg, it is located from the ankle to the second third of the thigh. The internal fragment is located the same way, only it ends at the level of the groin. Cotton pads are placed at the points of contact with the ankles.
After all operations are completed, the structure is carefully bandaged, and the patient is transported to the hospital for full help. If the fracture of the tibia is limited to damage to the ankle (rupture of ligaments and tendons, displacement of the joint, etc.), then one wide splint will be sufficient. The location runs along the foot and ends at the lower third of the thigh.

Fixation of the cervical spine

It is important to properly fixate a fracture of the cervical spine. The success of further treatment of the victim depends on correctly provided first aid. First of all, it is worth considering the items needed for this:

Two long kramer tires;
Bandage;
Cotton - gauze rolls.

The procedure is as follows. For ease of understanding, it is described in several steps:

The first fragment of the “ladder” is applied from the top of the forehead (where a small curved section is left), fits tightly to the shape of the head and ends at a level just below the shoulder blades. It is important that there is a clear bend at the level of the back of the head. To avoid unpleasant sensations for the patient, a cotton gauze roll is applied to the back of the head. At chest level, it must be securely fixed with a bandage.
The second fragment is superimposed across the first and runs from the upper third of the shoulder to the upper third of the paired shoulder, going around the head. It is important that both ends are secured to the shoulders with a bandage. Also, both fragments are attached to each other using either a thin bandage or braid.
It will be almost impossible to simulate the shape of the structure on the victim. You can find a way out with the help of a healthy person of similar build and height. Having made approximate bends on it, the design is transferred to the patient.

Fixation of the cervical spine

Immobilization is carried out in the following sequence:

Position the victim in such a way as to ensure maximum comfort and calm.
For fixation, two wire frames are needed, having previously prepared a soft cover for the frame.
From one part they make a cap that runs along the contour of the shoulder, the top of the head, the ear and returning again to the shoulder.
The other part runs along the back, is attached between the shoulder blades, runs along the neck along the back of the head and then around the head, reaching the forehead.
Both parts are fixed together with a bandage.

Why immobilize an injured limb?

There are several important reasons why fixation of an injured limb is essential:

Transportation of the victim is possible only after fixation of the fracture.
Displaced fractures must be immobilized so that the resulting fragments do not penetrate or damage the soft tissue. Thus, the fragment can damage large blood vessels, thereby causing internal bleeding. Or traumatization of the nerve pathways will entail a lot of negative consequences in the form of paresis, lack of sensitivity, etc.
An immobilized limb with bone damage will cause less pain to the victim.

In emergency situations, before the arrival of emergency medical services, it is allowed to use improvised means suitable for creating a makeshift temporary option.

Why is a hip fracture dangerous?

A closed or open hip fracture is considered a serious injury. This area contains several large arteries and nerve plexuses. When a crushed bone is displaced, severe bleeding often begins, sensitivity and mobility are lost.

A splint for a hip fracture is required for the following types of injuries:

open with bone fragments outward;
damage to the femoral neck, pelvic bones;
impacted injuries of the hip joint;
hip fracture.

If the hip is damaged in a patient with varicose veins, the risk of blockage of the vessel by a blood clot or pulmonary embolism increases. Often, bone fragments do not heal well due to displacement during transportation, so the patient remains disabled with limited mobility. He still has pain when walking, lameness, and he can only move with a crutch.

What is a Kramer tire?

The appearance of the tire is presented in the form of a ladder structure, the horizontal structural elements of which are made of high-strength steel, and the vertical ones of flexible aluminum alloy. Depending on the location of the injury, there are several options for a fixation device, varying in size. The ladder splint is used in the following clinical cases:

In case of fracture of the bones of the lower extremities (thigh, tibia);
In case of fracture of the bones of the shoulder girdle (shoulder, forearm);
With a fracture of the cervical spine;
Also in case of rupture of ligaments, tendons, etc.

The main advantages of this type of immobilization are the lightness of the design, its flexibility and multiple versatility of application. In addition, it is reliable and convenient for use in emergency situations. Along with a lot of advantages, there are several disadvantages. Among them is the rigidity of the structure, which can cause some discomfort, even when a soft fabric lining is placed. This is also the thermal conductivity of the materials from which the device is made. So, for example, at sub-zero temperatures, it will become extremely cold and will cause discomfort to the victim.

Despite its few shortcomings, it is firmly established in all emergency rooms and ambulances.

Concept

Another name for this orthopedic product is a staircase splint, which fully characterizes its appearance. The synonym is directly related to the structure of the product - the design in its original form really resembles a miniature staircase. But still some features can be highlighted:

The outer frame of a modern tire is made of an aluminum-based alloy, and is made in the form of thick wire. This material allows it to easily change its shape without losing its overall elasticity. At the same time, it does not lose its strength from repeated bending and does not collapse over time.
To create support, only the outer frame is not enough, so it is connected along its entire length, like a staircase, by many jumpers. They are already made of steel wire, which is almost impossible to bend. This combination with the flexibility of the outer contour gives the Kramer tire irreplaceable supporting properties.
Since the metal reacts quite quickly to a decrease or increase in temperature, the outside of the product is covered with a cover made of medical gauze or fabric. This ensures a more comfortable position of the splint on the limb without causing unpleasant pain or temperature sensations in the patient. Also, in case of contamination, the cover can be quickly changed, and the product itself will remain clean.

Staircase splints are widely used in traumatology and emergency medicine, where they are used for quick and reliable immobilization of individual segments of the musculoskeletal system.