Kramer splint for fractures: why is it used and how to apply it

The Kramer splint is a simple and ingenious invention of the middle of the last century, owned by the Soviet scientist, traumatologist Harry Kramer, and is still widely used in traumatology. The Kramer splint is the most convenient means of fixation for fractures of the limbs and cervical spine at home and at work, during an accident and sports, while transporting the victim to the hospital.

Lightness, reliability, convenience and the ability to model on any part of the body are qualities due to which this device has a permanent “registration” at ambulance stations, medical and trauma centers, and hospital departments.

Author of the article / Site experts Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

What is a Kramer tire?

This orthopedic device is a small ladder, since its design is a set of wire gratings and belts for fastening. The structure of the tire is clearly visible in the photo below. The tire is made of aluminum, because this material is very flexible and lightweight, bends well and can be modeled. This material allows you to fix the limb in almost any position, but the internal connection is made of steel, which gives the structure a certain rigidity during immobilization.

On the outside, the wire frame is covered with a cover made of cotton wool, gauze or any soft fabric. This allows you to mitigate the unpleasant sensations that arise when the skin touches hard and cold metal (the high thermal conductivity of metal leads to both its rapid overheating and rapid cooling; in winter such a product will be very cold).

When to use

First of all, this orthopedic product is used when transporting victims to a medical facility, when there is a need for reliable immobilization of damaged areas of the body. It is applied for fractures, dislocations, ruptures of tendons and ligaments of both upper and lower extremities. It is also used for compression of muscles and bones, severe bruises. With its help you can fix the cervical spine. Before arriving at the hospital, it is important to maintain a safe position for your leg, arm, or other body part to prevent the development of possible complications. The device helps to avoid them, since it forms artificial support for injured areas of the body.

The fixator is also used for soft tissue trauma, and attention should be paid to the methods of its application and the specific features of using this device.

Thus, the retainer is used when:

fractures of the bones of the arms and legs;
damage to the cervical spine;
traumatic brain injuries;
dislocations;
damage to muscle tissue (severe bruises, ruptured ligaments and tendons,
compression of tissues and crushing of bones;
frostbite and burns;
damage to nerve bundles and blood vessels.

For minor damage, this design is not used. However, it can be used as an analogue of a soft bandage.

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.

Application of a Kramer splint for a shoulder fracture

Before applying the fixative, you need to wrap it in cotton wool and bandage it, then put on the cover, having previously disinfected it with a special solution.

The algorithm for applying the fixator is as follows:

Place the victim on a chair facing you.
Cut clothes with scissors, gain access to the injury.
When examining the damage, identify the nature of the injury (fracture, dislocation or bruise).
Wrap the structure with cotton wool on both sides, and also bandage the cotton wool to it (to prevent skin damage);
At the corners of the splint at its end, tie two twisted gauze ribbons, each 80 cm long.
Then the wire frame is modeled at a right angle, and the bending point is adjusted according to the patient’s healthy arm.
A simulated splint is placed on the victim’s shoulder girdle.
Move your shoulder forward so that an angle of 30 degrees is formed.
Apply the clamp to your healthy arm so that the shoulder, elbow and hand are covered by it.
The end of the product should extend along the back to the opposite shoulder joint.
Place a piece of cotton wool in the armpit, and tie gauze garters at the other end of the splint in the forearm area.
Also place a cotton wool roller into your palm and secure the structure completely with a bandage.
You can apply a Deso bandage to more securely secure the entire shoulder girdle.

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.

Applying a device for lower limb injury

In case of injury to the lower limb, the ladder frame is applied in the following sequence:

Make the patient comfortable, use anesthesia (if necessary).
Give the device the desired shape.
One end of the clamp should run along the calves, and the other should be directed towards the toes, bending it at a right angle.
Rigid elements should be under the leg, which is bent at the ankle joint at 90 degrees.
The frame of the product should reach the middle of the person’s thigh.
The second part of the structure should be located above the leg, providing rigid immobilization.
Secure the bandage with a screw-shaped bandage from the tips of the toes, going up.
It is also advisable to use soft cotton rolls at the site of skin contact with the metal structure.
The fingers are left open and not fixed.

Device

The design is extremely simple, it is a ladder made of metal wire, which can be bent anywhere and at any angle, rotated around an axis - in a word, given the most physiological shape for a specific part of the body. In this case, the victim suffers much less pain than when applying a wooden splint or a splint made from improvised material.

The outer frame (frame) is made of aluminum alloy, this gives flexibility and the ability to take the desired shape. The internal jumpers (mesh) are made of rigid steel wire, which ensures rigid fixation.

Thanks to the mesh structure, the tire is lightweight, which also reduces the likelihood of injury when transporting a patient. In addition, you can quickly mount a splint and fix not only the fracture site itself, but also the joints closest to it, and, if necessary, the entire limb. This is ensured by reliable immobilization. Displacement of fragments during transportation of the patient to a medical facility is also prevented.

Kramer splints come in a wide variety of sizes: from small and narrow for the hand to 2-meter ones, applied to the hip, shoulder, there are also wide designs in case of fractures of the spine and pelvic bones.

Manufacturers of stair splints are various Russian companies, factories and associations for the production of medical supplies. The cost is low - from 500 rubles, you can purchase it in medical equipment stores, on the Internet on the websites of supplier companies.

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.