Traction New

TRACTION & SPLINTS

DR. ASHISH GOHIYA ASST. PROFESSOR DEPT. OF ORTHOPAEDICS GANDHI MEDICAL COLLEGE BHOPAL

TRACTION • Orthopedist’s great "master tool“. • Traction - the application of a force to stretch certain parts of the body in a specific direction

Inflammation

of a joint or fracture of bone

Muscles undergo spasm

Deformity & impaired function

TRACTION • Traction controls movements of an injured part of the body – aids in healing. • Traction and counter traction still form the basis of reduction of fractures and dislocations

TRACTION • • • •

Controls pain. Reduces fracture. Maintain reduction. Prevents & corrects deformity.

TRACTION • Based on duration • Continuous traction • Intermittent traction – Cervical – pelvic

TRACTION • Based on principle • Fixed traction • Sliding traction

FIXED TRACTION •

Traction is applied to the leg against a fixed point of counter pressure. – –

Fixed traction in Thomas’s splint Roger Anderson well-leg traction

SLIDING TRACTION • When the weight of all or part of the body, acting under the influence of gravity, is utilized to provide counter-traction.

SLIDING TRACTION • Exact weight required is determined by trial. • For the fracture of femoral shaft an initial weight of 10% of body weight • Foot end is elevated so that the body slides in opposite direction. • 1 inch (2.5 cm) for each 1 lb (0.46 kg) of traction weight

SLIDING TRACTION • • • • • • • • • • • •

Buck’s traction or Extension Perkin’s traction Hamilton Russell traction Tulloch Brown traction Ninety /Ninety tractionRryant’s ( or Gallows) traction Modified Bryant’s traction Sliding traction with Bohl;er-Braun frame Lateral upper femoral traction Agnes Hunt traction Pelvic traction Dunlop traction Olecrenon traction

TRACTION • Based on application • Skeletal traction • Skin traction –Adhesive –Non – adhesive

SKIN TRACTION • Traction force is applied over a large area of skin • Applied over limb just proximal to fracture site • “Coning effect”

SKIN TRACTION •

Adhesive skin traction: – Maximum weight 15 lb or 6.7 kg

•

Non-adhesive skin traction – Maximum weight should not exceed 10 lb or 4.5 kg – thin and atrophic skin, – skin sensitive to adhesive strapping,

SKIN TRACTION COMPLICATIONS • Allergic reactions to adhesives. • Excoriation of skin. • Pressure sores over bony prominences and tendoachillis. • Common peroneal nerve palsy.

SKELETAL TRACTION • pin or wire • more frequently used in lower limb fractures • Should be reserved for those cases in which skin traction is contraindicated or insufficient

SKELETAL TRACTION • SITES – Olecranon – Metacarpal – Upper end femur – Lower end of femur – Upper end of tibia – Lower end of tibia – calcaneus

SKELETAL TRACTION COMPLICATIONS • Infection • Cut out • Application of splint difficult • Distraction at fracture site • Ligament damage • Physeal damage • Depressed scars

HAMILTON RUSSEL TRACTION • Below knee skin traction is applied • A broad soft sling is placed under the knee • Both the cord one of knee sling and other of b/k skin traction are attached through a system of pulleys to suspend single weight

HAMILTON RUSSEL TRACTION • By the arrangement of pulleys at the distal end, a 10-pound weight exerts a 20-pound pull

NINETY / NINETY TRACTION • Used for sub trochanteric fractures and those in the proximal third of the shaft of the femur • Management of fractures with posterior wound is easier • Traction is given through lower femoral pin, which is more efficient, or by upper tibial pin.

NINETY / NINETY TRACTION • Complications of 90/90 traction: – those related with skeletal traction. – Stiffness and loss of extension of knee. – Flexion contracture of hip. – Injury to epiphyseal plate in children. – Neurovascular damage

SLIDING TRACTION WITH A THOMAS’S SPLINT AND KNEE FLEXION PIECE

• fracture of femur • Knee flexion piece allows easier mobilization of the knee • Always keep the hinge at the level of addutor tubercle. • Keep the knee flexed at about 20- 30 degree

SLIDING TRACTION WITH BOHLER BROWN SPLINT: • Used for the fracture of tibia or femur. • Skeletal traction is usually applied, but skin traction can be given b/k.

BRYANT’S (GALLOW’S ) TRACTION • the treatment of fracture shaft femur in children up to age of 2 yrs. • Weight of child should be less than 15- 18 kg • Above knee skin traction is applied bilaterally • Tie the traction to the over haed beam

MODIFIED BRYANT’S TRACTION • Sometimes used as a initial management of developmental dysplasia of hip (1 YR) • After 5 days of Bryant’s traction, abduction of both hips is begun increased by about 10 degree alternate days. • By three weeks hips should be fully abducted.

LATERAL UPPER FEMORAL TRACTION • For the management of central fracture dislocation of the hip • about 2.5 cm from most prominent part of greater trochanter mid way between ant. And post. surface of femur • threaded screw eye • Traction to continued for about 4-6 wks

PELVIC TRACTION • special canvas harness is buckled around the patient's pelvis • Long cords or straps attached to the harness to the foot of the bed • Used for conservative management of PIVD

CERVICAL TRACTIONS • • •

Halter traction Crutchfield tongs Cone or Barton tongs

CERVICAL TRACTIONS • • •

Halter traction Crutchfield tongs Cone or Barton tongs

DUNLOP TRACTION • T/t of supracondylar & transcondylar fracture of humerus • Useful when flexion of elbow causes circulatory embarrassment with loss of radial pulse • Apply skin traction to forearm • Abduct shoulder about 45 degree • the elbow is flexed 45 degree.

CHARNLEY’S TRACTION UNIT • • • 4. 5.

BK POP incorporating the Steinmann or Denham pin Common peroneal nerve and calf muscles protected External rotation of the foot and distal fragments is controlled The tendo achilles is protected from pressure sores Ipsilateral tibia # can be managed

SPLINTS • An appliance, either rigid or flexible, used to hold in position a displaced or movable part or to keep in place and protect an injured part. • Splints support and protect injured bones and soft tissue • reduces pain, swelling, and muscle spasm.

• airplane s. a static orthosis that holds the upper limb in abduction at the level of the shoulder; used following burns in the axillary region and for short periods following surgery to the shoulder or brachial plexus. • banjo traction s. a dynamic orthosis to aid extension of the fingers using a banjoshaped steel bar attached to the fingers with rubber bands and plastic rings.

• Cramer's s. a flexible wire splint consisting of parallel stout wires between which smaller wires are stretched like the rungs of a ladder • Coaptation s.’s small splints adjusted about a fractured limb for the purpose of producing coaptation of fragments

• Liston's s. a simple straight splint, often made of wood with padding, for fracture of the femur; it is adapted to the side of the body and lower limb. • Thomas s. a knee-ankle-foot orthosis consisting of two rigid rods attached to an ovoid ring that fits around the thigh; used in emergencies or for transporting patients, or combined with other apparatus to provide traction.

• Keller-Blake s. a hinged half-ring modification of the Thomas splint for fracture of the femur • Denis Browne s. a splint consisting of a pair of metal foot splints joined by a cross bar; used in talipes equinovarus.