Lower-limb traction

Limb traction is useful for reducing and immobilizing femoral shaft fractures  supracondylar and intercondylar fractures of the femur  condylar fractures of the upper end of the tibia  grossly infected or contaminated fractures of the tibia  and severe fractures of the ankle mortise with subluxation or dislocation or both

Neglected

dislocations of the hip and

knee gross deformities and displacements due to traumatic, infectious or rheumatoid conditions of the hip and knee and deformities after poliomyelitis can all be corrected by continuous traction.

Skin traction

Technique  Sedate the patient (anaesthesia is unnecessary).  Clean the limb with soap and water, and dry it  Prepare the skin with an antiseptic solution, preferably methylated spirit, and let it dry  . If a commercial traction set (complete with adhesive tapes, traction cords, spreader bar, and foam protection for the malleoli) is not available, improvise the apparatus as described below.

Open a roll of adhesive strapping on a clean dry table and spread it with the adhesive surface up. (Use a size appropriate to the size of the patient; for an adult, a 7.5-cm wide, nonelastic tape is usually suitable.) For aboveknee traction, measure a length of strapping that is twice the length of the limb from the greater trochanter to the sole of the foot . Add an extra 35 - 40 cm to accommodate the spreader and to leave enough space (10 - 15 cm) between the sole and the spreader to permit movement at the ankle. For below-knee traction, the length of strapping should be measured from the tibial condyles. For the treatment of compound fractures, traction should be applied just distal to the site of fracture and the strapping should be cut accordingly.

Place a square, wooden spreader of approximately 7.5 cm (with a central hole) in the middle of the length of strapping that you have spread on the table. Cut another length of strapping about 3540 cm long and centre it on the spreader with the adhesive surface down. The spreader is now sandwiched between the two strappings

Holding the patient’s ankle and foot, pull the limb steadily, elevating it from the bed. Instruct an assistant to hold the spreader with a loop of strapping projecting 10 - 15 cm beyond the sole of the foot Apply the strapping to the medial and lateral sides of the limb, still elevated and held in moderate traction Protect the malleoli, Achilles tendon insertion, and the head and neck of the fibula by placing strips of felt or cotton-wool padding under the strapping at these sites

For above-knee traction, the adhesive strapping should extend proximally to the groin on the medial side and to the greater trochanter on the lateral side To avoid causing deformity due to external rotation, place the lateral strapping slightly posterior, and the medial strapping slightly anterior to the mid-lateral and mid-medial lines, respectively

Ensure that the strapping lies flat on the surface of the limb. Do nor cover the anterior border of the tibia or encircle the limb with strapping Now apply a crepe or ordinary gauze bandage firmly over the strapping beginning 2 - 5 cm proximal to the malleoli. Continue bandaging up the limb, over the strappings, up to the groin (or as appropriate to the level of traction). Elevate the end of the patient’s bed and attach a traction cord through the spreader with the required weight . this should normally not exceed 5 kg

Contraindications

Do not apply skin traction to a limb with abrasions, lacerations, ulcers of the skin, loss of sensation, impending gangrene, atrophic skin, or peripheral vascular disease. Skin traction is also contraindicated in the treatment of marked overriding of fracture fragments or of gross, long-standing deformities

Complications

Possible complications include allergic reaction to the adhesive material (usually zinc oxide); blister formation or excoriation of the skin from the strapping slipping; pressure sores over the malleoli; and common peroneal nerve palsy. Most of these complications can be avoided by correct application of the adhesive strapping. The most important cause of common peroneal nerve palsy is lateral rotation of the limb, resulting in compression of the nerve at the upper end of the fibula. Avoid this by keeping the patient’s knee joint moderately flexed (up to 10°).

Different kinds of skin traction

Bucks Extension  Affection of the hip and femor

Bryant traction  Affection of hip and femor below 3yrs old

Boot cast traction For post poliomyelitis with residual paralyis of hip and knee

Modified buck’s extension traction  Affection of the hip and femor

Pelvic girdle For lumbo-sacral affection and herniated nucleus pulposus

Hammock suspension traction  Affection of the pelvis and malgained fracture

Skeletal traction

Balanced skeletal traction  Affection of the hip and/or femur

Ninety-ninety degrees traction  Subtrochanteric and proximal 3rd fractue of femor

Balance Skeletal Traction (BST)

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