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ORTHOPAEDICS .
SUBJECT SEMINAR ON :
TRACTION IN ORTHOPAEDICS
Inflammation of a joint
Deformity
fracture of bone
Pain
THE PURPOSE OF TRACTION IS TO:
• Based on principle
1. Fixed traction
2. Sliding traction
FIXED TRACTION
• The ‘Halo’, a metal ring secured with four screws into the
outer dipole of the skull, was popularised by Perry and
Nickel in the 1970s for prolonged cervical traction in place
of the old-fashioned, two-screw skull tongs used in cervical
fractures.
APPLICATION OF HALO SPLINT:
• For application of halo splint, choose a halo splint which will allows a clearance of
half inch i.e 1.25 cm to the circumference of head. The splint is positioned with its
lower margin laying just above the ears and 6mm above the eyebrows.
• For four fixation points anterior 2 pins are inserted about 1 cm above the lateral one
third of the eye brows that is in between the superior orbital ridges and the frontal
prominence. Posterior 2 pins are inserted about 1 cm above the top of ears in line
with the mastoid processes.
• The pelvic rods are fixed with make a stab wound
at point 2 inches superior and posterior to ASIS
(iliac tubercle), in fat patients it’s difficult to
palpate make a incision at summit of the iliac crest
large enough to pass the finger.
• Position of drilling jig , place posterior part of jig
over PSIS and anterior end of jig over the tubercle
of Iliac crest, continue the drilling around 6 inches
projects posteriorly.
• Indications Halo-pelvic traction was ideal for the treatment of severe and
rigid spinal deformities such as healed tuberculosis kyphosis and various
types of severe scoliosis such as that due to neurofibromatosis and
poliomyelitis.
• Complication was discovered in the odontoid process of the second
cervical vertebra. The blood supply to this process is essentially derived
from ligaments attached to this bone. With tension in the ligaments from
distraction, blood supply to the odontoid process is jeopardised leading to
avascular necrosis. This was a rather common complication in HPT. The
necrosis itself recovered, but stiffness and early degeneration of the
cervical spine.
COMPLICATIONS OF HALO-PELVIC TRACTION
• 1.Cranial screws – superficial infection around the cranial screws, cerebral abscess,
pain when the screw are tight, penetration to inner table; diagnosed by tangential
views x rays.
• 2.Pelvic rods – vague ache and pains , peritoneal penetration , superficial infection
hip contracture from ilio-psoas fibrosis and loosening
• 3.Neurological includes traction lesion abducent nerve palsy –moving of affected
eye to outward direction , glosso pharyngeal nerve palsy – difficulty in swallowing,
recurrent laryngeal nerve palsy- hoarseness, spinal cord – paraplegia
SLIDING TRACTION
When the weight of all or part of the body, acting under the
influence of gravity, is utilized to provide counter-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.
TYPES OF TRACTION ON APPLICATION
1. Skin traction
Adhesive and Non – adhesive
2. Manual traction
3. Skeletal traction
SKIN TRACTION
• Buck’s Traction
• Hamilton Russel Traction
• Tulloch Brown Traction
• Gallow’s or Brayant’s Traction
• Modified Brayan’s Traction
• Pelvic Traction
• Dunlop Traction
BUCK’S TRACTION:
•
Tulloch brown, or U loop tibial pin , traction and suspension
(nagle, 1951) with a nissen foot plate and stirrup ( nissen
1971)
• Indication for management of patients who have had a cup
arthroplasty or pseudoarthrosis operation on the hip , or
who have sustained a fracture of the shaft of femur.
• Not used in children
BRYANT’S (GALLOW’S ) TRACTION
• Steinmann pin may be either smooth or threaded Smooth is stronger but can slide if
angled
• Threaded pin is weaker, bends easier with higher weight, but will not slide and will
advance easily during insertion
• In general a 5 or 6 mm diameter pin is chosen for adults SKELETAL TRACTION
• Denham pin . introduced by denham in 1972 to reduce risk of pin sliding. This
type of pins are used in cancellous bone, such as calcaneus, or in osteoporotic bone.
SITES
• Lower limb
• Upper tibial
• Lower femoral
• Lower tibial
• Calcaneus
• Upper limb
• Olecrenon
• Metacarpel
PIN PLACEMENT
• Sterile field with limb exposed • Place sterile dressing around pin site
• Local anesthesia + sedation • Place protective caps over sharp pin
• Insert pin from known area of
neurovascular structure
• Distal femur: Medial toLateral
• Proximal Tibial: Lateral to Medial
• Calcaneus: Medial to Lateral
DISTAL FEMORAL TRACTION
• Place pin from medial to lateral at the adductor tubercle - slightly proximal to
epicondyle.
• Method of choice for acetabular and proximal femur fractures
• If there is a knee ligament injury usually use distal femur instead of proximal tibial
traction
PROXIMAL TIBIAL TRACTION
• X-rays are done pre-op and may be repeated during treatment to assure a stable
alignment
• Blood and urine tests are done
• Patient may meet with an anaesthesiologist to discuss health conditions (if skeletal
traction is being done)
POST –OP SKIN TRACTION
• Two main risks are: traction is applied incorrectly or the skin becomes irritated.
1. Bone inflammation may occur.
2. Infection may occur at the pin sites.
• Because of long periods of immobility, the patient may develop bed sores, reduced respiratory function,
urinary or circulatory problems.
• Traction can take an emotional toll on the patient.
Cut out
Distraction at fracture site
Physial damage
Nerve Injury
SLIDING TRACTION WITH BOHLER BROWN
SPLINT: