TRACTION IN

ORTHOPAEDICS

Principle of Traction

? WHAT IS TRACTION

.“Orthopedist’s great "master tool

Traction - the application of a force

to stretch certain parts of the body

in a specific direction

? WHY DO WE NEED TRACTION ---

Inflammation of a joint

Pain and muscle spasm

Defomity

fracture of bone

Abnormal Mobility

Pain

TRACTION
:The purpose of traction is to

 To regain normal length and alignment of

.involved bone

. To reduce and immobilize a fractured bone

. To relieve or eliminate muscle spasms

 To relieve pressure on nerves, especially

.spinal

 To prevent or reduce skeletal deformities or

.muscle contractures

TRACTION

. Controls pain

. Reduces fracture

. Maintain reduction

. Prevents & corrects deformity

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 –

Halo-Pelvic Traction –
THOMAS SPLINT

 Used for # shaft of femur

 Counter traction provided by ischeal

Tuberosity

 Girth should be taken at uppermost part of

thigh near ischeal tuberocity and add 5 cm to

.it

 Measure from Crotch to Heal and it should

.be 15-23 cm beyond heal

 Ring should be angled at 120° to inner side

.bar

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
 TRACTION to limbs

TYPES OF TRACTION ON

APPLICATION

Skin traction

Adhesive–

Non – adhesive–

Skeletal Traction

SKIN TRACTION

SKIN TRACTION

 Traction force is applied over a large

area of skin

 Applied over limb distal to fracture site

 Anteromedial and posterolateral part

should be covered with cotton and

.malleoli should be covered with cotton

” “Coning effect

SKIN TRACTION

: Adhesive skin traction

Maximum weight 6.7 kg –

 Non-adhesive skin traction

Maximum weight should not exceed 4.5 –

kg

,Used in thin and atrophic skin –

,skin sensitive to adhesive strapping –

COMMON SKIN TRACTIONS

 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

 Often used

preoperatively for

femoral fractures

 Can use tape

 No more than 5 kgs

 Not used to obtain or

on

HAMILTON RUSSEL TRACTION

 Below knee skin traction is applied

 A broad soft sling is placed under the

knee

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

kg 18

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

PELVIC TRACTION

 Used for conservative management of PIVD

 The amount by which foot end should be

, elevated depends upon patient’s weight

more heavy the patient, more should be

.elevation

DUNLOP TRACTION

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

Dunlop Traction

SKIN TRACTION

>>>>>>>>>>>>

: COMPLICATIONS Of Adhesive Skin Traction

. Allergic reactions to adhesives

. Excoriation of skin
 Pressure sores over bony prominences

.and tendoachillis

. Common peroneal nerve palsy

SKELETAL TRACTION
SKELETAL TRACTION

 pin or wire

 more frequently used in lower limb

fractures

 Should be reserved for those cases in

.which skin traction is insufficient

 Generally used when more weight is

.needed to give traction

. To treat fractures conservatively

SKELETAL TRACTION

 SITES

Upper tibial –

Lower femoral –

Lower tibial –

Calcaneus –

Olecrenon –

Metacarpel –

Proximal Tibial Traction

  Used for distal 2/3

femoral shaft fx

 Easy to avoid joint and

growth plate

 2 cm distal and

posterior to tibial

tubercle

Distal Tibial Traction

 Useful in certain tibial

plateau fx

 Pin inserted 5 cm

proximal to tip medial

malleolus , midway

between ant and post

.border of tibia

 Avoid saphenous vein

 Place through fibula to

avoid peroneal nerve

 Maintain partial hip and

knee flexion

Calcaneal Traction
 Temporary traction for

tibial shaft fx or

calcaneal fx

 Insert about 2 cm below

and behind the lateral

 malleolus

 Do not skewer subtalar

joint or NV bundle

 Maintain slight elevation

leg

SOME SKELETAL

TRACTIONS

 Lateral or Upper Femoral Traction

 Nintey / Nintey traction

 Olecrenone traction

 Perkin’s Traction

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

 Attach weight upto 9 kgs

 Traction to continued for about 4-6

wks

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 –

SKELETAL TRACTION
COMPLICATIONS

 Infection

 Cut out

 Distraction at fracture site

 Physeal damage

 Nerve Injury

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

SPINAL TRACTIONS
CERVICAL TRACTIONS

 SKIN TRACTION Head Halter traction

 SKELETAL TRACTION

Crutchfield tongs

Cone or Barton tongs

Head Halter traction

 Simple type cervical

traction

 Management of neck

pain

 Weight should not

exceed 3 kg initially

 Can only be used a few

hours at a time

 Head end should be

elevated to give counter

traction

Crutchfield Tongs

 Must incise skin and

drill cortex to place

 Rotate metal traction

loop so touches skull in

midsagittal plane

 Place at the line

connecting tips of

mastoid processes on

.both sides

CERVICAL TRACTIONS

LEVEL MAX. WT

C2 4.5-5.4 Kg

C3 4.5-6.7Kg

C4 6.7-9.0Kg

C5 9.0-11.3Kg

C6 9.0-13.5Kg
C7 11.3-15.8Kg

SUSPENSIONS

SUSPENSION

 Done for better nursing care

 To increase the mobility of patient

 To prevent dangers of immobilization

 Suspension system consists of traction cords

pulleys and weight

 Commonly Balken Beam frame is used for

.suspension purpose

BALKEN BEAM FRAME

. Commonly Used to suspends splints

 one or two Balken Frames are used

 Today balken frames are made up of Metal

tubes

 Two uprights are on each side of bed and are joined by two

.long horizontal bars

 Other short horizontal bar may be there joined to two

.uprights on same side or to long horizontal bar

TRACION CORDS

 Used to suspend weights to give traction

 Cords perform two functions – traction and

suspension

–  For this color code system is available

red or green for traction cords -

.white for suspension cords -

PULLEYS

 Function of pulley is to control the direction of

weight attached to end of the cord over

.pulley

 Large pulley wheels of 6cm in diameter and

6mm in diameter of axles are preferable

 Majority of pulleys are prepared from Tufnol

WEIGHTS

 The amount of weight required to suspend

- an appliance depends upon

weight of appliance -

weight of part of body suspended in -

appliance

.the amount of friction present in system -

CHARNLEY’S TRACTION

UNIT

 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 .1

Ipsilateral tibia # can be managed .2