SPLINTS AND TRACTION

Dr Digvijay Agarwal
Assistant Professor
 OBJECTIVE

• Attain a basic knowledge as to what orthopedic

injury gets what type of splint

• Develop an understanding of proper splint

application to avoid the hazards associated with
improper splinting technique(s)
 WHAT ARE SPLINTS??

• Devices that immobilize and protect an injured limb or

spine

• Can be of any rigid material POP, plastic or metal

• Usually along with some padding to make it comfortable

• They are used before or instead of casts or traction.

 INDICATIONS OF SPLINTS

• Fractures, sprains and dislocations

• Joint infections

• Acute arthritis/ gout

• Acute tenosynovitis
CONTRAINDICATIONS OF SPLINTS

• Compartment syndrome

• Need for open reduction

• Infected skin condition or when there is a high risk

of infection
 SPLINTING MATERIALS

• Plaster
• Crammer wire splints
• Fibreglass
• Pre-fabricated splints
• Air splints
• Vacuum splints
 PLASTER OF PARIS

• Calcium sulphate dehydrate

• When wet it crystallises
• Exothermic reaction
• Average setting time- 3 to 9
minutes
• Average drying time: 24-72 hrs
 PLASTER OF PARIS

ADVANTAGES
• Easier to mold
• Less expensive
DISADVANTAGES
• More difficult to apply
• Gets soggy and soft when it gets wet
CRAMMER WIRE SPLINT
 THOMAS SPLINT

• Hugh Owen Thomas- Father of

Orthopedics
• Father not a trained physician
(bone setter), was taken to court
to defend his practice 3 times
• Sent to train all the five sons
• An eccentric and temperamental
maninjured people to treat them?
• Would treat patients free on
Sundays
 THOMAS SPLINT

• Ring at an angle of 120 degrees

• Two side bars
• Outer bar bent to accommodate the greater
trochanter
• Leg supported on slings tied to the side bars
 BOHLER BRAUN SPLINT

• 3 Pulleys
• Proximal pulley to
prevent foot drop
• 2nd pulley- traction
in line with the
femur
• 3rd Pulley- traction
in line for traction in
line with the leg
 BOHLER BRAUN SPLINT

ADVANTAGES
• Traction unit is self contained easy option
• Limb in comfortable position
• Angle of traction changeable
• Wound care possible
• Multipurpose application
• Simultaneous traction through Calcaneal/distal tibia and
proximal tibia/distal femur possible
 DENNIS BROWN SPLINT

• Used in the treatment of club foot..

FIBRE GLASS SPLINT
PRE FABRICATED SPLINTS
 AIR SPLINTS- INFLATABLE

• Also called “pneumatic splints”

• Become rigid when filled with air
• Limit motion, control bleeding/swelling
• Injured part inserted into deflated splint
• Air infused and splint molds to injured body part
• Fill to point which allows indentation with fingertips
• Injury should be checked and treated within 30-45
minutes after application
CARE OF PATIENT ON SPLINT

• Padding on the fracture site

• Padding on bone prominences
• Active mobilisation of muscles and joints
• Watch out for effects of compression on nerves/ vessels
• Daily check and adjustments of weights
• Check pressure points and perineum for pressure points
• Care of back
PRE- POST CHECKS WITH SPLINTS- “FACTS”

• Function
• Arterial pulsations
• Capillary refill
• Temperature
• Sensations
THANKYOU
SPLINTS AND TRACTION

Dr Digvijay Agarwal
Assistant Professor
MECHANICAL IMMOBILISATION DEVICES

SPLINTS
• The use of various devices can achieve therapeutic benefits

TRACTIOINS
• Devices that immobilize by pulling on contracted muscles
• Not as easy to apply as splints
• May require special training for application to prevent
further injury
 TRACTIONS

• Traction is pulling effect exerted on a part of

skeletal system.

• Involves use of weights connected to patient with

ropes, pulleys, slings, etc.
 OBJECTIVE OF TRACTION

• Reduction of fracture/ dislocation

• Maintenance of #
• Reduce/ relieve pain
• Immobilisation of painful joint
• Prevention of deformity, counteracting muscle
spasm
• Correction of small defects
 PRINCIPLES OF EFFECTIVE TRACTION

• Traction must produce a pulling effect on the body

• Counter traction must be maintained
• The traction and counter pull must be in the opposite
directions
• Splints and slings must be suspended without interference
• Ropes must move freely through each pulley
• Precise amount of weight must be applied
• The weights must hang free
 TYPES OF TRACTIONS

Manual
• Pulling on body using hands and strength
• Used frequently to replace dislocation
Skin-Devices applied to skin such as pelvic belt,
Buck’s/Russell’s traction
Skeletal-Pulls directly on bone with wires, pins, tongs
into bone
ADVANTAGES OF TRACTION

• Regain normal length and alignment of involved bone.

• Relieves pain and muscle spasm
• Restricts movements while the injury heals
• Maintains functional position until the healing is complete
• Allows other activities
• Prevents further structural damage and deformity
• Prevent or reduce skeletal deformities or muscle contractures
• Provides a fusiform tamponade around a bleeding vessel
DISADVANTAGES OF TRACTION

•Costly in terms of hospital stay

•Hazards of prolonged bed rest
• Thromboembolism
•Decubitus ulcer
• Pnuemonia
•Require extensive nursing care
 SKIN TRACTION

• Limited force can be applied generally not to

exceed 5 lbs
• More commonly used in pediatric patients
• Can cause soft tissue problems especially in
elderly or rheumatoid patients
• Not as powerful when used during operative
procedure for both length or rotational control
Contraindications for Skin Traction

• Patients with loose skin

• Wounds on the limb
• Circulation problem- gangrene/ varicose veins
• Skin infection
Complications of Skin Traction

• Allergy

• Muscular atrophy

• Paralysis

• Oedema
 SKELETAL TRACTION

• More powerful than skin traction

• May pull up to 20% of body weight for the lower
extremity
• Requires local anesthesia for pin insertion if
patient is awake
• Preferred method of temporizing long bone,
pelvic, and acetabular fractures until operative
treatment can be performed
MODE OF SKELETAL TRACTIONS

• FIXED TRACTION Counter traction applied by

the splint

• SLIDING TRACTION Wt of body acts counter

traction
COMPLICATIONS OF SKELETAL TRACTION

• Pin/ wire tract infection

• Effects of prolonged pull on ligaments

• Pressure sores

• Difficulty in application of splints

THANKYOU