TRACTION & SPLINTS

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

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TRACTION

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

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Inflammation

of a joint or fracture of bone

Muscles undergo spasm

Deformity & impaired function

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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

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TRACTION
   

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

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TRACTION
 Based

on duration

 Continuous

traction  Intermittent traction
– Cervical – pelvic

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TRACTION
 Based

on principle

Fixed

traction Sliding traction

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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

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SLIDING TRACTION

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

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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 www.esnips.com/web/agohiya

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

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TRACTION
 Based

on application

Skeletal

traction Skin traction
– Adhesive – Non – adhesive

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SKIN TRACTION

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

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SKIN TRACTION

Adhesive skin traction:
– Maximum weight 15 lb or 6.7 kg Maximum weight should not exceed 10 lb or 4.5 kg thin and atrophic skin, skin sensitive to adhesive strapping,

Non-adhesive skin traction
– – –

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SKIN TRACTION
COMPLICATIONS  Allergic reactions to adhesives.  Excoriation of skin.  Pressure sores over bony prominences and tendoachillis.  Common peroneal nerve palsy. www.esnips.com/web/agohiya

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

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

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SKELETAL TRACTION
COMPLICATIONS  Infection  Cut out  Application of splint difficult  Distraction at fracture site  Ligament damage  Physeal damage  Depressed scars www.esnips.com/web/agohiya

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 www.esnips.com/web/agohiya

HAMILTON RUSSEL TRACTION

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

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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. www.esnips.com/web/agohiya

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

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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 www.esnips.com/web/agohiya

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.

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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 1518 kg Above knee skin traction is applied bilaterally Tie the traction to the over haed beam www.esnips.com/web/agohiya

BRYANT’S (GALLOW’S ) TRACTION

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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. www.esnips.com/web/agohiya

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 www.esnips.com/web/agohiya

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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

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CERVICAL TRACTIONS
  

Halter traction Crutchfield tongs Cone or Barton tongs

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CERVICAL TRACTIONS
  

Halter traction Crutchfield tongs Cone or Barton tongs

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CERVICAL TRACTIONS
LEVEL C2 C3 C4 C5 C6 C7 MAX. WT 4.5-5.4 Kg 4.5-6.7Kg 6.7-9.0Kg 9.0-11.3Kg 9.0-13.5Kg 11.3-15.8Kg

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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. www.esnips.com/web/agohiya

Dunlop Traction

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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

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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. www.esnips.com/web/agohiya

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.

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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 www.esnips.com/web/agohiya

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.

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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.

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