orthopedic tractions

download orthopedic tractions

of 83

Embed Size (px)

description

 

Transcript of orthopedic tractions

  • ORTHOPAEDIC TRACTION Dr. Srinivas Bodla Ortho PG(PIMS)
  • Definition
    • Traction is the application of a pulling force to a part of the body
  • History
    • Skin traction used extensively in Civil War for fractured femurs
    • Skeletal traction by a pin through bone introduced by Steinmann and Kirschner
    • Hippocrates - treated fracture shaft of femur and of leg with the leg straight in extension
    • Guy de chauliac- introduced continuous isotonic traction in the fracture of femur
  • History
    • Percival pott- fractured limb should be placed in the position in which muscles are most relaxed
    • Josiah crosby isotonic skin traction for treatment of shaft of femur
    • Thomas Bryant- Braynts traction for treatment of fracture shaft of femur in children
    • Thomas Thomas splint, used for applying fixed traction
  • History
      • Malgaigne introduced the 1 st effective traction which grasped the bone itself. He used malgaignes hooks
      • Fritz-Steinmann introduced a method of applying skeletal traction to the femur by means of two pins driven into the femoral condyles.
      • Lorenz-Bohler The Father of Traumatology popularised skeletal traction by means of steinmann pins after he devised Bohler stirrup.
  • General Considerations
    • Safe and dependable way of treating fractures for more than 100 years
    • Bone reduced and held by soft tissue
    • Less risk of infection at fracture site
    • No devascularization
    • Allows more joint mobility than plaster
  • Types
    • Skin traction
    • The traction force applied over a large area of skin
    • Adhesive and Non-adhesive skin tractions
    • Skeletal traction
    • Applied directly to the bone either by a pin or wire through the bone. (eg- Steinmann pin, denham pin, kirschner wire)
  • Advantages
    • decrease pain
    • minimize muscle spasms
    • reduce, align, and immobilize fractures
    • reduce deformity
    • increase space between opposing surfaces
  • Disadvantages
    • Costly in terms of hospital stay
    • Hazards of prolonged bed rest
      • Thromboembolism
      • Decubiti
      • Pneumonia
    • Requires meticulous nursing care
    • Can develop contractures
  • Understanding traction
  • Principles Of Effective Traction
    • Countertraction must be used to achieve effective traction.
    • Countertraction is the force acting the opposite direction .
    • Usually, the patient's body weight and bed position adjustments supply the needed countertraction.
  • Counter traction
    • Fixed traction- by applying force against a fixed point of body.
    • Ex:
    • fixed traction by thomas splint
    • Roger Anderson well leg traction
  • Counter traction
    • Sliding traction- by tilting bed so that patient tends to slide in opposite direction to traction force
    • Ex:
    • Hamilton russell traction
    • Tulloch Brown traction
    • Agnes Hunt traction
    • Perkins traction
  • APPLIANCES
  • Beds And Frames
    • Standard bed has 4-post traction frame
    • Ideal bed for traction with multiple injuries is adjustable height with Bradford frame
    • Mattress moves separate from frame
  • Beds and Frames
    • Bradford frame enables bedpan and linen changes without moving pt
    • Alternatively bed can be flexible to allow bending at hip or knee
  • Knots
    • Ideal knots can be tied with one hand while holding weight
    • Easy to tie and untie
    • Overhand loop knot will not slip
  • Knots
    • A slip knot tightens under tension
    • Up and over, down and over, up and through
  • Knots - types
    • Clover hitch
    • Barrel hitch
    • Reef knot
    • Half hitch
    • Two half hitches
  • Pulleys
    • To control the direction of weight
    • By altering site and by using more than 1 pulley the force exerted by a given weight can be increased
    • Pulleys of 5-6.25cm diameter with 6cm diameter axles are preferrable
  • Weights
    • Amount of weight required depends upon
    • Wt of the appliance
    • Wt of part of body suspended
    • Amount of friction present in the system
    • Mechanical advantage of the system employed for suspension
  • SKIN TRACTION
  • Skin traction
    • The traction force is applied over a large area, this spreads the load and is more comfortable and efficient.
    • Force applied is transmitted from skin to the bones via superficial fascia, deep fascia and intermuscular septa
    • For better efficiency the traction force is applied only to the limb distal to the fracture
  • Weight
        • Skin damage can result from too much of traction force.
        • Maximum weight recommended for skin traction is 6.7 kgs
        • depending on size and weight of the patient
  • Application
    • Adhesive skin traction :
        • Prepare the skin by shaving as well as washing & applying tincture benzoin which protects the skin and acts as an additional adhesive.
        • Avoid placing adhesive strapping over bony prominences, if not, cover them with cotton padding and do the strapping.
        • Leave a loop of 5 cm projecting beyond the distal end of limb to allow movement of fingers and foot.
  • Application
    • Non adhesive skin traction
      • Useful in thin and atrophic skin
      • Frequent reapplication may be necessary
      • Attached traction wt. must not be more than 4.5 kgs.
  • Indications
    • Temporary management of # of NOF and IT #
    • Management of # - Femoral shaft of older and hefty children
    • Undisplaced # of acetabulum
    • After reduction of dislocation of Hip
    • To correct minor fixed flexion deformities of hip and knee
  • Contraindications
    • Abrasions and lacerations of skin in the area to which traction is to be applied
    • Varicose veins, impending gangrene
    • Dermatitis
    • When there is marked shortening of the bony fragments as the traction weight required is greater than which can be applied through the skin
  • Complications
    • Allergic reactions to adhesive
    • Excortication of skin
    • Pressure sores
    • Common peroneal nerve palsy
  • SKELETAL TRACTION
  • Skeletal traction
    • It may be used as a means of reducing or maintaining the reduction of a fracture
    • It should be reserved for those cases in which skin traction is contraindicated
  • Steinmann Pin
    • Rigid stainless steel pins of varying lengths 4 6 mm in diameter. Bohler stirrup is attached to steinmann pin which allows the direction of the traction to be varied without turning the pin in the bone
  • Denham Pin
    • Identical to stienmann pin except for a short threaded length in the center . This threaded portion engages the bony cortex and reduce the risk of the pin sliding
    • Used in cancellous bone like calcaneum and osteoporitic bones
  • Kirschner wire
    • They are easy to inser