Traction

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TRACTION & SPLINTSTRACTION & SPLINTS

DR. ASHISH GOHIYADR. ASHISH GOHIYAASST. PROFESSORASST. PROFESSOR

DEPT. OF ORTHOPAEDICSDEPT. OF ORTHOPAEDICS GANDHI MEDICAL COLLEGEGANDHI MEDICAL COLLEGE

BHOPALBHOPAL


TRACTIONTRACTION

Orthopedist’s great "master tool“.Orthopedist’s great "master tool“.

Traction - the application of a force to Traction - the application of a force to

stretch certain parts of the body in a stretch certain parts of the body in a

specific direction specific direction


Inflammation of a joint or fracture of bone

Muscles undergo spasm

Deformity & impaired function


TRACTIONTRACTION

Traction controls movements of an Traction controls movements of an injured part of the body – aids in injured part of the body – aids in healing.healing.

Traction and counter traction still form Traction and counter traction still form the basis of reduction of fractures and the basis of reduction of fractures and dislocations dislocations


TRACTIONTRACTION

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


TRACTION TRACTION

Based on duration Based on duration Continuous tractionContinuous tractionIntermittent traction Intermittent traction –CervicalCervical– pelvicpelvic


TRACTION TRACTION

Based on principle Based on principle Fixed tractionFixed tractionSliding traction Sliding traction


FIXED TRACTION FIXED TRACTION

Traction is applied to the Traction is applied to the leg against a fixed point leg against a fixed point of counter pressure. of counter pressure. – Fixed traction in Fixed traction in

Thomas’s splintThomas’s splint– Roger Anderson well-leg Roger Anderson well-leg

tractiontraction


SLIDING TRACTIONSLIDING TRACTION

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


SLIDING TRACTIONSLIDING TRACTION

Exact weight required is determined by Exact weight required is determined by trial.trial.

For the fracture of femoral shaft an For the fracture of femoral shaft an initial weight of 10% of body weightinitial weight of 10% of body weight

Foot end is elevated so that the body Foot end is elevated so that the body slides in opposite direction.slides in opposite direction.

1 inch (2.5 cm) for each 1 lb (0.46 kg) 1 inch (2.5 cm) for each 1 lb (0.46 kg) of traction weightof traction weight


SLIDING TRACTIONSLIDING TRACTION Buck’s traction or ExtensionBuck’s traction or Extension Perkin’s tractionPerkin’s traction Hamilton Russell tractionHamilton Russell traction Tulloch Brown tractionTulloch Brown traction Ninety /Ninety tractionRryant’s ( or Gallows) Ninety /Ninety tractionRryant’s ( or Gallows)

tractiontraction Modified Bryant’s tractionModified Bryant’s traction Sliding traction with Bohl;er-Braun frameSliding traction with Bohl;er-Braun frame Lateral upper femoral tractionLateral upper femoral traction Agnes Hunt tractionAgnes Hunt traction Pelvic tractionPelvic traction Dunlop tractionDunlop traction Olecrenon tractionOlecrenon traction


TRACTION TRACTION

Based on application Based on application Skeletal tractionSkeletal tractionSkin traction Skin traction –Adhesive Adhesive –Non – adhesiveNon – adhesive


SKIN TRACTIONSKIN TRACTION

Traction force is applied over a large Traction force is applied over a large area of skin area of skin

Applied over limb just proximal to Applied over limb just proximal to fracture site fracture site

““Coning effect”Coning effect”



Adhesive skin traction:Adhesive skin traction: – Maximum weight 15 lb or 6.7 kg Maximum weight 15 lb or 6.7 kg

Non-adhesive skin tractionNon-adhesive skin traction – Maximum weight should not exceed 10 Maximum weight should not exceed 10

lb or 4.5 kglb or 4.5 kg– thin and atrophic skin,thin and atrophic skin,– skin sensitive to adhesive strapping,skin sensitive to adhesive strapping,



COMPLICATIONSCOMPLICATIONS Allergic reactions to adhesives.Allergic reactions to adhesives. Excoriation of skin.Excoriation of skin. Pressure sores over bony prominences Pressure sores over bony prominences

and tendoachillis.and tendoachillis. Common peroneal nerve palsy.Common peroneal nerve palsy.


SKELETAL TRACTION SKELETAL TRACTION

pin or wire pin or wire more frequently used in lower limb more frequently used in lower limb

fractures fractures Should be reserved for those cases in Should be reserved for those cases in

which skin traction is contraindicated or which skin traction is contraindicated or insufficient insufficient


SKELETAL TRACTIONSKELETAL TRACTION

SITESSITES– OlecranonOlecranon– MetacarpalMetacarpal– Upper end femur Upper end femur – Lower end of femurLower end of femur– Upper end of tibiaUpper end of tibia– Lower end of tibiaLower end of tibia– calcaneuscalcaneus


SKELETAL TRACTIONSKELETAL TRACTION

COMPLICATIONSCOMPLICATIONS InfectionInfection Cut outCut out Application of splint difficultApplication of splint difficult Distraction at fracture siteDistraction at fracture site Ligament damageLigament damage Physeal damagePhyseal damage Depressed scarsDepressed scars


HAMILTON RUSSEL TRACTION HAMILTON RUSSEL TRACTION

Below knee skin traction is applied Below knee skin traction is applied A broad soft sling is placed under the A broad soft sling is placed under the

knee knee Both the cord one of knee sling and Both the cord one of knee sling and

other of b/k skin traction are attached other of b/k skin traction are attached through a system of pulleys to suspend through a system of pulleys to suspend single weight single weight


HAMILTON RUSSEL TRACTION HAMILTON RUSSEL TRACTION

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


NINETY / NINETY TRACTION NINETY / NINETY TRACTION

Used for sub trochanteric fractures and Used for sub trochanteric fractures and those in the proximal third of the shaft those in the proximal third of the shaft of the femur of the femur

Management of fractures with posterior Management of fractures with posterior wound is easier wound is easier

Traction is given through lower femoral Traction is given through lower femoral pin, which is more efficient, or by upper pin, which is more efficient, or by upper tibial pin.tibial pin.


NINETY / NINETY TRACTION NINETY / NINETY TRACTION

Complications of 90/90 tractionComplications of 90/90 traction::– those related with skeletal traction.those related with skeletal traction.– Stiffness and loss of extension of knee.Stiffness and loss of extension of knee.– Flexion contracture of hip.Flexion contracture of hip.– Injury to epiphyseal plate in children.Injury to epiphyseal plate in children.– Neurovascular damage Neurovascular damage


SLIDING TRACTION WITH A SLIDING TRACTION WITH A THOMAS’S SPLINT AND KNEE THOMAS’S SPLINT AND KNEE FLEXION PIECE FLEXION PIECE fracture of femur fracture of femur Knee flexion piece allows easier Knee flexion piece allows easier

mobilization of the knee mobilization of the knee Always keep the hinge at the level of Always keep the hinge at the level of

addutor tubercle.addutor tubercle. Keep the knee flexed at about 20- 30 Keep the knee flexed at about 20- 30

degree degree


SLIDING TRACTION WITH SLIDING TRACTION WITH BOHLER BROWN SPLINT: BOHLER BROWN SPLINT:

Used for the fracture of tibia or femur.Used for the fracture of tibia or femur. Skeletal traction is usually applied, but Skeletal traction is usually applied, but

skin traction can be given b/k.skin traction can be given b/k.


BRYANT’S (GALLOW’S ) BRYANT’S (GALLOW’S ) TRACTION TRACTION

the treatment of fracture shaft femur in the treatment of fracture shaft femur in children up to age of 2 yrs.children up to age of 2 yrs.

Weight of child should be less than 15- Weight of child should be less than 15- 18 kg18 kg

Above knee skin traction is applied Above knee skin traction is applied bilaterally bilaterally

Tie the traction to the over haed beam Tie the traction to the over haed beam


BRYANT’S (GALLOW’S ) BRYANT’S (GALLOW’S ) TRACTION TRACTION


MODIFIED BRYANT’S MODIFIED BRYANT’S TRACTION TRACTION Sometimes used as a initial management Sometimes used as a initial management

of developmental dysplasia of hip (1 YR)of developmental dysplasia of hip (1 YR) After 5 days of Bryant’s traction, abduction After 5 days of Bryant’s traction, abduction

of both hips is begun increased by about of both hips is begun increased by about 10 degree alternate days.10 degree alternate days.

By three weeks hips should be fully By three weeks hips should be fully abducted.abducted.


LATERAL UPPER FEMORAL LATERAL UPPER FEMORAL TRACTION TRACTION

For the management of central fracture For the management of central fracture dislocation of the hip dislocation of the hip

about 2.5 cm from most prominent part about 2.5 cm from most prominent part of greater trochanter mid way between of greater trochanter mid way between ant. And post. surface of femur ant. And post. surface of femur

threaded screw eye threaded screw eye Traction to continued for about 4-6 wks Traction to continued for about 4-6 wks


PELVIC TRACTION PELVIC TRACTION special canvas harness is buckled around the special canvas harness is buckled around the

patient's pelvis patient's pelvis Long cords or straps attached to the harness Long cords or straps attached to the harness

to the foot of the bed to the foot of the bed Used for conservative management of PIVD Used for conservative management of PIVD


CERVICAL TRACTIONS CERVICAL TRACTIONS

Halter tractionHalter traction Crutchfield tongsCrutchfield tongs Cone or Barton Cone or Barton

tongstongs


CERVICAL TRACTIONSCERVICAL TRACTIONS

LEVELLEVEL MAX. WTMAX. WT

C2C2 4.5-5.4 Kg 4.5-5.4 Kg

C3C3 4.5-6.7Kg 4.5-6.7Kg

C4C4 6.7-9.0Kg 6.7-9.0Kg

C5C5 9.0-11.3Kg 9.0-11.3Kg

C6C6 9.0-13.5Kg 9.0-13.5Kg

C7C7 11.3-15.8Kg 11.3-15.8Kg


DUNLOP TRACTION DUNLOP TRACTION

T/t of supracondylar & transcondylar T/t of supracondylar & transcondylar fracture of humerus fracture of humerus

Useful when flexion of elbow causes Useful when flexion of elbow causes circulatory embarrassment with loss of circulatory embarrassment with loss of radial pulse radial pulse

Apply skin traction to forearmApply skin traction to forearm Abduct shoulder about 45 degree Abduct shoulder about 45 degree the elbow is flexed 45 degree. the elbow is flexed 45 degree.


Dunlop TractionDunlop Traction


CHARNLEY’S TRACTION CHARNLEY’S TRACTION UNITUNIT BK POP incorporating the Steinmann or Denham BK POP incorporating the Steinmann or Denham

pin pin Common peroneal nerve and calf muscles Common peroneal nerve and calf muscles

protected protected External rotation of the foot and distal fragments is External rotation of the foot and distal fragments is

controlled controlled 1.1. The tendo achilles is protected from pressure sores The tendo achilles is protected from pressure sores 2.2. Ipsilateral tibia # can be managedIpsilateral tibia # can be managed


SPLINTSSPLINTS

An appliance, either rigid or flexible, An appliance, either rigid or flexible, used to hold in position a displaced or used to hold in position a displaced or movable part or to keep in place and movable part or to keep in place and protect an injured part. protect an injured part.

Splints support and protect injured Splints support and protect injured bones and soft tissuebones and soft tissue

reduces pain, swelling, and muscle reduces pain, swelling, and muscle spasm.spasm.


airplane s.airplane s. a static orthosis that holds the a static orthosis that holds the upper limb in abduction at the level of the upper limb in abduction at the level of the shoulder; used following burns in the axillary shoulder; used following burns in the axillary region and for short periods following surgery region and for short periods following surgery to the shoulder or brachial plexus. to the shoulder or brachial plexus.

banjo traction s.banjo traction s. a dynamic orthosis to aid a dynamic orthosis to aid extension of the fingers using a banjo-extension of the fingers using a banjo-shaped steel bar attached to the fingers with shaped steel bar attached to the fingers with rubber bands and plastic rings.rubber bands and plastic rings.


Cramer's s.Cramer's s. a flexible wire splint a flexible wire splint consisting of parallel stout wires consisting of parallel stout wires between which smaller wires are between which smaller wires are stretched like the rungs of a ladderstretched like the rungs of a ladder

Coaptation s.’sCoaptation s.’s small splints adjusted small splints adjusted about a fractured limb for the purpose about a fractured limb for the purpose of producing coaptation of fragmentsof producing coaptation of fragments


Liston's s.Liston's s. a simple straight splint, often a simple straight splint, often made of wood with padding, for fracture of made of wood with padding, for fracture of the femur; it is adapted to the side of the the femur; it is adapted to the side of the body and lower limb. body and lower limb.

Thomas s.Thomas s. a knee-ankle-foot orthosis a knee-ankle-foot orthosis consisting of two rigid rods attached to an consisting of two rigid rods attached to an ovoid ring that fits around the thigh; used in ovoid ring that fits around the thigh; used in emergencies or for transporting patients, or emergencies or for transporting patients, or combined with other apparatus to provide combined with other apparatus to provide traction.traction.


Keller-Blake s.Keller-Blake s. a hinged half-ring a hinged half-ring modification of the Thomas splint for modification of the Thomas splint for fracture of the femurfracture of the femur

Denis Browne s.Denis Browne s. a splint consisting of a splint consisting of a pair of metal foot splints joined by a a pair of metal foot splints joined by a cross bar; used in talipes equinovarus.cross bar; used in talipes equinovarus.

Traction

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