traction upper n lower ext.pptx

8/14/2019 traction upper n lower ext.pptx

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UPPER AND LOWER EXTREMITY TRACTION IN ORTHOPAEDIC

Orthopaedic and Traumatology Departement Textbook ReadingJuly 2013

Presented By

Ahmad Ramdhani Amir

Mahafendy S. Tukan

Nur Afeeza

Emil Kardani

Henry Liemer Wijaya

Advisor

Dr. Hendrian ChaniagoDr. Harianto Simbolon

Dr. Luthfi Muammar

SUpervisor

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY

MAKASSAR

2013


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Introduction

Inflamation of the joint or fractured bone cancause painful limb thus can result muscle spasm

Purpose of traction is

To relive pain and allow the limb to be rested

To immobilize a joint or part of the body

To prevent or reduce muscle spasm

Stewart, JDM. Hallet, JP. Traction and Orthopaedic

Appliances. 2nded. London : Churchill Livingstone


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Methods of Applying Traction

SkinTraction Skeletal

Traction


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SKIN TRACTION


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Skin Traction

The force is applied over the large area of skin

Load spreading, more comfortable and efficient

The traction force must be applied to the limb

distal to the fracture site, otherwise the efficiencyof the traction force is reduced




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Skin Traction

Adhesive

Strapping can only stretchedtransversely

Limited force max.15 lb

(6.7kg)

Elastoplast Skin Traction Kit,Tractac, Seton Skin TractionKit, Orthotrac, and Skin-Trac

Non adhesive

The grip is less secure

Frequent reapplications maybe necessary

Limited force max.10 lb(4.5kg)

Ventfoam Skin TractionBandage, Specialist Foam

Traction, and Notac Trantion


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Skin Traction

Adhesive Non adhesive


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Bucks Traction

Often used

preoperatively forfemoral fractures

Can use tape or pre-

made boot

No more than 10 lbs Not used to obtain or

hold reduction

Brooker AF, Schmeisser G. Orthopaedic Traction

Manual. 1980. London: Williams & Wilkins


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Contraindications

Impairment of circulation

Dermatitis

Abrasions of the skin

Laceration of the skin in the area to which thetraction to be applied




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Complications

Excoriating of the skin from slipping of theadhesive strapping

Common peroneal nerve palsy

Pressure sores around the malleoli and over thetendocalcaneus

Allergic reaction to adhesive




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SKELETAL TRACTION


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Skeletal Traction

A metal pin or wire is driven through the bone inskeletal traction

Freaquently used in the management of lower

limb fractures




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Types of pin used

Types of pin Discription

Steinmann pin Rigid stainless pins of varying lenghts, 4-6mm in diameter

Bohler stirrup is applied so that the direction of the traction

to be varied without turning the pin in the bone

Denham pin Identical to a Steinmann pin except for a short raised

threaded length situated toward the end held in the

introducer

The threaded length engage the bony cortex and reduces

the risk of the pin sliding

Suitable for use in cancellous bone (eg. Calcaneus ,

osteoporotic bone)

Kirschner wire Small diameter

Insufficiently rigid until pulled taut in a special stirrup

Rotation of the stirrup is impared to the wire

The wire easily cuts out of the bone if the heavy traction

weight is applied




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Bohler stirrup with Steinmann

pin

Denham pin

Kirschner wire strainer


Appliances. 2

nd

ed. London : Churchill Livingstone


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Common sites for applicationofskeletal traction

OLECRANON

Just deep to thesubcutaneous border ofthe upper end of theulna, 1 inches (3,0cm) distal to the tip ofthe olecranon

Avoid elbow joint

Drive the Kirschner wirefrom medial to lateral atright angles to thelongitudinal axis of theulna

Avoid the ulnar nerve.

Position for K-wire in olecranon




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SECOND AND THRID

METACARPALS

The point of insertionof the Kirschner wireis s -1 inch (2,0 -2,5cm) proximal tothe distal end of thesecond metacarpal

The wire traversesthe second and thethird metacarpaltransversely to lie at

right angles to thelongitudinal axis of

Position for K-wire in second and

third metacarpal

Brooker AF, Schmeisser G. Orthopaedic TractionManual. 1980. London: Williams & Wilkins

C it f li ti f


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Upper end of femur

greater trochenter

The lateral surface of

the femur, 1 inch (2,5

cm) below the mostprominent part of the

greater trochanter,

mid-way between the

anterior and posteriorsurface of the femur.

Position for screw eye in upper

end of femur for lateral femoral

traction




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LOWER END OF FEMUR

Predisposes to knee stiffness from fibrosis in the extensor

mechanism of the knee

Steinmann pin through the lower end of the femur must be removed

after two to three weeks and be replaced by one through the upper

end of tibia

UPPER END OF TIBIA

The point insertion is inch (2,0 cm) behind the crest, just below the

level of tubercle of the tibia

The pin should be driven from the lateral to the medial side of the

limb to avoid damage to the common peroneal nerveStewart, JDM. Hallet, JP. Traction and

Orthopaedic Appliances. 2nded. London :

Churchill Livingstone


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Position for Steinmann pin inlower end of femur and upper

end of tibia


Appliances. 2nd



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LOWER END OF TIBIA

The point of insertion is 2 inches (5,0 cm) above the

level of the ankle joint, midway between the posterior

and anterior borders of the tibia

CALCANEUS

The point insertion is inch (2,0 cm) below and

behind th lateral malleolus. (as the lateral malleolus

lies inch more posterior and distal than the medialmalleolus, the above point correspondens with that

1 inches below and behind the malleolus. Care

must be taken to avoid entering the subtalar joinStewart, JDM. Hallet, JP. Traction and Orthopaedic

Appliances. 2nd



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Position for Steinmann pin in lower end of tibia and

calcaneusStewart, JDM. Hallet, JP. Traction and Orthopaedic

Appliances. 2nd



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The limb must be held in the same

degree of lateral rotation as thenormal limb; the Steinmann pin

lies horizontally

The steinmann pin is inserted at right

angles to the longitudinal axis of thelimb




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Complications

1. Introduction of infection into bone

2. Incorrect placement of the pin or wire may

- Allow the pin or wire to cut out of the bone

causing pain and the failure of the traction system

- Make control of rotation of the limb difficult

- Make the application of splint difficult


Appliances. 2nd



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Complications

3. Distraction at the fracture site as very largetraction force can be applied through skeletal

traction

4. Ligamentous damage if a large traction force is

applied through a joint for a prolonged period oftime

5. Damage to epiphyseal growth plate when use in

children

6. Depressed scar


Appliances. 2nd



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UPPER EXTREMITY TRACTION


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Upper Extremity Traction

Can treat most fractures

Requires bed rest

Usually reserved for comatose or multiply injured

patient or settings where surgery can not be done


Appliances. 2nd



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Forearm Skin Traction

Adhesive strip with Ace

wrap

Useful for elevation inany injury

Can treat difficult

clavicle fractures with

excellent cosmetic result Risk is skin loss




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Double Skin Traction

Used for greater

tuberosity or prox

humeral shaft fx Arm abducted 30

degrees

Elbow flexed 90 degrees

7-10 lbs on forearm 5-7 lbs on arm

Risk of ischemia at

antecubital fossaBrooker AF, Schmeisser G. Orthopaedic Traction



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Dunlops Traction

Used for supracondylar

and transcondylar

fractures in children Used when closed

reduction difficult or

traumatic

Forearm skin tractionwith weight on upper

arm

Elbow flexed 45 degreesBrooker AF, Schmeisser G. Orthopaedic Traction



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LOWER EXTREMITY TRACTION

LOWER EXTREMITY


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LOWER EXTREMITY

TRACTION

Can be used to treat most lower extremityfractures of the long bones

Requires bed rest

Used when surgery can not be done for one

reason or another

Uses skin and skeletal traction


Appliances. 2nd



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Upper Femoral Traction

Several traction options

for acetabular fractures

Lateral traction for

fractures with medial or

anterior force

Stretched capsule and

ligamentum may reduce

acetabular fragments




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Split Russells Traction

Bucks with sling

May be used in more

distal femur fx in

children

Can be modified to hip

and knee exerciser




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Bryants Traction

Useful for treatment

femoral shaft fx in infant

or small child

Combines gallows

traction and Bucks

traction

Raise mattress for

countertraction

Rarely, if ever used

currently Brooker AF, Schmeisser G. Orthopaedic Traction



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90-90 Traction

Useful for subtroch and

proximal 3rdfemur

fracture

Especially in young

children

Matches flexion of

proximal fragment

Can cause flexion

contracture in adultBrooker AF, Schmeisser G. Orthopaedic Traction



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Femoral Traction Pin

Must avoid suprapatellar

pouch, NV structures, and

growth plate in children

Place just proximal to

adductor tubercle along

midcoronal plane

At level proximal pole

patella in extended

positionBrooker AF, Schmeisser G. Orthopaedic Traction



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Distal Femoral Traction

Alignment of traction

along axis of femur

Used for superior force

acetabular fx and

femoral shaft fx

Used when strong force

needed or kneepathology present




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THANK YOU

traction upper n lower ext.pptx

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