Download - Traction New
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TRACTION & SPLINTS
DR. ASHISH GOHIYAASST. 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
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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
• Non-adhesive skin traction – Maximum weight should not exceed 10 lb or
4.5 kg– thin and atrophic skin,– skin sensitive to adhesive strapping,
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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.
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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
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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
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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.
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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
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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 15- 18 kg
• Above knee skin traction is applied bilaterally
• Tie the traction to the over haed beam
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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.
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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
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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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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.
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CHARNLEY’S TRACTION UNIT• 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 1. The tendo achilles is protected from pressure sores 2. 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.
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• 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 banjo-shaped 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
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• 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.