SPLINTS AND TRACTIONS IN ORTHOPAEDICS

SPLINTS ANY MATERIAL USED TO SUPPORT A

FRACTURE

UNCONVENTIONAL-CRUDE,TEMPORARY & USED AS A FIRST AID MEASURE.EX:WOOD,BOARD

CONVENTIONAL-REFINED & SOPHISTICATED,SERVE BOTH AS FIRST AID & DEFINITIVE MEASURE.EX:POP SPLINT,THOMAS SPLINT.

PLASTER OF PARIS SPLINTS

PLASTER OF PARISSEMI HYDRATED CALCIUM SULPHATE.

COMMERCIAL POP ROLLS-ROLLS OF MUSLIN STIFFENED BY STARCH,POP POWDER & AN ACCLERATOR SUBSTANCE LIKE ALUM

POP-AN IDEAL SPLINT

Cheap,easily available,comfortable Easy to mould,quick setting Strong & light Easy to remove Permeable to radiography Permeable to air,hence underlying

skin can breath Non-inflammable

VARIOUS FORMS OF POP

4 forms-SlabCastSpicaFunctional cast brace

SLAB

Temporary splintUSES Initial stages of fracture treatment &

during first aid Immobilise the limb postoperatively &

in infections

It is made up of half by pop & half by bandage roll,hence can accommodate the

Swelling in the initial stages of fracture

Slab is prepared acc to the required length

3 methods of applying a slab

Dry method-slab prepared first & dipped in water

Wet method-slab is prepared after diping the pop roll in water

Pattern method-slabs are fashioned in desired way before dipping it in water

CASTS

Pop roll completely encircles the limbDefinitive form of fracture treatment

& corrects deformities

3 methods Skin tight cast-cast is directly applied

over the skin.can cause pressure sores.dificult to remove as hair may be incorporated into the cast.

Bologna cast-cotton padding is applied to the limb before putting the cast

Three tier cast-stockinette is used first over which cotton padding is done before applying the pop cast.

SPICA

It encircles a part of the body

Eg:hip spica,thumb spica

FUNCTIONAL CAST BRACE Its based on the principle that If function is

allowed during closed method of fracture treatment,it stimulates osteogenesis,promotes soft tissue healing & prevents development of joint stiffness & rehabilitation

Mode of action-hydraulic action of muscle is brought to play.fracture brace allows movements of the joints & permits the load

To be transmitted to the muscle. The muscles which are surrounded by inelastic deep fascia if encased in a hard plaster cannot be stretched beyond the confines of cast. On movements & bearing weight,muscle forces are hence driven inward towards the fracture. This helps the fracture to be held firmly.

Technique consists of applying an external splint to fractured limb.

RULES OF APPLICATION OF POP CASTS

Correct size-8in for thigh,6in for leg,4in for forearm

Joint above & joint below should be included

Should be moulded with palm & not with fingers for fear of indentation.

Joint should be immobilised in functional position.

Plaster should be just fit & should not be too tight or too loose.

Uniform thickness of plaster is preferred.

STAGES OF PLASTERINGApplication of pop slabCast setting stage-change of pop to

gypsum.time takento form a rigid dressing after contact with water

Set wet castCast drying by evaporation of excess

water

Complications of POP

Due to tight fit Pain Pressure sore Compartment syndrome Peripheral nerve injuries Cast syndrome

Due to improper application Joint stiffness

Plaster blisters & sores BreakageDue to plaster allergy Allergic dermatitis

Cast disease manifested as muscle atrophy,osteoporosis,joint stiffness,muscle weakness,skin breakdown,compartment syndrome,blister formation.

THOMAS SPLINT

Parts A padded metal oval ring with soft leather

set at an angle 120 to the inner bar 2 side bars-one inner & other outer bar of

unequal length. They bisect the oval ring. The outer bar longer than inner bar

Distal end-2 side bar joined in the form of W.

Outer side bar is angled 2in below the padded ring to clear the prominent greater trochanter

USES

Immobilise fracture femur

First aid

Transportation of injured patient

In the treatment of joint diseases like TB knee

length of splint-measurement from the highest point on the medial side of the groin toheel plus 6in.

BOHLER-BRAUN SPLINT

Bohler’s modification of braun splint Consists of heavy metallic frame

with 3 pulleysProximal pulley prevents foot dropSecond pulley to apply traction in

the line of femurThird pulley to apply traction in the

line of supracondylar area

BB SPLINT

USES

Communited trochantric fracture of femur

Fracture shaft of femur & supracondylar fracture of femur

Fracture shaft of tibia & fibula

PROBLEMS OF BB SPLINT

Makes nursing care difficult

Heavy frame

Associated with recumbant problems like bed sores,pneumonia,renal calculi

CRAMER WIRE SPLINT

Temporary splintage of fracture during transportation

It is made up of thick parallel wires made up of interlacing wires

It can be bent into different shapes in ordr to immobilise different parts of body

CARE OF SPLINTS

Padding-well padded at the bony prominences & at the injury sites

Bandage-should be tied with optimum pressure

Exercises-active exercises of the joints & muscles should be permitted within the splints

Daily checking & adjustments of splints are recommended

Neurovascular status-distal neurovascular status should be assessed daily

COMMON SPLINTS IN ORTHOPAEDICS

Cervical spineSOMI BRACE4 post collar

Upper limbAeroplane splint-brachial plexus

injuryCock up splint-radial n palsyKnuckle bender splint-ulnar n palsy

SpineMilwaukee brace-scoliosisBoston braceLumbar belts & corsets-backache

Lower limbThomas splint,BB splintFootdrop splint

COCK UP SPLINT

MILWAUKEE

TRACTIONS IN ORTHOPAEDICS

Tractions play an important role in the management of fractures in orthopaedics.

USESTo reduce fracture or dislocationTo retain fracture after reductionTo overcome muscle spasmTo control movement of injured part

of body & to aid in healing

METHODS OF APPLYING TRACTIONS

TRACTION BY GRAVITY

Applies only to upper limb.

With a wrist sling weight of arm provides continuous traction to humerus

SKIN TRACTION

Traction is applied over large area of skin.

Maximum weight that can be applied through skin traction is 5kg.

If weight is applied more than this,traction will slide down peeling off the skin.

Skin traction is applied to the limb distal to the fracture site

TYPES OF SKIN TRACTION

Adhesive skin traction Adhesive material is used for

strapping which is applied anteromedial & posterolateral on either side of lowerlimbs.

Nonadhesive skin traction Useful in thin & atrophic skin & in pts

sensitive to adhesive strap.

IMPORTANT SKIN TRACTIONS

BUCK’S EXTENSION Commonest type of skin tractions

applied to the lower limb

USES• Temporary trtmt of fracture neck of

femur• Undisplaced fracture of acetabulam• After redn of hip dislocation

DUNLOP’S TRACTION

In upper limbs

Indicated for supracondylar fractures,intercondylar fractures of humerus where elbow flexion causes circulatory embarrassement

DUNLOP’S TRACTION

GALLOW’S TRACTION

Fracture shaft of femur in children less than 2yrs

Legs of the child are tied to overhead beam. Hips are kept a little raised from bed so that weight of the body provides counter traction & fracture is reduced.

SKELETAL TRACTION

Traction is given through a metal or pin driven through bone.

Reserved for cases where skin traction is contraindicated & where applied weight needed is more than 5kg.

SKELETAL TRACTION

PINS USED FOR SKELETAL TRACTION

STEINMANN’S PIN Stainless steel rod 3-6mm dia Upper end of tibia,supracondylar

region of femur & calcaneum.

DENHAM’S PIN Threaded in the centre & engeges

the bony cortex Useful in cancellous bone like

calcaneum

K-WIRE Smith traction given by passing k-

wire through olecranon in supracondylar fracture

STEINMANN’S PIN WITH BOHLER’S STIRRUP

DENHAM’S PIN

TYPES OF TRACTION

FIXED TRACTION Pull is exerted against the fixed

point. Counter traction is applied by part of

the body Eg:thomas splint-ring of the splint

lies against the ischial tuberosity & povides counter traction

SLIDING TRACTION Weight of the body acts as counter

traction

Eg:traction given for pelvic fracture,where weight o body acts as counter traction.made effective by elevating the foot end of bed.

RULES FOR APPLYING SKELETAL TRACTION

Applied under anaesthesia Aseptic precautions Drive the pin from lateral to medial

side in case of upper tibial traction, to avoid injurig lateral popliteal nerve.

Pin shold be at right angles to the limb & parallel to ground

For femural shaft fracture, initial weight required is 10% of patient’s body weight.

For every 1lb of weight,end of bed should be raised by 1in.

DAILY CARE OF A PT IN TRACTION

Proper functioning of traction unit to be ensured.traction weights should not be touching the ground.

Check the terminal part of the limb-its colour,warmth,sensations.

Any swelling of the fingers showstight bandage or slipped skin traction.

Proper positioning of the fracture should be ensured by check xrays

COMPLICATIONS OF TRACTION

Circulatory embarrassment Nerve & vessel injury Pin site-

infection,migration,breakage, bending.

Injury to epiphysis in children c/c osteomyelitis

Common tractions

Head or cervical tractionHead –halterHalopelvic

Upper limbDunlop’sMetacarpal

Lower limbGallow’sRussel’sBuck’spelvic

RUSSEL’S TRACTION