splints & tractions IN ORTHOAPAEDIC PRACTICE .pptx

splints & tractions IN ORTHOAPAEDIC PRACTICES ONLY FOR UG AMD P TEACHING PURPOSES

1. SPLINTS AND TRACTIONS Rangeen C handran

2. SPLINT Any material used to support a fracture is known as splint. Unconventional. Conventional.

3. INDICATIONS Temporary immobilization of sprains, fractures, and reduced dislocations Control of pain Prevention of further soft tissue or neurovascular injuries

4. CRAMER-WIRE SPLINT

5. CRAMER-WIRE SPLINT Ladder splint. Used for temporary splintage of fractures during transportation. Made of 2 thick parallel wires with interlacing wires. Can be bent into different shapes.

6. THOMAS KNEE-BED SPLINT Thomas splint. Devised by Hugh. Owen Thomas. Initially used for immobilisation for tuberculosis of the knee.

7. PARTS OF THOMAS SPLINT Consist of: Ring Medial bar Lateral bar

8. USE Immobilisation of lower limb

9. BOHLER BRAUN SPLINT

10. Bohler’s modification of braun splint. Consisted of only 1 pulley.

11. Bohler braun splint Pulley @a - calcaneal /distal tibial traction. Pulley @ b - distal femoral/proximal tibial traction Pulley @c - change angle of traction

12. ADVANTAGES Angle of traction can be changed without changing traction arrangements. Simultaneous tractions possible.

13. DISADVANTAGE Not suitable for transportation.

14. DENNIS BROWN SPLINT Use-Club foot(CTEV)

15. ALUMINIUM FINGER SPLINT

16. COCK-UP WRIST SPLINT

17. KNUCKLE BENDER SPLINT

18. VOLKMANN’S SPLINT

19. AEROPLANE SPLINT

20. SOMI BRACE

21. ASHE BRACE

22. TAYLOR’S BRACE

23. MILWAUKEE BRACE

24. BOSTON BRACE

25. CARE OF A PATIENT IN A SPLINT Splint should be properly applied, well padded at bony prominences and at the fracture sites Bandage of the splint shouldn’t be too tight nor too loose. Patient should be encouraged to actively exercise the muscles and the joints inside the splint as much as permitted. Any compression of nerve or vessel should be detected early and managed accordingly. Daily checking and adjustments should be made.

26. Orthopedist’s great "master tool“. Traction - the application of a force to stretch certain parts of the body in a specific direction No matter how complicated a fracture might appear to be, traction will most often times pull the fragments into alignment very nicely. WHAT IS TRACTION ?

27. OBJECTIVES

28. THOMAS SPLINT RUSSEL’S TRACTION

29. Skin traction Skeletal traction

30. A)Skin Traction Skin traction: An adhesive strap is applied on the skin and traction applied. The traction force is transmitted from the skin through the deep fascia and intermuscular septae to the bone. These days, readymade foam traction kits are available for this purpose. e.g . Lower limb traction with the leg pulled by holding the skin of the whole leg with adhesive plaster as in the following methods Thomas’ splint traction Gallows traction .

31. Skin traction(Bucks) :

32. B)Skeletal traction (Pin traction) Here the leg is pulled by a pin through the bone. Skeletal traction: The traction is applied directly on the bone by inserting a K-wire or Steinmann pin through the bone. Common types are : Upper tibial traction with Steinmann pin is applied by passing a Steinmann’s pin across the tibia ½” below the tibial tubercle . Lower femoral traction with Steinmann pin passed across the femur above the level of the condyles. Lower tibial / calcaneal traction Olecranon traction with K wire Skull traction

33. 2) Skeletal traction(UTPT)

34. Point Skin traction Skeletal traction Required for Mild to moderate force Moderate to severe force Age used for Children Adults Applied with Adhesive plaster Steinmann pin, K-wire Applied On skin Through bone Common site Below knee Upper tibial pin traction Weight permitted Up to 3-4 kg Up to 20 kg Used for Short duration Long duration Comparison between skin and skeletal tractions

35. PRINCIPLES OF TRACTION The methods of traction are based on two principles described below. 1)Fixed Traction: In this method, traction is applied to the leg against a fixed point of counter pressure. This is done by the use of Thomas splint. The ring of the splint is made to hitch against the ischial tuberosity which acts as the point of counter pressure in the perineum.

36. 2)Balanced/sliding Traction: In this method, while traction is applied to the leg to pull the distal fragment down ward, the counter traction is effected by the body weight itself. This is achieved by resting the leg on a Thomas or Bohler -Braun splint and raising the foot end of the bed. The leg is pulled either by skin traction or skeletal traction .

37. 2a. Russel’s Traction: This is a type of balanced traction where there is no splint. The leg is held off the bed with a sling at the knee level and resting on a pillow under the calf. With a compound system of pulleys and an overhead beam, below knee skin traction is applied and weights are hung at the end of the bed

38. Russell's traction This is a type of balanced traction where there is no splint. The leg is held off the bed with a sling at the knee level and resting on a pillow under the calf. With a compound system of pulleys and an overhead beam, below knee skin traction is applied and weights are hung at the end of the bed

39. If a Thomas’ splint is used, the tapes are tied to the end of the splint and the entire splint is then suspended, as in balanced traction. COMBINED TRACTION

40. DISADVANTAGES Prolonged hospital stay (costly) Prolonged bed stay and its complication Continuous nursing care Development of contracture

41. Traction systems and their uses Name Uses Gallow's traction Fracture shaft of the femur in children < 2 years Bryant's traction Fracture shaft of the femur in children < 2 years Russell's traction Trochanteric fractures Buck's traction Conventional skin traction Perkin's traction Fracture shaft of femur in adults 90°-90° traction Fracture shaft of femur in children Agnes-Hunt traction Correction of hip deformity Well-leg traction Correction of adduct or abduct deformity of hip

42. Traction systems and their uses Name Uses Dunlop traction Supracondylar fracture of humerus Smith's traction Supracondylar fracture of humerus Calcaneal traction Open fractures of ankle or leg Metacarpal traction Open forearm fractures Head-halter traction Cervical spine injuries Crutchfield traction Cervical spine injuries Halo-pelvic traction Scoliosis