Splints and Tractions

Basics about splints and traction application for medical graduates

1. Mechanical Immobilisation Devices SPLINTS and TRACTIONS Surgeon Rear Admiral Pavan Sarin , NM ( Retd ) Professor Orthopaedics North DMC Medical College

2. WHAT ARE SPLINTS? Devices that immobilize and protect an injured limb or spine Can be of any rigid material- POP, plastic or metal Usually along with some padding to make it comfortable They are used before or instead of casts or traction .

3. INDICATIONS OF SPLINTS Fractures, sprains and dislocations Joint infections Acute arthritis/ gout Acute tenosynovitis

4. CONTRAINDICATIONS OF SPLINTS Compartment syndrome Need for open reduction Infected skin condition or when there is a high risk of infection

5. SPLINTING MATERIALS Plaster Crammer wire splints Fibreglass Pre-fabricated splints Air splints Vacuum splints

6. POP Calcium sulphate dehydrate When wet it crystallises Exothermic reaction Average setting time- 3 to 9 minutes Average drying time: 24-72 hrs

7. POP Advantages Easier to mold Less expensive Disadvantages More difficult to apply Gets soggy and soft when it gets wet

8. CRAMMER WIRE SPLINT Used for temporary quick splintage of a limb for transport Two thick parallel wires with ladder like thin wires Malleable, can easily be bent to the contour of limb

9. THOMAS SPLINT Hugh Owen Thomas- Father of Orthopedics Father not a trained physician (bone setter), was taken to court to defend his practice 3 times Sent to train all the five sons An eccentric and temperamental man- i njured people to treat them? Would treat patients free on Sundays

10. THOMAS SPLINT Ring at an angle of 120 degrees Two side bars Outer bar bent to accommodate the greater trochanter Leg supported on slings tied to the side bars

11. THOMAS SPLINT WITH TRACTION

12. BOHLER BRAUN SPLINT- 3 Pulleys Proximal pulley to prevent foot drop 2 nd pulley- traction in line with the femur 3 rd Pulley- traction in line for traction in line with the leg

13. BOHLER BRAUN SPLINT- Advantages Traction unit is self contained- easy tption Limb in comfortable position Angle of traction changeable Wound care possible Multipurpose application Simultaneous traction through Calcaneal/distal tibia and proximal tibia/distal femur possible

14. DENNIS BROWN SPLINT U sed in the treatment of club foot. Father of paediatric surgery in the UK.

15. COCK-UP SPLINT

16. AEROPLANE SPLINT

17. Sternal-Occipital-Mandibular Immobilizer (SOMI ) BRACE

18. LUMBAR CORSET

19. Air Splints- Inflatable Also called “pneumatic splints” Become rigid when filled with air Limit motion, control bleeding/swelling Injured part inserted into deflated splint Air infused and splint molds to injured body part Fill to point which allows indentation with fingertips Injury should be checked and treated within 30-45 minutes after application

20. Vacuum Splints O perate by extracting air from the splint T housands of polystyrene balls inside the splint mold around the injured body part similar to a cast. Advantages- Ability to provide support whilst relieving pressure at the injury site Ability to conform to any shape L imb may also be X-rayed with the splint in situ

21. CARE OF PATIENT ON SPLINT Padding on the fracture site Padding on bone prominences Active mobilisation of muscles and joints Watch out for effects of compression on nerves/ vessels Daily check and adjustments of weights Check pressure points and perineum for pressure points Care of back

22. Pre- Post Checks with Splints- FACTS F unction A rterial pulsations C apillary refill T emperature S ensations

23. MECHANICAL IMMOBILISATION DEVICES SPLITS The use of various devices can achieve therapeutic benefits TRACTIOINS Devices that immobilize by pulling on contracted muscles Not as easy to apply as splints May require special training for application to prevent further injury

24. TRACTIONS Traction is pulling effect exerted on a part of skeletal system. Involves use of weights connected to patient with ropes, pulleys, slings, etc.

25. OBJECTIVE of TRACTION Reduction of fracture/ dislocation Maintenance of “ Reduce/ relieve pain Immobilisation of painful joint Prevention of deformity, counteracting muscle spasm Correction of small defects

26. PRINCIPLES OF EFFECTIVE TRACTION Traction must produce a pulling effect on the body Counter traction must be maintained The traction and counter pull must be in the opposite directions Splints and slings must be suspended without interference Ropes must move freely through each pulley Precise amount of weight must be applied The weights must hang free

27. TYPES OF TRACTIONS Manual - Pulling on body using hands and strength Used frequently to replace dislocation Skin-Devices applied to skin such as pelvic belt, Buck’s/Russell’s traction Skeletal-Pulls directly on bone with wires, pins, tongs into bone

28. BUCKS TRACTION

29. ADVANTAGES OF TRACTION Regain normal length and alignment of involved bone. Relieves pain and muscle spasm Restricts movements while the injury heals Maintains functional position until the healing is complete Allows other activities Prevents further structural damage and deformity Relieves pressure on nerves ( esp spine) Prevent or reduce skeletal deformities or muscle contractures Provides a fusiform tamponade around a bleeding vessel

30. DISADVANTAGES OF TRACTION Costly in terms of hospital stay Hazards of prolonged bed rest Thromboembolism Decubitus ulcer Pnuemonia Require extensive nursing care

31. SKIN TRACTION Limited force can be applied - generally not to exceed 5 lbs More commonly used in pediatric patients Can cause soft tissue problems especially in elderly or rheumatoid patients Not as powerful when used during operative procedure for both length or rotational control

32. Contraindications for Skin Traction Patients with loose skin Wounds on the limb Circulation problem- gangrene/ varicose veins Skin infection

33. Complications of Skin Traction Allergy Muscular atrophy Paralysis Oedema

34. SKELETAL TRACTION More powerful than skin traction May pull up to 20% of body weight for the lower extremity Requires local anesthesia for pin insertion if patient is awake Preferred method of temporizing long bone, pelvic, and acetabular fractures until operative treatment can be performed

35. SKIN vs SKELETAL TRACTION Skin Traction Skeletal Traction Required for force Mild Moderate/ severe Age used Children Adults Applied with Adhesive tape Steinmann, K-wire Commonly Below knee Upper tibia Weight permitted 2-3 kg Up to 20 kgm Duration Short Long

36. TYPES of SKELATAL FIXATION Choice of thin wire vs. Steinman pin Thin wire is more difficult to insert with hand drill and requires a tension traction bow

37. SITES OF SKELETAL TRACTION

38. MODE OF SKELETAL TRACTIONS FIXED TRACTION Counter traction applied by the splint SLIDING TRACTION Wt of body acts counter traction

39. 90- 90 Traction

40. COMPLICATIONS OF SKELETAL TRACTION Pin/ wire tract infection Effects of prolonged pull on ligaments Pressure sores Difficulty in application of splints

41. SUMMARY SPLINTS Indications Contraindications Cramer wire Thomas splint BB splint Air/vacuum splints Care of patient with splint TRACTIONS Objective Principle Types of hold Sites of skeletal fixation Advantages Disadvantages Complications Fixed/ sliding