Splints and tractions in orthopedics

overall review of splints and tractions in orthopedics.

1. SPLINTS AND TRACTIONS IN ORTHOPEDICS MODERATORS :- Dr.J.Venkateshwarlu(Professor & HOD) Dr.K.Kishore Kumar ( Associate Professor) Dr.K.Ram Mohan (Assistant Professor) Dr.Sirish (Assistant Professor) - Presented by Dr.P.GAYATRI

2. 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.

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

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

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

6. 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

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 ● Devised by Hugh. Owen Thomas. ● Initially used for immobilisation for tuberculosis of the knee.

10. PARTS OF 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. BOHLER – BRAUN SPLINT • Proximal pulley to prevent foot drop. • 2nd pulley- traction in line with the femur. • 3rd Pulley- traction in line for traction in line with the leg.

12. BOHLER BRAUN SPLINT - ADVANTAGES • Traction unit is self contained.. • 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

13. DENNIS BROWN SPLINT Used in the treatment of club foot.

14. COCK-UP SPLINT Wrist splint. Used in the injuries around wrist such as : Distal radial & ulnar fractures Wrist drop Carpal tunnel syndrome.

15. ALUMINIUM FINGER SPLINT Used in the treatment of mallet finger

16. VOLKMANN’S SPLINT Used in the treatment of Volkmann’s ischemic contracture.

17. AEROPLANE SPLINT Used in Brachial plexus injury

18. SOMI BRACE Sternal -occipital- mandibular -immobilizer brace. Used in atlanto -axial instability caused by rheumatoid arthritis.

19. LUMBAR CORSET Used in the treatment of Lower back pain Immobilisation after lumbar laminectomy .

20. ASH BRACE Anterior spinal hyperextension brace. Flexion immobilisation to treat thoracicand vertebral lumbar body fractures T6 – L1 Reduction of kyphosis in patients with osteoporosis.

21. MILWAUKEE BRACE Used in scoliosis

22. TAYLOR’S BRACE Commonly used for osteoporosis , degenerative spine disease.

23. CARE OF A 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

24. PRE-POST CHECKS WITH SPLINTS - FACTS • F unction • A rterial pulsations • C apillary refill • T emperature • S ensations

25. TRACTIONS Traction is a method of restoring alignment to a fracture through gradual neutralisation of muscular forces. Traction is pulling effect exerted on a part of skeletal system. Involves use of weights connected to patient with ropes, pulleys, slings, etc.

26. OBJECTIVES OF TRACTION • Reduction of fracture/ dislocation • Reduce/ relieve pain • Immobilisation of painful joint • Prevention of deformity, counteracting muscle spasm • Correction of small defects.

27. 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.

28. TYPES OF TRACTION FIXED TRACTION : Counter-traction is provided by a 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 under influence of gravity provides counter-traction. Eg : traction given for pelvic fracture, where weight of the body acts as counter traction , made effective by elevating the foot end of bed.

29. METHODS OF APPLYING TRACTION SKIN TRACTION SKELETAL TRACTION

30. SKIN TRACTION Traction is applied over large area of skin. Maximum weight that can be applied through skin traction is 6.7kg. If weight is applied more than this, traction will slide down peeling off the skin. Skin traction is applied to the limb distal to fracture site.

31. TYPES OF SKIN TRACTION ADHESIVE SKIN TRACTION : Adhesive material is used for strapping which is applied anteromedial & posterolateralon either side of lowerlimbs . NONADHESIVE SKIN TRACTION : Useful in thin & atrophic skin & in pts sensitive to adhesive strap.

32. IMPORTANT SKIN TRACTIONS BUCK’S EXTENSION : Commonest type of skin tractions applied to the lower limb. USES : • Temporary treatment of fracture neck of femur • Undisplaced fracture of acetabulam • After reduction of hip dislocation.

33. DUNLOP’S TRACTION In upper limbs Indicated for supracondylar fractures, intercondylar fractures of humerus where elbow flexion causes circulatory embarrassement

34. 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.

35. SKIN TRACTION CONTRAINDICATIONS OF SKIN TRACTION • Patients with loose skin • Wounds on the limb • Circulation problem- gangrene/ varicose veins • Skin infection COMPLICATIONS OF SKIN TRACTION Allergy Muscular atrophy Paralysis Oedema

36. 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.

37. PINS USED FOR SKELETAL TRACTION STEINMANN’S PIN Stainless steel rod 3-6mm diameter Upper end of tibia, supracondylar region of femur & calcaneum .

38. PINS USED FOR SKELETAL TRACTION DENHAM’S PIN Threaded in the centre & engages the bony cortex. Useful in cancellous bone like calcaneum .

39. PINS USED FOR SKELETAL TRACTION K – WIRE Smith traction given by passing k-wire through olecranon in supracondylar fracture.

40. 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 injury to lateral popliteal nerve. ● Pin should be at right angles to the limb & parallel to ground. ● For femur 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.

41. ADVANTAGES OF APPLYING 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.

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

43. COMPLICATIONS OF TRACTION Circulatory embarrassment Nerve & vessel injury Pin site- infection,migration,breakage , bending. Injury to epiphysis in children. Pressure sores.

44. DAILY CARE OF A PATIENT 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 shows tight bandage or slipped skin traction. Proper positioning of the fracture should be ensured by check x-rays. Physiotherapy of limb should be continued to minimise muscle wasting.