Traction in Orthopaedic

Traction in Orthopaedic

1. Traction in O rthopaedics Dr. Sumit Pensia Resident orthopaedics JLNMC,Ajmer

2. Definition : traction is defined as force applied to overcome the deforming force origenated by muscle spasm Relive pain Aids in healing of bone and soft tissue

3. Types Based on method of application Skin traction Skeletal traction

4. Based on countertraction mechanism Fixed Traction By applying force against a fixed point of body proximal to attachments of musle in spasm. Sliding Traction By tilting bed so that patient tends to slide in opposite direction to traction force

5. Indications To reduce the fracture or dislocation To maintain the reduction To correct the deformity To reduce the muscle spasm

6. Advantages Decrease pain Minimize muscle spasms Reduces, aligns, and immobilizes fractures Reduce deformity Increase space between opposing surfaces

7. Disadvantages Needs more hospital stay Hazards of prolonged bed rest Thromboembolism Decubitius ulcers Pneumonia Requires meticulous nursing care Can develop contractures

8. 1.Skin traction Applied over a large area of skin This spreads the load and is more comfortable and efficient Traction force must be applied distal to fracture site Maximum traction weight can be applied with skin traction is 15lb ( 6.7kg )

9. Types of skin traction Adhesive skin traction Nonadhesive skin traction

10. A. Adhesive skin traction Elastoplast skin traction kit Tractac Seton skin traction kit Orthotrac Skin- trac

11. How to apply Prepare the skin by shaving as well as washing & applying tincture benzoin which protects the skin and acts as an additional adhesive. Avoid placing adhesive strapping over bony prominences, if not, cover them with cotton padding and do the strapping. Leave a loop of 5 cm projecting beyond the distal end of limb to allow movement of toes and foot . Max. traction weight can be 15lb(6.7kg)

12. B.Non adhesive skin traction Useful in thin and atrophic skin allergy to adhesive strapping Frequent reapplication may be necessary Attached traction wt. must not be more than 10lb ( 4.5kg )

13. Contraindications Abrasions of the skin Lacerations of the skin in the area to which traction is applied Impairment of circulation – varicose ulcers, impending gangrene Dermatitis Marked shortening of bony fragments, when traction weight is required will be greater than can be applied through the skin

14. Complications Allergic reaction to adhesive Excoriation of skin from stripping of the adhesive strapping

15. Complications Pressure sore around the malleoli and over the tendocalcaneus

16. Complications Common peroneal nerve palsy d ue to rotation and encircling bandage

17. Buck’s traction Used in temporary management of fractures of Femoral neck Femoral shaft in older children Undisplaced fractures of the acetabulum After reduction of a hip dislocation To correct minor flexed deformities of the hip or knee In place of pelvic traction in management of low back pain Weight not more than 4.5 kgs Elevate the foot end of bed

18. Hamilton Russell Traction Used in management of fractures of the femoral shaft Buck’s traction with sling under the knee

19. Bryants (Gallows) traction Convenient and satisfactory for the treatment of fractures of the shaft of femur in children upto age of two years who weight less than 35-40lb ( 15.9- 18.2kg )

20. Apply adhesive strapping to both lowerlimbs Tie the traction cords to an overhead beam Tighten the traction cords sufficiently to raise the buttocks just clear of the mattress Counter traction is obtained by the weight of the pelvis and lower trunk Check the vascular status of limbs because of danger of vascular compromise

21. How to check state of circulation Observe colour and temp. of both feet Passive dorsiflexion of ankle,it should be painless and full movement If dorsiflexion is limited or painful,muscle ischemia may be present Immediate lower the limb and remove bandage

22. Modified Bryant’s traction Sometimes used in initial management of congenital dislocation of hip After 5days of application of bryants traction abduction of both hips begun, being increased by 10 degrees on alternate days By 3 weeks hips should be fully abducted

23. Dunlop’s Traction Forearm skin traction with weight on upper arm Used for supracondylar and transcondylar fractures in children Used when closed reduction difficult Upper arm abducted 45 degree and Elbow is flexed 45 degrees

24. 2.Skeletal traction It should be reserved for those cases in which skin traction is contraindicated In patients with lacerated wounds In patients with external fixator in situ When the weight required for traction is more then 6.7 kgs - Obese patients

25. Steinmann Pin Rigid stainless steel pins of varying lengths 4 – 6 mm in diameter. Bohler stirrup is attached to steinmann pin which allows the direction of the traction to be varied without turning the pin in the bone

26. Denham Pin Identical to stienmann pin except for a short threaded length in the center . This threaded portion engages the bony cortex and reduce the risk of the pin sliding Used in cancellous bone like calcaneum and osteoporitic bones

27. Kirschner wire They are easy to insert and minimize the chance of soft tissue damage and infections It easily cuts out of the bone if a heavy traction weight is applied Most commonly used in upper limb eg . Olecranon traction

28. Proximal Tibial Traction Used for distal 2/3 rd femoral shaft fractures Easy to avoid joint and growth plate 2cm distal and posterior to tibial tubercle Pin should be driven from the lateral to the medial side to avoid damage to the common peroneal nerve.

29. Application of skeletal traction insertion of ST pin in lower limb Use GA or LA Shave the skin Use full aseptic precaution Paint the skin with iodine and spirit Mount the pin/wire on the hand drill Cont.

30. Hold the limb in same degree of lateral rotation as the normal limb and with ankle at right angles. Identify the site of insertion and make a stab wound Hold the pin horizontally at right angles to the long axis of the limb. Apply small cotton woolen pads soaked in tincture around the pins to seal the wound

31. Complications Introduction of infection into bone Distraction at fracture site Ligamentous damage Damage to epiphyseal growth plates Depressed scars

32. Lateral Upper Femoral Traction Lateral surface of femur 1 inch below the most prominent part of greater trochanter,mid way b/w ant & post surface of femur

33. Distal Femoral Traction Alignment of traction along axis of femur Used for femoral shaft fracture

34. Draw 1 st line from before backwards at the level of the upper pole of patella,2 nd line from below upwards anterior to the head of the fibula, where these two lines intersect is the point of insertion of a Steinmann pin Just proximal to lateral femoral condyle. In an average adult this point lies nearly 3 cm from the lateral knee joint line

35. Distal Tibial Traction Useful in certain tibial plateau fracture Pin inserted 5 cm above the level of the ankle joint, midway between the anterior and posterior borders of the tibia Avoid saphenous vein Maintain partial hip and knee flexion

36. Calcaneal Traction Temporary traction for tibial shaft fracture Insert about 1 1/4 inches (3cms ) inferior and posterior to medial malleolus or ¾ inch below behind lat.malleolus . Cure must be taken to avoid entering subtalar joint

37. Olecranon Pin Traction Supracondylar/distal humerus fractures Greater traction forces allowed Can make angular and rotational corrections Place pin 1.25 inches distal to tip Avoid ulnar nerve

38. Point of insertion: just deep to the SC border of the upper end of ulna (3cms) This avoids ulnar joint and also an open epiphysis Technique: Pass K-wire from medial to lateral side - pass the wire at right angles to the long axis of the ulna to avoid ulnar nerve .

39. Metacarpal Pin Traction Used for obtaining difficult reduction forearm/distal radius fracture Once reduction obtained, pins can be incorporated in cast Pin placed radial to ulnar through base 2 nd /3 rd MC Stiffness of intrinsics is common

40. Point of Insertion: 2-2.5 cms proximal to the distal end of 2nd metacarpal Technique: push the 1st dorsal interosseius and palpate the subcutaneous portion of the bone. Pass the K-wire at right angles to the longitudinal axis of the radius, the wire traversing 2nd and 3rd metacarpal diaphysis transversely.

41. Crutchfield Tong

42. Draw a line bisecting skull back to front Draw 2 nd line joining tips of mastoid process

43. Management of patients in traction Care of the patient Care of the traction suspension system Radiographic examination Physiotherapy Removal of traction

44. Care of the injured limb- Pain Parasthesia or Numbness Skin irritation Swelling Weakness of ankle, toe, wrist or finger movement

45. Radiographic Examination 2-3 times in first week Weekly for next 3 weeks Monthly until union occurs After each manipulation After each weight change

46. Removal Of Traction Elbow fracture with olecranon pin - 3 weeks Tibial fracture with calcaneal pin - 3-6 weeks Trochanteric fracture of femur - 6 weeks Femoral shaft fracture with application of cast brace and partial weight bearing - 6 weeks without external support and partial weight bearing - 12 weeks

47. THOMAS SPLINT WITH TRACTION

48. Uses of thomas splint Commonly used for immobilisation of hip and thigh injuries Immobilise fracture femur First aid Transportation of injured patient In the treatment of joint diseases like TB knee

49. Parts of thomas splint A padded metal oval ring with soft leather set at an angle 120 to the inner bar The ring size is found by addition of 2 inches to the thigh circumference at the highest point of the groin 2 side bars-one inner & other outer bar of unequal length. They bisect the oval ring. The outer bar longer than inner bar.

50. Outer side bar is angled 2 inch below the padded ring to clear the prominent greater trochanter Distal end-2 side bar joined in the form of W. The length is the measurement from the highest point on the medial side of the groin up to the heel plus 6 inches

51. Thomas Splint - used as traction splint

52. Thank you