TRACTION IN orthopedic ORTHOPAEDICS-1.pptx

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1. TRACTION IN ORTHOPEDICS ODADA ARNOLD MAGAK MBChB level 6 supervisor: Dr Musa Date: 26th February 2025

2. TRACTION traction refers to the application of a pulling force to a part of a body along the longitudinal axis for management of maskuloskeletal disorders.

3. purpose reduction of fractures and dislocations maintain reduction counter muscle spasms relieve pain relieve pressure on nerves to gain normal length of a bone to prevent or reduce skeletal derformities or muscle contractures keep the patient comfortale until definitive management

4. principles counter traction is required traction ought be continuous i.e uninterupted the patient on the system as well as the sysem itself should be constatly monitored- observe and record neurovascular status , counter traction ought be maintained, the traction weights are not on the floor, pulleys are freely running, minimal friction in the cord and pulleys, watch out for bed sores in the patients once a fracture is reduced a decreasing amount of weight is required to maintain the reduction.

5. classification based on method of application ; skin, skeletal, gravity based on mechanism : fixed - where pull is exerted against a fixed point of counter traction i.e fixed traction over a thomas splint where counter traction is provided by the ischial tuberosity, halo pelvic traction and roger anderson well leg traction balanced- pull is exerted against an opposing force, either by the weight of the body or by bed adjustments.i.e perkins, 90-90, gllows , tulloch brawn, bucks, hamilton russel. olecranon pin,metarcapal pin, dunlop combined

6. equipments needed for traction adjustable orthopedic bed balkan beam frame trapeze traction cords pulleys weights skeletal and skin traction apparatus splints

7. disadvantages of traction requires continuous nursing care hazards of prolonged bed rest contracture development

8. skin traction mechanism; traction is usualy applied over a wide area and force is transmitted to the skeleton through the soft tissue traction is applied distal to the fracture site. usually used for temporary fracture stabilization or definitely especially in children. Of note is that skin traction cannot reliably reduce a fracture

9. types adhesive skin traction: adhesive material is used for strapping which is applied anteromedial and posterolateral on either side of the lower limb non adhesive skin traction: useful in thin and atrophic skin,in patients sensitive to adhsive strap, less secure than the adhesive strap hence require monitoring and frequent reapplication

10. technique shave and clean the skin ensure skin is dry apply adhesive strapping avoid placing over bony prominences, and bony prominences be padded with cotton leave a loop of about 15 cms to allow dorsi and plantar flexion duration 4-6 weeks

11. contraindications abrasions lacerations impaired circulation dermatitis marked shortening allergy to adhesive

12. complications allergic reactions to the adhesive strapping excoriation of skin due to slippage of the adhesive strapping pressure sores over the malleoli common peroneal nerve palsy

13. weight used 10% body weight a maximum of 6.7 kgs for the adhesive skin traction a maximum of 4.5 kgs for the non adhesive type

14. most commonly applied types cervical: head halter lower limb: bucks,gallows or bryants,modified bryants, hamilton russel, agnus hunt, pelvic traction

15. bucks traction used in temporary management of: femoral neck fractures femoral shaft fractures in older and larger children undisplaced fractures of the acetabulum correction of minor fixed flexion deformities of hip after reduction od dislocation of hip

16. hamilton russel management of shaft of femur fractures after arthroplasty operations on the hip application: below knee skin traction, pulleys attached to spreader, soft sling placed under skin. weight adults 3.6 kgs, children 0.2- 1.8 kgs

17. Bryants used in fracture shaft of femur in children < 2years apply adhesive strapping on both lower limbs tie traction cords to an overhead beam tighten the traction cord to raise the buttocks just clear the mattress counter traction obtained by weight of pelvis vascular complications of bryants traction may occur in either the injured or normal limb a careful check must be done in both limbs during the first 24-48 hours

18. bryants traction used in children under 2 safe, 2-4 years vascular complications morecan be prevented using a posterior splint), obver 4 years its absolutely contraindicated.

19. modified bryants traction used in the initial management of CHD when diagnosed over the age of 1 year after 5 days abduction of the hip is started abduction is increased by 10 degreed on alternate days by 3 weeks the hips should be fully abducted complications: restless child due to pain

20. pelvic traction special canvas harness is buckled around the patients pelvis long cords attach the harness to the foot of the pelvis footbed raised to provide sliding traction bucks traction may also be applied

21. dunlops used in management of supracondylar and transcondylar fractures of humerus in children

22. cervical traction/ halters traction treatment of cervical spondylosis as an outpatient maximum weight 1.4 to 2.3 kgs two types canvas and crile head halter head end of bed should be raised to provide counter traction

23. skeletal traction application of traction force by a pin or wire transfixing bone

24. indications cases in which skin traction is contraindicatd patients with lacerated wounds temporary or definitive management of musculoskeletal disorders

25. equipments steinman pin Denham pin- has a central threaded portion, useful in cancelous or osteoporotic bone kirschner wires supporting devices, bohler stirrup, k wire strainer

26. principles of application applied under general or local anaesthesia follow strict aseptic techniques pins should be at right angles to the limb and parallel to the ground direction of pin insertion is chosen such that we avoid damage to neurovascular structures

27. site upper limb :2nd and third metacarpals olecranon- insert the pin from the medial side of the ulna 2 cms from the tip of the olecranon and 1 cm anterior from the posterior cortex. this ought avoid the ulnar nerve that passes through the groove inferior to the medial epicondyle of the humerus. lower limb: distal femur, upper femur-2.5 cms below most prominent part of the greater trochanter proximal tibia-2 cms distal,2 cms posterior to tibial toberosity lateral to medial distal tibia-5 cms proximal to tip of medial malleolus calcaneal-4.5 cms inferior and 4 cms posterior to the tip of the medial malleolus. begin from the medial side to avoid damage to the posterior tibial artery and nerve and to avoid entering the subtalar joint.

28. weight 10% of persons body weight

29. complications during application: nerve injury,injury to vessels,injury to muscles, ligaments and tendons,injury to epiphysis in children,pain when pin in situ: infection due to improper aseptic measures, pin migration due to loosening,breakage of pin, bending of the pin, distraction of fracture fragments and ligament damage. late complications: pin tract infections,chronic osteomyelitis with ring sequestra at the site, depressed scar.

30. commonly applied types perkins ninety ninety olecranon pin traction crutchfield tongs tulloch brown

31. perkins fracture femur from subtrochanteric region distally in all ages fracture tochanter in < 50 years principle: use of skeletal traction without any external splintage, coupled with active movements of injured limbs weight7-15 kgs

32. ninety- ninety used in fracture femur with wounds over posterior aspect of thigh subtrochanteric and proximal third fracture femur in both children and adults both hip and knee flexed at 90 degrees skeletal traction is applied through lower femur or upper tibia 3 methods of supporting leg in 90/90: below knee plaster cast second steinman pin through lower end of tibia using a tulloch brown U loop

33. dangers of 90/90 those of skeletal traction stiffness and loss of extension of knee flexion contracture of hip injury to the lower femoral or upper tibial epiphyseal growth plates in childrenneurovascular damage

34. skull traction applied by gaining access on the outer table of skull with metal pins used in cervical spine injuries and infectious conditions weight 9.1 to 18.2 kgs used are, crutch field tongs, gardner well tongs, halo splint

35. goals to realign spine to prevent loss of function of undamaged neuronal tissue to improve neurological recovery to obtain and maintain spinal stability to obtain early functional recovery

36. olecranon traction indications: supracondylar fractures of humerus comminuted fracture of lower end of humerus unstable fracture of the shaft of humerus weight 1.3 to 1.8 kgs

37. tulloch brown application: steinmann pin through the proximal tibia, support legs on slings suspended from light duralumin U loops which is slipped over the ends of of stainman pin attach the nissen stirrup to the steinmann pin it enables the leg to be suspended and rotational movements controlled

38. Thank you