Traction JEFF_in_orthopaedics-1(1).ppt

Traction

1. TRACTION IN
ORTHOPAEDICS
PRESENTER –DR.SUDHANSHU KOTHADIA

2. Principle of Traction

3. WHAT IS TRACTION ?
Orthopedist’s great "master tool“.
Traction-the application of a force
to stretch certain parts of the body
in a specific direction

4. WHY DO WE NEED TRACTION ?
Inflammation of a joint
Pain and muscle spasm
Defomity

5. fracture of bone
Abnormal Mobility
Pain

6. TRACTION
The purpose of traction is to:
To regain normal length and alignment of
involved bone.
To reduce and immobilize a fractured bone.
To relieve or eliminate muscle spasms.
To relieve pressure on nerves, especially
spinal.
To prevent or reduce skeletal deformities or
muscle contractures.

7. TRACTION
Controls pain.
Reduces fracture.
Maintain reduction.
Prevents & corrects deformity.

8. TRACTION
Based on principle
Fixed traction
Sliding traction

9. FIXED TRACTION
Traction is applied to the leg against a fixed point
of counter pressure.
–Fixed traction in Thomas’s splint
–Roger Anderson well-leg traction
–Halo-Pelvic Traction

10. THOMAS SPLINT
Used for # shaft of femur
Counter traction provided by ischeal
Tuberosity
Girth should be taken at uppermost part of
thigh near ischealtuberocityand add 5 cm to
it.
Measure from Crotch to Heal and it should
be 15-23 cm beyond heal.
Ring should be angled at 120°to inner side
bar.

11. SLIDING TRACTION
When the weight of all or part of the body,
acting under the influence of gravity, is
utilized to provide counter-traction.

12. SLIDING TRACTION
Exact weight required is determined by
trial.
For the fracture of femoral shaft an
initial weight of 10% of body weight
Foot end is elevated so that the body
slides in opposite direction.
1 inch (2.5 cm) for each 1 lb (0.46 kg)
of traction weight

13. TRACTION to limbs

14. TYPES OF TRACTION ON
APPLICATION
Skin traction
–Adhesive
–Non –adhesive
Skeletal Traction

15. SKIN TRACTION

16. SKIN TRACTION
Traction force is applied over a large
area of skin
Applied over limb distal to fracture site
Anteromedialand posterolateralpart
should be covered with cotton and
malleolishould be covered with cotton.
“Coning effect”

17. SKIN TRACTION
Adhesive skin traction:
–Maximum weight 6.7 kg
Non-adhesive skin traction
–Maximum weight should not exceed 4.5
kg
–Used in thin and atrophic skin,
–skin sensitive to adhesive strapping,

18. COMMON SKIN TRACTIONS
Buck’s Traction
Hamilton RusselTraction
Tulloch Brown Traction
Gallow’sor Brayant’sTraction
Modified Brayan’sTraction
Pelvic Traction
Dunlop Traction

19. Buck’s Traction
Often used
preoperatively for
femoral fractures
Can use tape
No more than 5 kgs
Not used to obtain or
hold reduction

20. HAMILTON RUSSEL TRACTION
Below knee skin traction is applied
A broad soft sling is placed under the
knee

21. BRYANT’S (GALLOW’S )
TRACTION
the treatment of fracture shaft femur in
children up to age of 2 yrs.
Weight of child should be less than 15-
18 kg
Above knee skin traction is applied
bilaterally
Tie the traction to the over haed
beam.

22. MODIFIED BRYANT’S
TRACTION
Sometimes used as a initial
management of developmental
dysplasia of hip (1 YR)
After 5 days of Bryant’s traction,
abduction of both hips is begun
increased by about 10 degree
alternate days.
By three weeks hips should be
fully abducted.

23. PELVIC TRACTION
Used for conservative management of PIVD
The amount by which foot end should be
elevated depends upon patient’s weight ,
more heavy the patient, more should be
elevation.

24. DUNLOP TRACTION
T/t of supracondylar& transcondylar
fracture of humerus
Useful when flexion of elbow causes
circulatory embarrassment with loss of
radial pulse
Apply skin traction to forearm
Abduct shoulder about 45 degree
the elbow is flexed 45 degree.

25. Dunlop Traction

26. SKIN TRACTION
COMPLICATIONS Of Adhesive Skin Traction :
Allergic reactions to adhesives.
Excoriation of skin.
Pressure sores over bony prominences
and tendoachillis.
Common peronealnerve palsy.

27. SKELETAL TRACTION

28. SKELETAL TRACTION
pin or wire
more frequently used in lower limb
fractures
Should be reserved for those cases in
which skin traction is insufficient.
Generally used when more weight is
needed to give traction.
To treat fractures conservatively.

29. SKELETAL TRACTION
SITES
–Upper tibial
–Lower femoral
–Lower tibial
–Calcaneus
–Olecrenon
–Metacarpel

30. Proximal TibialTraction
Used for distal 2/3
rd
femoral shaft fx
Easy to avoid joint and
growth plate
2 cm distal and
posterior to tibial
tubercle

31. Distal TibialTraction
Useful in certain tibial
plateau fx
Pin inserted 5 cm
proximal to tip medial
malleolus, midway
between ant and post
border of tibia.
Avoid saphenousvein
Place through fibula to
avoid peronealnerve
Maintain partial hip and
knee flexion

32. CalcanealTraction
Temporary traction for
tibialshaft fxor
calcanealfx
Insert about 2 cm below
and behind the lateral
malleolus
Do not skewer subtalar
joint or NV bundle
Maintain slight elevation
leg

33. SOME SKELETAL
TRACTIONS
Lateral or Upper Femoral Traction
Nintey/ Ninteytraction
Olecrenonetraction
Perkin’s Traction

34. LATERAL UPPER FEMORAL
TRACTION
For the management of central
fracture dislocation of the hip
about 2.5 cm from most prominent
part of greater trochantermid way
between ant. And post. surface of
femur
threaded screw eye
Attach weight upto9 kgs
Traction to continued for about 4-6
wks

35. NINETY / NINETY TRACTION
Used for sub trochantericfractures and
those in the proximal third of the shaft
of the femur
Management of fractures with posterior
wound is easier
Traction is given through lower femoral
pin, which is more efficient, or by upper
tibialpin.

37. NINETY / NINETY TRACTION
Complications of 90/90 traction:
–those related with skeletal traction.
–Stiffness and loss of extension of knee.
–Flexion contracture of hip.
–Injury to epiphysealplate in children.
–Neurovascular damage

38. SKELETAL TRACTION
COMPLICATIONS
Infection
Cut out
Distraction at fracture site
Physealdamage
Nerve Injury

39. SLIDING TRACTION WITH
BOHLER BROWN SPLINT:
Used for the fracture of tibia or femur.
Skeletal traction is usually applied, but
skin traction can be given b/k.

40. SPINAL TRACTIONS

41. CERVICAL TRACTIONS
SKIN TRACTION Head Halter traction
SKELETAL TRACTION
Crutchfield tongs
Cone or Barton tongs

42. Head Halter traction
Simple type cervical
traction
Management of neck
pain
Weight should not
exceed 3 kg initially
Can only be used a few
hours at a time
Head end should be
elevated to give counter
traction

43. Crutchfield Tongs
Must incise skin and
drill cortex to place
Rotate metal traction
loop so touches skull in
midsagittalplane
Place at the line
connecting tips of
mastoid processes on
both sides.

44. CERVICAL TRACTIONS
LEVEL MAX. WT
C2 4.5-5.4 Kg
C3 4.5-6.7Kg
C4 6.7-9.0Kg
C5 9.0-11.3Kg
C6 9.0-13.5Kg
C7 11.3-15.8Kg

45. SUSPENSIONS

46. SUSPENSION
Done for better nursing care
To increase the mobility of patient
To prevent dangers of immobilization
Suspension system consists of traction cords
pulleys and weight
Commonly BalkenBeam frame is used for
suspension purpose.

47. BALKEN BEAM FRAME
Commonly Used to suspends splints.
one or two BalkenFrames are used
Today balkenframes are made up of Metal
tubes
Two uprights are on each side of bed and are joined by two
long horizontal bars.
Other short horizontal bar may be there joined to two
uprights on same side or to long horizontal bar.

48. TRACION CORDS
Used to suspend weights to give traction
Cords perform two functions –tractionand
suspension
For this color code system is available –
-red or greenfor tractioncords
-white for suspension cords.

49. PULLEYS
Function of pulley is to control the direction of
weight attached to end of the cord over
pulley.
Large pulley wheels of 6cm in diameter and
6mm in diameter of axles are preferable
Majority of pulleys are prepared from Tufnol

50. WEIGHTS
The amount of weight required to suspend
an appliance depends upon -
-weight of appliance
-weight of part of body suspended in
appliance
-the amount of friction present in system.

51. CHARNLEY’S TRACTION
UNIT
BK POP incorporating the Steinmann or Denham
pin
Common peronealnerve and calf muscles
protected
External rotation of the foot and distal fragments is
controlled
1.The tendoachillesis protected from pressure sores
2.Ipsilateraltibia # can be managed