TRACTION & SPLINTS

DR. ASHISH GOHIYA

ASST. PROFESSOR
DEPT. OF ORTHOPAEDICS
GANDHI MEDICAL COLLEGE
BHOPAL
 TRACTION

• Orthopedist’s great "master tool“.

• Traction - the application of a force to
stretch certain parts of the body in a
specific direction
Inflammation of a joint or
fracture of bone

Muscles undergo spasm

Deformity & impaired function

 TRACTION
• Traction controls movements of an injured
part of the body – aids in healing.
• Traction and counter traction still form the
basis of reduction of fractures and
dislocations
 TRACTION
• Controls pain.
• Reduces fracture.
• Maintain reduction.
• Prevents & corrects deformity.
 TRACTION
• Based on duration
• Continuous traction
• Intermittent traction
– Cervical
– pelvic
 TRACTION
• Based on principle
• Fixed traction
• Sliding traction
 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
 SLIDING TRACTION
• When the weight of all or part of the body,
acting under the influence of gravity, is utilized
to provide counter-traction.
 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
 SLIDING TRACTION
• Buck’s traction or Extension
• Perkin’s traction
• Hamilton Russell traction
• Tulloch Brown traction
• Ninety /Ninety tractionRryant’s ( or Gallows)
traction
• Modified Bryant’s traction
• Sliding traction with Bohl;er-Braun frame
• Lateral upper femoral traction
• Agnes Hunt traction
• Pelvic traction
• Dunlop traction
• Olecrenon traction
 TRACTION
• Based on application
• Skeletal traction
• Skin traction
–Adhesive
–Non – adhesive
 SKIN TRACTION
• Traction force is applied over a large area
of skin
• Applied over limb just proximal to fracture
site
• “Coning effect”
 SKIN TRACTION
• Adhesive skin traction:
– Maximum weight 15 lb or 6.7 kg
• Non-adhesive skin traction
– Maximum weight should not exceed 10 lb or
4.5 kg
– thin and atrophic skin,
– skin sensitive to adhesive strapping,
 SKIN TRACTION
COMPLICATIONS
• Allergic reactions to adhesives.
• Excoriation of skin.
• Pressure sores over bony prominences
and tendoachillis.
• Common peroneal nerve palsy.
 SKELETAL TRACTION
• pin or wire
• more frequently used in lower limb
fractures
• Should be reserved for those cases in
which skin traction is contraindicated or
insufficient
 SKELETAL TRACTION
• SITES
– Olecranon
– Metacarpal
– Upper end femur
– Lower end of femur
– Upper end of tibia
– Lower end of tibia
– calcaneus
 SKELETAL TRACTION
COMPLICATIONS
• Infection
• Cut out
• Application of splint difficult
• Distraction at fracture site
• Ligament damage
• Physeal damage
• Depressed scars
HAMILTON RUSSEL TRACTION
• Below knee skin traction is applied
• A broad soft sling is placed under the knee
• Both the cord one of knee sling and other
of b/k skin traction are attached through a
system of pulleys to suspend single weight
HAMILTON RUSSEL TRACTION
• By the arrangement of pulleys at the distal
end, a 10-pound weight exerts a 20-pound
pull
NINETY / NINETY TRACTION
• Used for sub trochanteric fractures 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
tibial pin.
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 epiphyseal plate in children.
– Neurovascular damage
 SLIDING TRACTION WITH A
THOMAS’S SPLINT AND KNEE
FLEXION PIECE
• fracture of femur
• Knee flexion piece allows easier
mobilization of the knee
• Always keep the hinge at the level of
addutor tubercle.
• Keep the knee flexed at about 20- 30
degree
 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.
 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
 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.
 LATERAL UPPER FEMORAL
TRACTION
• For the management of central fracture
dislocation of the hip
• about 2.5 cm from most prominent part of
greater trochanter mid way between ant.
And post. surface of femur
• threaded screw eye
• Traction to continued for about 4-6 wks
 PELVIC TRACTION
• special canvas harness is buckled around the
patient's pelvis
• Long cords or straps attached to the harness
to the foot of the bed
• Used for conservative management of PIVD
 CERVICAL TRACTIONS
• Halter traction
• Crutchfield tongs
• Cone or Barton
tongs
 CERVICAL TRACTIONS
• Halter traction
• Crutchfield tongs
• Cone or Barton
tongs
 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.
CHARNLEY’S TRACTION UNIT
• BK POP incorporating the Steinmann or Denham
pin
• Common peroneal nerve and calf muscles
protected
• External rotation of the foot and distal fragments is
controlled
4. The tendo achilles is protected from pressure sores
5. Ipsilateral tibia # can be managed
 SPLINTS

• An appliance, either rigid or flexible,

used to hold in position a displaced or
movable part or to keep in place and
protect an injured part.
• Splints support and protect injured
bones and soft tissue
• reduces pain, swelling, and muscle
spasm.
• airplane s. a static orthosis that holds the
upper limb in abduction at the level of the
shoulder; used following burns in the axillary
region and for short periods following surgery
to the shoulder or brachial plexus.
• banjo traction s. a dynamic orthosis to aid
extension of the fingers using a banjo-
shaped steel bar attached to the fingers with
rubber bands and plastic rings.
• Cramer's s. a flexible wire splint
consisting of parallel stout wires
between which smaller wires are
stretched like the rungs of a ladder
• Coaptation s.’s small splints adjusted
about a fractured limb for the purpose
of producing coaptation of fragments
• Liston's s. a simple straight splint, often made
of wood with padding, for fracture of the femur; it
is adapted to the side of the body and lower
limb.
• Thomas s. a knee-ankle-foot orthosis
consisting of two rigid rods attached to an ovoid
ring that fits around the thigh; used in
emergencies or for transporting patients, or
combined with other apparatus to provide
traction.
• Keller-Blake s. a hinged half-ring
modification of the Thomas splint for
fracture of the femur
• Denis Browne s. a splint consisting of a
pair of metal foot splints joined by a cross
bar; used in talipes equinovarus.