Conservative Treatment of Fractures BY DR. TARIF AL-AKHRAS

Objectives Traction:Traction: –Methods. Types –Indications / contraindications –Complications Casting:Casting: –Types –Indications / contraindications –Complications

TRACTION IN ORTHOPEDICs

TRACTION Traction treatment involves the use of puling force to a part of the body to overcome muscle spasm, shortening and some time the effect of gravityTraction treatment involves the use of puling force to a part of the body to overcome muscle spasm, shortening and some time the effect of gravity

TRACTION As well as acting on limbs, traction can be applied to the pelvis and spine.As well as acting on limbs, traction can be applied to the pelvis and spine.

TRACTION By controlling movement of the injured part, traction enables bone and soft tissue to heal and can be used as a method of treatment.By controlling movement of the injured part, traction enables bone and soft tissue to heal and can be used as a method of treatment.

TRACTION It is used for : Restoring and maintaining of bone alignment following fracture.Restoring and maintaining of bone alignment following fracture. Resting inflamed joint and maintaining them in functional position.Resting inflamed joint and maintaining them in functional position. Gradually correcting deformity due to contracted soft tissue.Gradually correcting deformity due to contracted soft tissue. Relieving pain due to muscle spasm.Relieving pain due to muscle spasm.

TRACTION TYPE OF TRACTION : 1.Manual traction 2.Skin traction 3.Skeletal traction 4.Traction by gravity

TRACTION Manual tractionManual traction Exerted directly when the physician pulls on the part during manipulation to obtain closed reduction of a fracture or dislocation.

TRACTION SKIN TRACTION UTTILIZED In childrenIn children In temporary management in adult ( femoral fracture or dislocation )In temporary management in adult ( femoral fracture or dislocation )

TRACTION Contraindication to skin traction Diseases predisposing skin to damage and poor healingDiseases predisposing skin to damage and poor healing (DM, varicose ulcers and use steroid drug). Any wounds, sores or rash in the area where traction to be applied.Any wounds, sores or rash in the area where traction to be applied. Marked swelling in the area.Marked swelling in the area. A history of hypersensitive skin.A history of hypersensitive skin. Any suspicion of circulation problem.Any suspicion of circulation problem.

TRACTION Advantages of skin traction Easy to applyEasy to apply No hazard of bone infection or epiphyseal plate injuryNo hazard of bone infection or epiphyseal plate injury

TRACTION Different type of skin traction / Foam traction

TRACTION Different type of skin traction

TRACTION Different type of skin traction fixed traction Cervical skin traction fixed traction Cervical skin traction

TRACTION Skeletal traction Achieved by inserting Kirschner wire or Steinman pin directly into the bone

TRACTION

TRACTION The most commonly used sites for pin insertion are : Upper tibiaUpper tibia Femoral condyleFemoral condyle CalcaneumCalcaneum OlecranonOlecranon SkullSkull

TRACTION Complication of skletal traction Infection:Infection:

TRACTION predisposing factor Poor insertion techniquePoor insertion technique Loosening of the pinLoosening of the pin Tension of the skin and subcutaneous tissues leading to ncrosisTension of the skin and subcutaneous tissues leading to ncrosis

traction Over distraction of the bone fragmentsOver distraction of the bone fragments Nerve damage: can result from the use of heavy traction forcesNerve damage: can result from the use of heavy traction forces Breaking of the pins or wireBreaking of the pins or wire

Plaster of ParisPlaster of Paris

Plaster of Paris POP was first used in orthopedics by Mathysen, a Dutch surgeon in 1852POP was first used in orthopedics by Mathysen, a Dutch surgeon in 1852 It commercially available since 1931It commercially available since 1931

Plaster of Paris its chemical formula its chemical formula (CaSO4) 2 H 2 O+3H 2 O 2(CaSO4×H 2 O)+heat (CaSO4) 2 H 2 O+3H 2 O 2(CaSO4×H 2 O)+heat Hemihydrated calcium Hydrated calcium Hemihydrated calcium Hydrated calcium sulfate Sulfate sulfate Sulfate ( plaster of Paris) (gypsum) ( plaster of Paris) (gypsum)

Plaster of Paris It used in four form SlabSlab CastCast SpicaSpica Functional cast braceFunctional cast brace

Plaster of Paris Slab It is a temporary splint made up of half by POP and half by bandage roll.It is a temporary splint made up of half by POP and half by bandage roll. Used in the initial stages of fracture treatment, during first aid and to immobilize the limbs postoperativelyUsed in the initial stages of fracture treatment, during first aid and to immobilize the limbs postoperatively

Plaster of Paris Cast The POP roll completely encircles the limb.The POP roll completely encircles the limb. It is used as definitive form of fracture treatment and also to correct deformity.It is used as definitive form of fracture treatment and also to correct deformity.

Plaster of Paris Spica This is encircles apart of the body, e.g. thumb spica hip spica thumb spica hip spica

Plaster of Paris Rules of application of POP  Choose the correct size of the roll.  A joint above and joint below should be included.  The joint should be immobilized in functional postoins.  The plaster should not be too tight or too loose

Complications off Plaster of Paris Due to tight fit PainPain Pressure sorePressure sore Compartmental syndromeCompartmental syndrome Peripheral nerve injuryPeripheral nerve injury

Complications off Plaster of Paris Due to improper aplication  Joint stifnes  Blisters and sores  breakage Due to plaster allergy Allergic dermatitisAllergic dermatitis

Plaster of Paris

Fiber glass cast Advantage Advantage The materials are strong, light weight, cool, The materials are strong, light weight, cool, water resistant and radiolucent water resistant and radiolucent Disadvantage Disadvantage expensive, sharp edge expensive, sharp edge

Fiber glass cast