TRACTION IN ORTHOPAEDICS PRESENTER – DR.SUDHANSHU KOTHADIA

Principle of Traction

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 No matter how complicated a fracture might appear to be, traction will often times pull the fragments into alignment very nicely.

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

fracture of bone Abnormal Mobility agonist and antagonist muscle. Pain

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.

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

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 Halo-Pelvic Traction the traction cords are tied to the distal end of the splint and the counter-traction force passes along the side bars of the splint to the ring and hence to the body proximal to the attachment of the muscles in spasm.

THOMAS SPLINT Used for # shaft of femur Counter traction provided by ischeal Tuberosity Girth should be taken at uppermost part of thigh near ischeal tuberocity and 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.

SLIDING TRACTION When the weight of all or part of the body, acting under the influence of gravity, is utilized to provide counter-traction. Initially more weight for reduction then reduce

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

TRACTION to limbs

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

SKIN TRACTION

SKIN TRACTION Traction force is applied over a large area of skin Applied over limb distal to fracture site Anteromedial and posterolateral part should be covered with cotton and malleoli should be covered with cotton. “Coning effect”

SKIN TRACTION Adhesive skin traction: Non-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,

COMMON SKIN TRACTIONS Buck’s Traction Hamilton Russel Traction Tulloch Brown Traction Gallow’s or Brayant’s Traction Modified Brayan’s Traction Pelvic Traction Dunlop Traction

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

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

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.

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.

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.

Dunlop Traction

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

SKELETAL TRACTION

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.

SKELETAL TRACTION SITES Upper tibial Lower femoral Lower tibial Calcaneus Olecrenon Metacarpel

Proximal Tibial Traction Used for distal 2/3rd femoral shaft fx Easy to avoid joint and growth plate 2 cm distal and posterior to tibial tubercle

Distal Tibial Traction Useful in certain tibial plateau fx Pin inserted 5 cm proximal to tip medial malleolus , midway between ant and post border of tibia. Avoid saphenous vein Place through fibula to avoid peroneal nerve Maintain partial hip and knee flexion

Calcaneal Traction Temporary traction for tibial shaft fx or calcaneal fx Insert about 2 cm below and behind the lateral malleolus Do not skewer subtalar joint or NV bundle Maintain slight elevation leg

SOME SKELETAL TRACTIONS Lateral or Upper Femoral Traction Nintey / Nintey traction Olecrenone traction Perkin’s Traction

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 Attach weight upto 9 kgs Traction to continued for about 4-6 wks

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

SKELETAL TRACTION COMPLICATIONS Infection Cut out Distraction at fracture site Physeal damage Nerve Injury

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.

SPINAL TRACTIONS

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

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

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

CERVICAL TRACTIONS LEVEL MAX. WT C2 4.5-5.4 Kg C3 4.5-6.7Kg C4

SUSPENSIONS

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 Balken Beam frame is used for suspension purpose.

BALKEN BEAM FRAME Commonly Used to suspends splints. one or two Balken Frames are used Today balken frames 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.

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

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

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.

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 The tendo achilles is protected from pressure sores Ipsilateral tibia # can be managed

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