ORTHOPAEDIC TRACTION Dr. Srinivas Bodla Ortho PG(PIMS)
Definition
Traction is the application of a pulling force to a part of the body
History
Skin traction used extensively in Civil War for fractured femurs
Skeletal traction by a pin through bone introduced by Steinmann and Kirschner
Hippocrates - treated fracture shaft of femur and of leg with the leg straight in extension
Guy de chauliac- introduced continuous isotonic traction in the fracture of femur
History
Percival pott- fractured limb should be placed in the position in which muscles are most relaxed
Josiah crosby isotonic skin traction for treatment of shaft of femur
Thomas Bryant- Braynts traction for treatment of fracture shaft of femur in children
Thomas Thomas splint, used for applying fixed traction
History
Malgaigne introduced the 1 st effective traction which grasped the bone itself. He used malgaignes hooks
Fritz-Steinmann introduced a method of applying skeletal traction to the femur by means of two pins driven into the femoral condyles.
Lorenz-Bohler The Father of Traumatology popularised skeletal traction by means of steinmann pins after he devised Bohler stirrup.
General Considerations
Safe and dependable way of treating fractures for more than 100 years
Bone reduced and held by soft tissue
Less risk of infection at fracture site
No devascularization
Allows more joint mobility than plaster
Types
Skin traction
The traction force applied over a large area of skin
Adhesive and Non-adhesive skin tractions
Skeletal traction
Applied directly to the bone either by a pin or wire through the bone. (eg- Steinmann pin, denham pin, kirschner wire)
Advantages
decrease pain
minimize muscle spasms
reduce, align, and immobilize fractures
reduce deformity
increase space between opposing surfaces
Disadvantages
Costly in terms of hospital stay
Hazards of prolonged bed rest
Thromboembolism
Decubiti
Pneumonia
Requires meticulous nursing care
Can develop contractures
Understanding traction
Principles Of Effective Traction
Countertraction must be used to achieve effective traction.
Countertraction is the force acting the opposite direction .
Usually, the patient's body weight and bed position adjustments supply the needed countertraction.
Counter traction
Fixed traction- by applying force against a fixed point of body.
Ex:
fixed traction by thomas splint
Roger Anderson well leg traction
Counter traction
Sliding traction- by tilting bed so that patient tends to slide in opposite direction to traction force
Ex:
Hamilton russell traction
Tulloch Brown traction
Agnes Hunt traction
Perkins traction
APPLIANCES
Beds And Frames
Standard bed has 4-post traction frame
Ideal bed for traction with multiple injuries is adjustable height with Bradford frame
Mattress moves separate from frame
Beds and Frames
Bradford frame enables bedpan and linen changes without moving pt
Alternatively bed can be flexible to allow bending at hip or knee
Knots
Ideal knots can be tied with one hand while holding weight
Easy to tie and untie
Overhand loop knot will not slip
Knots
A slip knot tightens under tension
Up and over, down and over, up and through
Knots - types
Clover hitch
Barrel hitch
Reef knot
Half hitch
Two half hitches
Pulleys
To control the direction of weight
By altering site and by using more than 1 pulley the force exerted by a given weight can be increased
Pulleys of 5-6.25cm diameter with 6cm diameter axles are preferrable
Weights
Amount of weight required depends upon
Wt of the appliance
Wt of part of body suspended
Amount of friction present in the system
Mechanical advantage of the system employed for suspension
SKIN TRACTION
Skin traction
The traction force is applied over a large area, this spreads the load and is more comfortable and efficient.
Force applied is transmitted from skin to the bones via superficial fascia, deep fascia and intermuscular septa
For better efficiency the traction force is applied only to the limb distal to the fracture
Weight
Skin damage can result from too much of traction force.
Maximum weight recommended for skin traction is 6.7 kgs
depending on size and weight of the patient
Application
Adhesive skin traction :
Prepare the skin by shaving as well as washing & applying tincture benzoin which protects the skin and acts as an additional adhesive.
Avoid placing adhesive strapping over bony prominences, if not, cover them with cotton padding and do the strapping.
Leave a loop of 5 cm projecting beyond the distal end of limb to allow movement of fingers and foot.
Application
Non adhesive skin traction
Useful in thin and atrophic skin
Frequent reapplication may be necessary
Attached traction wt. must not be more than 4.5 kgs.
Indications
Temporary management of # of NOF and IT #
Management of # - Femoral shaft of older and hefty children
Undisplaced # of acetabulum
After reduction of dislocation of Hip
To correct minor fixed flexion deformities of hip and knee
Contraindications
Abrasions and lacerations of skin in the area to which traction is to be applied
Varicose veins, impending gangrene
Dermatitis
When there is marked shortening of the bony fragments as the traction weight required is greater than which can be applied through the skin
Complications
Allergic reactions to adhesive
Excortication of skin
Pressure sores
Common peroneal nerve palsy
SKELETAL TRACTION
Skeletal traction
It may be used as a means of reducing or maintaining the reduction of a fracture
It should be reserved for those cases in which skin traction is contraindicated
Steinmann Pin
Rigid stainless steel pins of varying lengths 4 6 mm in diameter. Bohler stirrup is attached to steinmann pin which allows the direction of the traction to be varied without turning the pin in the bone
Denham Pin
Identical to stienmann pin except for a short threaded length in the center . This threaded portion engages the bony cortex and reduce the risk of the pin sliding
Used in cancellous bone like calcaneum and osteoporitic bones
