TRACTION IN

ORTHOPAEDICSDr. Muslihah Binti Zainon OUTLINEPrinciple of traction Skin traction Skeletal traction Management PRINCIPLE OF TRACTIONDEFINITIONTraction is the application of a force to stretch certain parts of the o!" in a speci#c !irection$ENE%&' (ONSIDE%&TIONSSafe an! !epen!ale )a" of treating fractures for more than *++ "earsBone re!uce! an! hel! " soft tissue'ess risk infection at fracture siteNo !e,asculari-ation&llo)s more .oint moilit" than plasterT/E P0%POSE OF T%&(TIONTo regain normal length and alignment of in,ol,e! oneTo reduce an! immobilie a fracture! oneTo relie!e or eliminate mu"cle "#a"m"To relie!e #re""ure on ner!e"1 especiall" spinalTo #re!ent or reduce "$eletal de%ormitie" or mu"cle contracture"(ontrols painDIS&D2&NT&$ES(ostl" in terms of hospital sta"/a-ar!s of prolonge! e! restThromoemolismDecuitiPneumonia%e3uires meticulous nursing care(an !e,elop contractures0NDE%ST&NDIN$ T%&(TIONP%IN(IP'ES OF EFFE(TI2E T%&(TION (ountertraction must e use! to achie,e e4ecti,e traction. Countertraction is the force acting the opposite !irection& 0suall"1 the patient5s o!" )eight an! e! position a!.ustments suppl" the nee!e! countertraction.(O0NTE%T%&(TIONFi'ed traction 6 " appl"ing force against a #7e! point of counter pressure 8o!"9. E7: #7e! traction " Thomas splint%oger &n!erson )ell leg traction(O0NTE%T%&(TION(alanced ) Sliding traction 6 " tilting e! so that patient ten!s to sli!e in opposite !irection to traction forceE7:/amilton %ussell tractionTulloch Bro)n traction&gnes /unt tractionPerkins tractionTRACTIONTOLI*(SMET/ODS OF T%&(TION* TRACTION (+ ,RA-IT+ S.IN TRACTION S.ELETAL TRACTIONTRACTION (+ ,RA-IT+T%&(TION B; $%&2IT;applies onl" to upper lim in.uries)ith a )rist sling the )eight of the arm pro,i!es continuous traction to the humerusSkin tractionS.IN TRACTIONS Protect the malleoli1 &chilles ten!on insertion1 an! the hea! an! neck of the #ula " placing strips of felt or cotton6)ool pa!!ing un!er the strapping at these sites lea,e enough space 8*+ 6 *@ cm9 et)een the sole an! the sprea!er to permit mo,ement at the ankle9&pplication attaching traction 8F1 $9Ma7imum )eight recommen!e! for skin traction is @ kgSkin !amage can result from too much of traction forceIn!icationsTempor" traction :preoperati,epainTemporar" management of A of NOF an! IT AManagement of A 6 Femoral shaft of ol!er an! heft" chil!ren &fter re!uction of!islocation of /ipTo correct minor #7e! Be7ion !eformities of hip an! knee(ontrain!ications lim )ith arasions1 lacerations1 ulcers of the skinlim )ith loss of sensation1 impen!ing gangrene1 atrophic skinperipheral ,ascular !isease marke! o,erri!ing of fracture fragmentsEl!erl" patients are not t"picall" recommen!e! for skin traction ecause their skin is fragile an! their circulation ma" alrea!" e !amage! or )eakene!.(omplicationsallergic reaction to the a!hesi,e material 8usuall" -inc o7i!e9> lister formation or e7coriation of the skin from the strapping slipping> pressure sores o,er the malleoli> common peroneal ner,e pals"most important cause : lateral rotation of the lim1 compression of the ner,e at the upper en! of the #ula &,oi! this " keeping the patientCs knee .oint mo!eratel" Be7e! 8up to *+D9(ommon Skin TractionsBuckCs Traction%ussel Traction$allo)Cs or Bra"antCs TractionMo!i#e! Bra"antCs TractionPel,ic TractionDunlop TractionBuckCs TractionOften use! preoperati,el" for femoral fractures(an use tapeNo more than @ kgsNot use! to otain or hol! re!uction%ussel Traction Belo) knee skin traction is applie! & roa! soft sling is place! un!er the kneeBr"antCs 8$allo)Cs 9 Traction 0seful for treatment of fracture femoral shaft in chil!ren up to age of E "rs.Feight of chil! shoul! e less than *@6 *G kg&o,e knee skin traction is applie! ilaterall" Tie the traction to the o,er hea!eamMo!i#e! Br"antCs Traction Sometimes use! as a initial management of !e,elopmental !"splasia of hip 8* "r9&fter @ !a"s of Br"antCs traction1 a!uction of oth hips is egun increase! " aout *+ !egree alternate !a"s.B" three )eeks hips shoul! e full" a!ucte!.Pel,ic Traction use! to relie,e lo) ack pain1 an! hip an! leg pain associate! )ith lo)er ack !isor!ers&pplies traction to the lo)er spine )ith a elt )rappe! snugl" aroun! the hips. Fearing the elt too high1 like aroun! the )aist1 )ill ha,e no ene#t an! ma" cause more pain> the force must e !irectl" applie! to the pel,is. Dunlop Traction (ommonl" use! for supracon!"lar H transcon!"lar fracture of humerus 8preferale in chil!ren9&ppl" skin traction to forearm&!uct shoul!er aout I@ !egree the elo) is Be7e! I@ !egree 8pre,ents poor circulation to the elo)9 S.ELETAL TRACTIONS the )oun!s are moist> percussion o,er the one elicits ten!erness> an! the pin ecomes loose. If the infection is not controlle! " repeate! !ressings an! antiiotics1 remo,e the pin an! emplo" an alternati,e metho! of traction. If the one is osteoporotic an! the traction too hea,"1 the pin )ill cut through the one. Distraction at fracture site &ccurate insertion of the pin a,oi!s complications from !amage to the neighouring neuro,ascular un!les an! from penetration into a neighouring .oint. Pre,ent possile sti4ness in the .oint or contractures of ten!ons " repeate! acti,e an! assiste! e7ercises. Damage to epiph"seal gro)th plates Depresse! scars(ommon Skeletal TractionsPro7imal Tiial TractionDistal Tiial Traction0pper Femoral TractionM+NM+ Traction(alcaneal TractionOlecranon Traction0pper Femoral TractionSe,eral traction options for acetaular fractures'ateral traction for fractures )ith me!ial or anterior forceStretche! capsule an! ligamentum ma" re!uce acetaular fragments&ttach )eight up to M kgsTraction to continue! for aout I6K )ks Ninet" N Ninet"Traction 0se! for su trochanteric fractures an! those in the pro7imal thir! of the shaft of the femur Management of fractures )ith posterior )oun! is easier Traction is gi,en through lo)er femoral pin1 )hich is more e=cient1 or " upper tiial pin.Com#lication" o% 34)34 traction:those relate! )ith skeletal traction.Sti4ness an! loss of e7tension of knee.Fle7ion contracture of hip.Neuro,ascular !amage Pro7imal Tiial Traction0se! for !istal ENLr! femoral shaft fracture(ontrain!icate! if the knee ligaments ha,e een in.ure!.Distal Tiial Traction0seful in certain tiial plateau fractureMaintain partial hip an! knee Be7ion(alcaneal TractionTemporar" traction for tiial shaft f7 or calcaneal f7Do not ske)er sutalar .oint or N2 un!leMaintain slight ele,ation legOlecranon Traction0suall" use in supracon!"lar fracture%arel" use! to!a"Support forearm an! )rist )ith skin traction 6 elo) at M+ !egreesIn!ication : if the fracture is se,erel" !isplace! an! cannot e re!uce! " manipulation> if1 )ith the elo) Be7e! *++ !egrees1 the pulse is oliterate! an! image intensi#cation is not a,ailale to allo) pinning an! then straightening of the elo) for se,ere open in.uries or multiple in.uries of the lim/aloIn!icate! for certain cer,ical fractures as !e#niti,e treatment or supplementar" protection to internal #7ationDisa!,antagesPin prolems%espirator" compromise'eft: OSafe -oneP for halo pins.Place anterior pins aout * cm ao,e orital rim1 o,er lateral t)o thir!s of the orit1 an! elo) skull e3uator 8)i!est circumference9.%ight: OSafe -oneP a,oi!s temporalis muscle an! fossa laterall"1 an! supraorital an! supatrochlear ner,es an! frontal sinus me!iall".Posterior pin placement is much less critical ecause the lack of neuromuscular structures an! uniform thickness of the posterior skull./alo %ing TractionDirection of traction force can e controlle!No mo,ement et)een skull an! #7ation pins&llo)s the pt out of e! )hile traction maintaine!0se! for c6spine or t6spine f7/alo %ing Traction%ing )ith threa!e! holes&llo) *6*.@ cm clearance aroun! hea!Place elo) e3uatorSpacer !iscs use! to position ring(entral anterior an! E most posterior/alo %ing TractionT)o anterior pins Place! in frontal one groo,eSup an! lat to supraorital ri!geT)o posterior pinsPlace! posterior an! superior to e7ternal earTighten pins to @6K inch6poun!s )ith scre)!ri,er/alo TractionTraction pull more anterior for e7tensionMore posterior for Be7ion0se same )eight as )ith tong traction/alo 2estMa.or use of halo traction is comine )ith o!" .acket&llo)s pt out of e!(an use plaster .acket or plastic1 sheepskin line! .acket/alo 2estPin site infection a risk(an remo,e pins an! place in !i4erent holePin penetration can pro!uce (SF leakScars o,er e"ero)s(an get sores eneath ,est*ANA,E*ENTManagement of patients in traction(are of the patient(are of the traction suspension s"stem%a!iographic e7aminationPh"siotherap"%emo,al of tractionThe patient(are of the in.ure! lim6 PainParasthesia or NumnessSkin irritationS)ellingFeakness of ankle1 toe1 )rist or #nger mo,ementThe traction suspension s"stemSplintsSlings an! pa!!ingSkin tractionSkeletal tractionStirrups(or!Pulle"sFeights%a!iographic e7aminationE6L times in #rst )eekFeekl" for ne7t L )eeksMonthl" until union occurs&fter each manipulation&fter each )eight change%emo,al of tractionElo) A )ith olecranon pin6 L )ksTiial A )ith calcaneal pin 6 L6K)ksTrochanteric A of femur 6 K)ksFemoral shaft A )ith cast race6 K )ks)ithout e7ternal support 6*E)ks%eferences :*. &ple"s S"stem of Orthopae!ics an! Fractures M e!. E+*+E. (ampell5& Surger/ at the Di"trict Ho"#ital6 Ob"tetric"7 ,/naecolog/7 Ortho#aedic" and Traumatolog/8F/O> *MM*> E+Q pages9I. http:NN))).primar"6surger".orgNpsN,olENhtmlNsect+LIK.html@. http:NN))).rcse!.ac.ukNfello)sNl,anrensurgNclassi#cationNtractionNtraction.htmAhallettT/&N< ;O0