Traction in orthopaedics

AJIMSHA SHOUKATH09M2386

WHAT IS TRACTION ?

Traction - the application of a force to stretch certain parts of the body in a specific direction

WHY DO WE NEED TRACTION ?

Reduction of fractures and dislocations and

their maintenance

For immobilizing a painful, inflamed joint

For the prevention of deformity, by

counteracting the muscle spasms associated

with painful joint conditions.

For correction of soft tissue contractures by

stretching them out

TRACTION

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

TRACTION

Based on principle Fixed tractionSliding 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

THOMAS SPLINT

Used for # shaft of femur Counter traction provided by ischeal

Tuberosity

SLIDING TRACTION

When the weight of all or part of the body, acting under the influence of gravity, is utilized to provide counter-traction.

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.

SKIN TRACTION

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

Buck’s Traction

Often used preoperatively for femoral fractures

Can use tape No more than 5 kgs

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 head 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.

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

SOME SKELETAL TRACTIONS

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

LATERAL or 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 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.

SKELETAL TRACTION

COMPLICATIONS

Infection Cut out Distraction at fracture site Nerve Injury

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

CERVICAL TRACTIONS

LEVELLEVEL MAX. WTMAX. WT

C2C2 4.5-5.4 Kg 4.5-5.4 Kg

C3C3 4.5-6.7Kg 4.5-6.7Kg

C4C4 6.7-9.0Kg 6.7-9.0Kg

C5C5 9.0-11.3Kg 9.0-11.3Kg

C6C6 9.0-13.5Kg 9.0-13.5Kg

C7C7 11.3-15.8Kg 11.3-15.8Kg