Upload
nurul-fitrawati-ridwan
View
229
Download
0
Embed Size (px)
Citation preview
8/14/2019 traction upper n lower ext.pptx
1/38
UPPER AND LOWER EXTREMITY TRACTION IN ORTHOPAEDIC
Orthopaedic and Traumatology Departement Textbook ReadingJuly 2013
Presented By
Ahmad Ramdhani Amir
Mahafendy S. Tukan
Nur Afeeza
Emil Kardani
Henry Liemer Wijaya
Advisor
Dr. Hendrian ChaniagoDr. Harianto Simbolon
Dr. Luthfi Muammar
SUpervisor
MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
MAKASSAR
2013
8/14/2019 traction upper n lower ext.pptx
2/38
Introduction
Inflamation of the joint or fractured bone cancause painful limb thus can result muscle spasm
Purpose of traction is
To relive pain and allow the limb to be rested
To immobilize a joint or part of the body
To prevent or reduce muscle spasm
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nded. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
3/38
Methods of Applying Traction
SkinTraction Skeletal
Traction
8/14/2019 traction upper n lower ext.pptx
4/38
SKIN TRACTION
8/14/2019 traction upper n lower ext.pptx
5/38
Skin Traction
The force is applied over the large area of skin
Load spreading, more comfortable and efficient
The traction force must be applied to the limb
distal to the fracture site, otherwise the efficiencyof the traction force is reduced
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nded. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
6/38
Skin Traction
Adhesive
Strapping can only stretchedtransversely
Limited force max.15 lb
(6.7kg)
Elastoplast Skin Traction Kit,Tractac, Seton Skin TractionKit, Orthotrac, and Skin-Trac
Non adhesive
The grip is less secure
Frequent reapplications maybe necessary
Limited force max.10 lb(4.5kg)
Ventfoam Skin TractionBandage, Specialist Foam
Traction, and Notac Trantion
8/14/2019 traction upper n lower ext.pptx
7/38
Skin Traction
Adhesive Non adhesive
8/14/2019 traction upper n lower ext.pptx
8/38
Bucks Traction
Often used
preoperatively forfemoral fractures
Can use tape or pre-
made boot
No more than 10 lbs Not used to obtain or
hold reduction
Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
9/38
Contraindications
Impairment of circulation
Dermatitis
Abrasions of the skin
Laceration of the skin in the area to which thetraction to be applied
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nded. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
10/38
Complications
Excoriating of the skin from slipping of theadhesive strapping
Common peroneal nerve palsy
Pressure sores around the malleoli and over thetendocalcaneus
Allergic reaction to adhesive
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nded. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
11/38
SKELETAL TRACTION
8/14/2019 traction upper n lower ext.pptx
12/38
Skeletal Traction
A metal pin or wire is driven through the bone inskeletal traction
Freaquently used in the management of lower
limb fractures
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nded. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
13/38
Types of pin used
Types of pin Discription
Steinmann pin Rigid stainless pins of varying lenghts, 4-6mm in diameter
Bohler stirrup is applied so that the direction of the traction
to be varied without turning the pin in the bone
Denham pin Identical to a Steinmann pin except for a short raised
threaded length situated toward the end held in the
introducer
The threaded length engage the bony cortex and reduces
the risk of the pin sliding
Suitable for use in cancellous bone (eg. Calcaneus ,
osteoporotic bone)
Kirschner wire Small diameter
Insufficiently rigid until pulled taut in a special stirrup
Rotation of the stirrup is impared to the wire
The wire easily cuts out of the bone if the heavy traction
weight is applied
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nded. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
14/38
Bohler stirrup with Steinmann
pin
Denham pin
Kirschner wire strainer
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2
nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
15/38
Common sites for applicationofskeletal traction
OLECRANON
Just deep to thesubcutaneous border ofthe upper end of theulna, 1 inches (3,0cm) distal to the tip ofthe olecranon
Avoid elbow joint
Drive the Kirschner wirefrom medial to lateral atright angles to thelongitudinal axis of theulna
Avoid the ulnar nerve.
Position for K-wire in olecranon
Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
16/38
Common sites for applicationofskeletal traction
SECOND AND THRID
METACARPALS
The point of insertionof the Kirschner wireis s -1 inch (2,0 -2,5cm) proximal tothe distal end of thesecond metacarpal
The wire traversesthe second and thethird metacarpaltransversely to lie at
right angles to thelongitudinal axis of
Position for K-wire in second and
third metacarpal
Brooker AF, Schmeisser G. Orthopaedic TractionManual. 1980. London: Williams & Wilkins
C it f li ti f
8/14/2019 traction upper n lower ext.pptx
17/38
Common sites for applicationofskeletal traction
Upper end of femur
greater trochenter
The lateral surface of
the femur, 1 inch (2,5
cm) below the mostprominent part of the
greater trochanter,
mid-way between the
anterior and posteriorsurface of the femur.
Position for screw eye in upper
end of femur for lateral femoral
traction
Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
18/38
Common sites for applicationofskeletal traction
LOWER END OF FEMUR
Predisposes to knee stiffness from fibrosis in the extensor
mechanism of the knee
Steinmann pin through the lower end of the femur must be removed
after two to three weeks and be replaced by one through the upper
end of tibia
UPPER END OF TIBIA
The point insertion is inch (2,0 cm) behind the crest, just below the
level of tubercle of the tibia
The pin should be driven from the lateral to the medial side of the
limb to avoid damage to the common peroneal nerveStewart, JDM. Hallet, JP. Traction and
Orthopaedic Appliances. 2nded. London :
Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
19/38
Position for Steinmann pin inlower end of femur and upper
end of tibia
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
20/38
Common sites for applicationofskeletal traction
LOWER END OF TIBIA
The point of insertion is 2 inches (5,0 cm) above the
level of the ankle joint, midway between the posterior
and anterior borders of the tibia
CALCANEUS
The point insertion is inch (2,0 cm) below and
behind th lateral malleolus. (as the lateral malleolus
lies inch more posterior and distal than the medialmalleolus, the above point correspondens with that
1 inches below and behind the malleolus. Care
must be taken to avoid entering the subtalar joinStewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
21/38
Position for Steinmann pin in lower end of tibia and
calcaneusStewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
22/38
The limb must be held in the same
degree of lateral rotation as thenormal limb; the Steinmann pin
lies horizontally
The steinmann pin is inserted at right
angles to the longitudinal axis of thelimb
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nded. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
23/38
Complications
1. Introduction of infection into bone
2. Incorrect placement of the pin or wire may
- Allow the pin or wire to cut out of the bone
causing pain and the failure of the traction system
- Make control of rotation of the limb difficult
- Make the application of splint difficult
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
24/38
Complications
3. Distraction at the fracture site as very largetraction force can be applied through skeletal
traction
4. Ligamentous damage if a large traction force is
applied through a joint for a prolonged period oftime
5. Damage to epiphyseal growth plate when use in
children
6. Depressed scar
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
25/38
UPPER EXTREMITY TRACTION
8/14/2019 traction upper n lower ext.pptx
26/38
Upper Extremity Traction
Can treat most fractures
Requires bed rest
Usually reserved for comatose or multiply injured
patient or settings where surgery can not be done
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
27/38
Forearm Skin Traction
Adhesive strip with Ace
wrap
Useful for elevation inany injury
Can treat difficult
clavicle fractures with
excellent cosmetic result Risk is skin loss
Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
28/38
Double Skin Traction
Used for greater
tuberosity or prox
humeral shaft fx Arm abducted 30
degrees
Elbow flexed 90 degrees
7-10 lbs on forearm 5-7 lbs on arm
Risk of ischemia at
antecubital fossaBrooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
29/38
Dunlops Traction
Used for supracondylar
and transcondylar
fractures in children Used when closed
reduction difficult or
traumatic
Forearm skin tractionwith weight on upper
arm
Elbow flexed 45 degreesBrooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
30/38
LOWER EXTREMITY TRACTION
LOWER EXTREMITY
8/14/2019 traction upper n lower ext.pptx
31/38
LOWER EXTREMITY
TRACTION
Can be used to treat most lower extremityfractures of the long bones
Requires bed rest
Used when surgery can not be done for one
reason or another
Uses skin and skeletal traction
Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd
ed. London : Churchill Livingstone
8/14/2019 traction upper n lower ext.pptx
32/38
Upper Femoral Traction
Several traction options
for acetabular fractures
Lateral traction for
fractures with medial or
anterior force
Stretched capsule and
ligamentum may reduce
acetabular fragments
Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
33/38
Split Russells Traction
Bucks with sling
May be used in more
distal femur fx in
children
Can be modified to hip
and knee exerciser
Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
34/38
Bryants Traction
Useful for treatment
femoral shaft fx in infant
or small child
Combines gallows
traction and Bucks
traction
Raise mattress for
countertraction
Rarely, if ever used
currently Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
35/38
90-90 Traction
Useful for subtroch and
proximal 3rdfemur
fracture
Especially in young
children
Matches flexion of
proximal fragment
Can cause flexion
contracture in adultBrooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
36/38
Femoral Traction Pin
Must avoid suprapatellar
pouch, NV structures, and
growth plate in children
Place just proximal to
adductor tubercle along
midcoronal plane
At level proximal pole
patella in extended
positionBrooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
37/38
Distal Femoral Traction
Alignment of traction
along axis of femur
Used for superior force
acetabular fx and
femoral shaft fx
Used when strong force
needed or kneepathology present
Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
8/14/2019 traction upper n lower ext.pptx
38/38
THANK YOU