Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
TRACTION IN ORTHOPAEDIC
GEDE MADE OKA RAHADITYA
Orthopaedic and Traumatology Department – Saiful Anwar Hospital, Malang
OUTLINES
DEFINITION AND PRINCIPLES
HISTORY
PURPOSE, ADVANTAGES AND DISADVANTAGES
APPLIANCES
TYPE OF TRACTION
SKIN TRACTION...
DEFINITION AND PRINCIPLES
raction is the application of a pulling force to a part of the body
“Traction is the application...
DEFINITION AND PRINCIPLES
PRINCIPLES
• Provide Counter traction, using the patient’s body or
pull of weights in the opposi...
HISTORY
• The use of traction dates as far
back as 3000 years (Aztecs and
the ancient Egyptians)
• Hippocrates (350 BC) wr...
HISTORY
Pott’s doctrine
• Most Fracture deformities result
from the contraction of the
surrounding muscles
• Fractured lim...
PURPOSE, ADVANTAGES AND DISADVANTAGES
• CONTROLS PAIN
• REDUCES FRACTURE
• MAINTAIN REDUCTION
• PREVENTS AND CORRECT DEFOR...
PURPOSE, ADVANTAGES AND DISADVANTAGES
ADVANTAGES
• Reduce pain
• Minimize muscle spasm
• bone reduce and held by soft tiss...
PURPOSE, ADVANTAGES AND DISADVANTAGES
DISADVANTAGES
1. Costly in terms of hospital stay
2. Hazards of prolonged bed rest :...
APPLIANCES
BED AND FRAMES
KNOTS
PULLEYS WEIGHTS
APPLIANCES
BED AND FRAMES
• Standard bed has 4-post traction frame
• Ideal bed for traction with multiple injuries is adju...
APPLIANCES
BED AND FRAMES
• Bradford frame enables bedpan and linen changes
without moving pt
• Alternatively bed can be f...
APPLIANCES
KNOTS
• Ideal knots can be tied with
one hand while holding
weight
• Easy to tie and untie
• Overhand loop knot...
APPLIANCES
KNOTS
• A slip knot tightens under
tension
• Up and over, down and
over, up and through
APPLIANCES
KNOTS
• Clover hitch
• Barrel hitch
• Reef knot
• Half hitch
• Two half hitches
APPLIANCES
PULLEYS
• To control the direction of
weight
• By altering site and by using
more than 1 pulley the force
exert...
APPLIANCES
WEIGHTS
• Amount of weight required depends
upon
• Wt of the appliance
• Wt of part of body suspended
• Amount ...
APPLIANCES
ATTENTION!!!
1. POSITION
2. COUNTERTRACTION
3. FRICTION
4. CONTINOUS
5. LINE OF PULL
6. PROTECTION OF CARDIOVAS...
TYPE OF TRACTION
BASED ON PRINCIPLE
1. Fixed Traction
2. Sliding Traction
BASED ON APPLICATION
1. Skin Traction
2. Skeleta...
TYPE OF TRACTION
BASED ON PRINCIPLE
1. Fixed Traction
Traction is applied to the leg against a fixed point of
counter pres...
TYPE OF TRACTION
BASED ON PRINCIPLE
Thomas Splint
• Used for fracture shaft of
femur
• Counter traction provided
by ischea...
TYPE OF TRACTION
BASED ON PRINCIPLE
When the weight of all or part of the body, acting
under the influence of gravity, is ...
SKIN TRACTION
• Traction force is applied over a large area of skin
• Applied over limb distal to fracture site
• Anterome...
SKIN TRACTION
• Skin damage can result from too much of traction force.
• Maximum weight recommended for skin traction is ...
SKIN TRACTION
• Prepare the skin by shaving as well as washing &
applying tincture benzoin which protects the skin
and act...
SKIN TRACTION
• Useful in thin and atrophic skin
• Frequent reapplication may be necessary
• Attached traction wt. must no...
SKIN TRACTION
• Temporary management of fracture of NOF and IT #
• Management of fracture - Femoral shaft of older and
hef...
SKIN TRACTION
• Abrasions and lacerations of skin in the area to
which traction is to be applied
• Varicose veins, impendi...
SKIN TRACTION
Complication
• Allergic reactions to adhesive
• Excortication of skin
• Pressure sores
• Common peroneal ner...
SKELETAL TRACTION
• It may be used as a means of reducing or
maintaining the reduction of a fracture
• It should be reserv...
SKELETAL TRACTION
• Rigid stainless steel pins of varying lengths 4 – 6
mm in diameter. Bohler stirrup is attached to
stei...
SKELETAL TRACTION
• Identical to stienmann pin except for a short threaded
length in the center . This threaded portion en...
SKELETAL TRACTION
• They are easy to insert and minimize the chance of soft
tissue damage and infections
• It easily cuts ...
SKELETAL TRACTION
• Follow regular OT procedures
• Use GA or LA
• Paint the skin with iodine and spirit
• Mount the pin/wi...
SKELETAL TRACTION
Application
• Apply small cotton woolen pads soaked in tincture
around the pins to seal the wound
• The ...
SKELETAL TRACTION
• Introduction of infection into bone
• Distraction at fracture site
• Ligamentous damage
• Damage to ep...
• Used to treat the unstable spine
• Pull along axis of spine
• Preserves alignment and volume of canal
SPECIFIC TRACTION
...
SPECIFIC TRACTION
SPINAL TRACTION
• Easy to apply
• Place directly cephalad to
external auditory meatus
• In line with mas...
SPECIFIC TRACTION
SPINAL TRACTION
Gardner Tongs
• Pin site care important
• Weight ranges from 5 lbs for c-spine to
about ...
SPECIFIC TRACTION
SPINAL TRACTION
Crutchfield Tongs
• Must incise skin and drill cortex to place
• Rotate metal traction l...
SPECIFIC TRACTION
SPINAL TRACTION
Recommended Weights in Cervical Traction
(Crutchfield)
SPECIFIC TRACTION
SPINAL TRACTION
• Direction of traction force can be controlled
• No movement between skull and fixation...
SPECIFIC TRACTION
SPINAL TRACTION
Halo Ring Traction
• Ring with threaded holes
• Allow 1-1.5 cm clearance around head
• P...
SPECIFIC TRACTION
SPINAL TRACTION
Halo Ring Traction
• Two anterior pins
• Placed in frontal bone groove
• Sup and lat to ...
SPECIFIC TRACTION
SPINAL TRACTION
• To immobilize the spine.
• To slowly correct or reduce
the deformities of the spine
su...
SPECIFIC TRACTION
• Can treat most fractures
• Requires bed rest
• Usually reserved for comatose or multiply injured
patie...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
Forearm Skin Traction
• Adhesive strip with Ace wrap
• Useful for elevation in ...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
• Used for greater tuberosity or prox
humeral shaft fx
• Arm abducted 30 degree...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
Dunlop’s Traction• Used for supracondylar
and transcondylar
fractures in childr...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
Olecranon Pin Traction
• Supracondylar/distal humerus fractures
• Greater tract...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
• Used for humeral
fractures
• Arm held in moderate
abduction
• Forearm in skin...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
• Point of insertion:
• just deep to the SC border of the upper end of ulna
(3c...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
Metacarpal Pin Traction
• Used for obtaining difficult
reduction forearm/distal...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
Metacarpal Pin Traction
• Point of Insertion: 2-2.5 cms proximal to the
distal ...
SPECIFIC TRACTION
UPPER EXTREMITY TRACTION
Finger traps
• Used for distal forearm
reductions
• Changing fingers imparts
ra...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Can be used to treat most lower extremity fractures
of the long bones
• Requi...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Often used preoperatively for
femoral fractures
• Can use tape or pre-made bo...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Several traction options for
acetabular fractures
• Lateral traction for frac...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Lateral surface of femur (2.5cm) below the
most prominent part of GT midway
b...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Buck’s with sling
• May be used in more distal
femur fx in children
• Can be ...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Useful for treatment femoral shaft fx in
infant or small child
• Combines gal...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Useful for subtroch and proximal
3rd femur fx
• Especially in young children
...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
Distal Femoral Traction
• Alignment of traction along axis
of femur
• Used for ...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
Distal Femoral Traction
• Draw 1st line from before backwards
at the level of t...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Used for distal 2/3rd femoral shaft fx
• Femoral pin allows rotational moment...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Treatment of Fr tibia.
• Treatment of Fr of femur
from the subtrochanter
regi...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
Balanced Suspension with Pearson Attachment
• Enables elevation of limb to
corr...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Middle 3rd fx had mild flexion prox fragment
• 30 degrees elevation with trac...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Useful in certain tibial plateau fx
• Pin inserted 5 cm above the level of
th...
SPECIFIC TRACTION
LOWER EXTREMITY TRACTION
• Temporary traction for tibial shaft
fx or calcaneal fx
• Insert about 1.5 inc...
THANK YOU
Upcoming SlideShare
Loading in …5
×

Traction in orthopaedic

7,663 views

Published on

application of traction in orthopaedic practice

Published in: Health & Medicine
  • Be the first to comment

Traction in orthopaedic

  1. 1. TRACTION IN ORTHOPAEDIC GEDE MADE OKA RAHADITYA Orthopaedic and Traumatology Department – Saiful Anwar Hospital, Malang
  2. 2. OUTLINES DEFINITION AND PRINCIPLES HISTORY PURPOSE, ADVANTAGES AND DISADVANTAGES APPLIANCES TYPE OF TRACTION SKIN TRACTION SKELETAL TRACTION SPECIFIC TRACTION
  3. 3. DEFINITION AND PRINCIPLES raction is the application of a pulling force to a part of the body “Traction is the application of a pulling force for medical purposes, to treat muscle or skeletal disorder - for example, to reduce fracture, maintain bone alignment, relieve pain, or prevent spinal injury” “Traction is the application of a force to stretch certain parts of the body in a specific direction”
  4. 4. DEFINITION AND PRINCIPLES PRINCIPLES • Provide Counter traction, using the patient’s body or pull of weights in the opposite direction . • Maintain continuous traction in a correct line of pull. • Prevent friction • Provide daily traction care
  5. 5. HISTORY • The use of traction dates as far back as 3000 years (Aztecs and the ancient Egyptians) • Hippocrates (350 BC) wrote about manual traction and the forces of extension and counterextension • Guy de Chauliac (1300 - 1368) : introduction of continuous traction
  6. 6. HISTORY Pott’s doctrine • Most Fracture deformities result from the contraction of the surrounding muscles • Fractured limb should be placed in the positions in which its muscles are most relaxed • Shaft of the femur : flexion of the hip and the knee
  7. 7. PURPOSE, ADVANTAGES AND DISADVANTAGES • CONTROLS PAIN • REDUCES FRACTURE • MAINTAIN REDUCTION • PREVENTS AND CORRECT DEFORMITY PURPOSE
  8. 8. PURPOSE, ADVANTAGES AND DISADVANTAGES ADVANTAGES • Reduce pain • Minimize muscle spasm • bone reduce and held by soft tissue • increase space between opposing surfaces • allows more joint mobility than plaster
  9. 9. PURPOSE, ADVANTAGES AND DISADVANTAGES DISADVANTAGES 1. Costly in terms of hospital stay 2. Hazards of prolonged bed rest : • DVT, PE • Pressure wounds/ulcers • Pneumonia 3. Requires meticulous nursing care 4. Can develop contractures
  10. 10. APPLIANCES BED AND FRAMES KNOTS PULLEYS WEIGHTS
  11. 11. APPLIANCES BED 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
  12. 12. APPLIANCES BED AND FRAMES • Bradford frame enables bedpan and linen changes without moving pt • Alternatively bed can be flexible to allow bending at hip or knee
  13. 13. APPLIANCES KNOTS • Ideal knots can be tied with one hand while holding weight • Easy to tie and untie • Overhand loop knot will not slip
  14. 14. APPLIANCES KNOTS • A slip knot tightens under tension • Up and over, down and over, up and through
  15. 15. APPLIANCES KNOTS • Clover hitch • Barrel hitch • Reef knot • Half hitch • Two half hitches
  16. 16. APPLIANCES 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
  17. 17. APPLIANCES 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
  18. 18. APPLIANCES ATTENTION!!! 1. POSITION 2. COUNTERTRACTION 3. FRICTION 4. CONTINOUS 5. LINE OF PULL 6. PROTECTION OF CARDIOVASCULAR SYSTEM 7. MAINTENANCE OF NEUROVASCULAR STATUS 8. SKIN CARE 9. MAINTENANCE OF THE MUSCULOSKELETAL SYSTEM 10.NEVER IGNORE A PATIENT’S COMPLAINT
  19. 19. TYPE OF TRACTION BASED ON PRINCIPLE 1. Fixed Traction 2. Sliding Traction BASED ON APPLICATION 1. Skin Traction 2. Skeletal Traction
  20. 20. TYPE OF TRACTION BASED ON PRINCIPLE 1. 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
  21. 21. TYPE OF TRACTION BASED ON PRINCIPLE Thomas Splint • Used for fracture shaft of femur • Counter traction provided by ischeal Tuberosity
  22. 22. TYPE OF TRACTION BASED ON PRINCIPLE When the weight of all or part of the body, acting under the influence of gravity, is utilized to provide counter-traction. 2. Sliding Traction
  23. 23. 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
  24. 24. SKIN TRACTION • Skin damage can result from too much of traction force. • Maximum weight recommended for skin traction is 6.7 kg • depending on size and weight of the patient Weight
  25. 25. 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. Adhesive skin traction
  26. 26. SKIN TRACTION • Useful in thin and atrophic skin • Frequent reapplication may be necessary • Attached traction wt. must not be more than 4.5 kgs. Non adhesive skin traction
  27. 27. SKIN TRACTION • Temporary management of fracture of NOF and IT # • Management of fracture - Femoral shaft of older and hefty children • Undisplaced fracture of acetabulum • After reduction of dislocation of Hip • To correct minor fixed flexion deformities of hip and knee Indication
  28. 28. SKIN TRACTION • 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 Contraindication
  29. 29. SKIN TRACTION Complication • Allergic reactions to adhesive • Excortication of skin • Pressure sores • Common peroneal nerve palsy
  30. 30. 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
  31. 31. SKELETAL TRACTION • 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 Steinmann Pin
  32. 32. SKELETAL TRACTION • 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
  33. 33. SKELETAL TRACTION • They are easy to insert and minimize the chance of soft tissue damage and infections • It easily cuts out of the bone if a heavy traction weight is applied • Most commonly used in upper limb eg. Olecranon traction Kirschner wire
  34. 34. SKELETAL TRACTION • Follow regular OT procedures • Use GA or LA • Paint the skin with iodine and spirit • Mount the pin/wire on the hand drill • Hold the limb in same degree of lateral rotation as the normal limb and with ankle at right angles. • Identify the site of insertion and make a stab wound • Hold the pin horizontally at right angles to the long axis of the limb. Application
  35. 35. SKELETAL TRACTION Application • Apply small cotton woolen pads soaked in tincture around the pins to seal the wound • The pin should pass only through skin, SC tissue and bone avoiding muscles and tendons
  36. 36. SKELETAL TRACTION • Introduction of infection into bone • Distraction at fracture site • Ligamentous damage • Damage to epiphyseal growth plates • Depressed scars Complications
  37. 37. • Used to treat the unstable spine • Pull along axis of spine • Preserves alignment and volume of canal SPECIFIC TRACTION SPINAL TRACTION
  38. 38. SPECIFIC TRACTION SPINAL TRACTION • Easy to apply • Place directly cephalad to external auditory meatus • In line with mastoid process • Just clear top of ears • Screws applied with 30 lbs pressure Gardner Tongs
  39. 39. SPECIFIC TRACTION SPINAL TRACTION Gardner Tongs • Pin site care important • Weight ranges from 5 lbs for c-spine to about 20 lbs for lumbar spine • Excessive manipulation with placement must be avoided • Poor placement can cause flex/ext forces • Can get occipital decubitus
  40. 40. SPECIFIC TRACTION SPINAL TRACTION Crutchfield Tongs • Must incise skin and drill cortex to place • Rotate metal traction loop so touches skull in midsagittal plane • Place directly above ext auditory meatus • Risks similar to Gardner tongs
  41. 41. SPECIFIC TRACTION SPINAL TRACTION Recommended Weights in Cervical Traction (Crutchfield)
  42. 42. SPECIFIC TRACTION SPINAL TRACTION • Direction of traction force can be controlled • No movement between skull and fixation pins • Allows the pt out of bed while traction maintained • Used for c-spine or t-spine fx Halo Ring Traction
  43. 43. SPECIFIC TRACTION SPINAL TRACTION Halo Ring Traction • Ring with threaded holes • Allow 1-1.5 cm clearance around head • Place below equator • Spacer discs used to position ring • Central anterior and 2 most posterior
  44. 44. SPECIFIC TRACTION SPINAL TRACTION Halo Ring Traction • Two anterior pins • Placed in frontal bone groove • Sup and lat to supraorbital ridge • Two posterior pins • Placed posterior and superior to external ear • Tighten pins to 5-6 inch-pounds with screwdriver
  45. 45. SPECIFIC TRACTION SPINAL TRACTION • To immobilize the spine. • To slowly correct or reduce the deformities of the spine such as scoliosis. Halo pelvic traction
  46. 46. SPECIFIC TRACTION • Can treat most fractures • Requires bed rest • Usually reserved for comatose or multiply injured patient or settings where surgery can not be done UPPER EXTREMITY TRACTION
  47. 47. SPECIFIC TRACTION UPPER EXTREMITY TRACTION Forearm Skin Traction • Adhesive strip with Ace wrap • Useful for elevation in any injury • Can treat difficult clavicle fractures with excellent cosmetic result • Risk is skin loss
  48. 48. SPECIFIC TRACTION UPPER EXTREMITY 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 fossa Double Skin Traction
  49. 49. SPECIFIC TRACTION UPPER EXTREMITY TRACTION Dunlop’s Traction• Used for supracondylar and transcondylar fractures in children • Used when closed reduction difficult or traumatic • Forearm skin traction with weight on upper arm • Elbow flexed 45 degrees
  50. 50. SPECIFIC TRACTION UPPER EXTREMITY TRACTION Olecranon Pin Traction • Supracondylar/distal humerus fractures • Greater traction forces allowed • Can make angular and rotational corrections • Place pin 1.25 inches distal to tip • Avoid ulnar nerve
  51. 51. SPECIFIC TRACTION UPPER EXTREMITY TRACTION • Used for humeral fractures • Arm held in moderate abduction • Forearm in skin traction • Excessive weight will distract fracture Lateral Olecranon Traction
  52. 52. SPECIFIC TRACTION UPPER EXTREMITY TRACTION • Point of insertion: • just deep to the SC border of the upper end of ulna (3cms) • This avoids ulnar joint and also an open epiphysis • Technique: • Pass K-wire from medial to lateral side - pass the wire at right angles to the long axis of the ulna to avoid ulnar nerve Olecranon traction
  53. 53. SPECIFIC TRACTION UPPER EXTREMITY TRACTION Metacarpal Pin Traction • Used for obtaining difficult reduction forearm/distal radius fx • Once reduction obtained, pins can be incorporated in cast • Pin placed radial to ulnar through base 2nd/3rd MC • Stiffness intrinsics common
  54. 54. SPECIFIC TRACTION UPPER EXTREMITY TRACTION Metacarpal Pin Traction • Point of Insertion: 2-2.5 cms proximal to the distal end of 2nd metacarpal • Technique: push the 1st dorsal interosseius muscle volarly and palpate the subcutaneous portion of the bone. Pass the K-wire at right angles to the longitudinal axis of the radius, the wire traversing 2nd and 3rd metacarpal diaphysis transversly.
  55. 55. SPECIFIC TRACTION UPPER EXTREMITY TRACTION Finger traps • Used for distal forearm reductions • Changing fingers imparts radial/ulnar angulation • Can get skin loss/necrosis • Recommend no more than 20 minutes
  56. 56. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Can be used to treat most lower extremity fractures of the long bones • Requires bed rest • Used when surgery can not be done for one reason or another • Uses skin and skeletal traction
  57. 57. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Often used preoperatively for femoral fractures • Can use tape or pre-made boot • No more than 10 lbs • Not used to obtain or hold reduction Buck’s Traction
  58. 58. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Several traction options for acetabular fractures • Lateral traction for fractures with medial or anterior force • Stretched capsule and ligamentum may reduce acetabular fragments Upper Femoral Traction
  59. 59. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Lateral surface of femur (2.5cm) below the most prominent part of GT midway between the anterior and posterior surface of femur • A coarse threaded cancellous screw is used. Must avoid suprapatellar pouch, NV structures, and growth plate in children Femoral Traction Pin
  60. 60. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Buck’s with sling • May be used in more distal femur fx in children • Can be modified to hip and knee exerciser Split Russell’s Traction
  61. 61. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Useful for treatment femoral shaft fx in infant or small child • Combines gallows traction and Buck’s traction • Raise mattress for countertraction • Rarely, if ever used currently Bryant’s Traction
  62. 62. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Useful for subtroch and proximal 3rd femur fx • Especially in young children • Matches flexion of proximal fragment • Can cause flexion contracture in adult 90-90 Traction
  63. 63. SPECIFIC TRACTION LOWER EXTREMITY TRACTION 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 knee pathology present
  64. 64. SPECIFIC TRACTION LOWER EXTREMITY TRACTION Distal Femoral Traction • Draw 1st line from before backwards at the level of the upper pole of patella,2nd line from below upwards anterior to the head of the fibula, where these two lines intersect is the point of insertion of a Steinmann pin • Just proximal to lateral femoral condyle. In an average adult this point lies nearly 3 cm from the lateral knee joint line
  65. 65. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Used for distal 2/3rd femoral shaft fx • Femoral pin allows rotational moments • Easy to avoid joint and growth plate • 2cm distal and posterior to tibial tubercle • Pin should be driven from the lateral to the medial side to avoid damage to the common peroneal nerve. Proximal Tibial Traction
  66. 66. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Treatment of Fr tibia. • Treatment of Fr of femur from the subtrochanter region and distally. • Trochanteric Fr of femur in pts under 45-50yrs age. • Denham pin is inserted through upper end of tibia for fr of femur, the mid tibia for fr of condyles of tibia. Perkin’s traction:
  67. 67. SPECIFIC TRACTION LOWER EXTREMITY TRACTION Balanced Suspension with Pearson Attachment • Enables elevation of limb to correct angular malalignment • Counterweighted support system • Four suspension points allow angular and rotational control
  68. 68. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Middle 3rd fx had mild flexion prox fragment • 30 degrees elevation with traction in line with femur • Distal 3rd fx has distal fragment flexed post • Knee should be flexed more sharply • Fulcrum at level fracture • Traction at downward angle • Reduces pull gastroc Pearson Attachment
  69. 69. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Useful in certain tibial plateau fx • Pin inserted 5 cm above the level of the ankle joint, midway between the anterior and posterior borders of the tibia • Avoid saphenous vein • Place through fibula to avoid peroneal nerve • Maintain partial hip and knee flexion Distal Tibial Traction
  70. 70. SPECIFIC TRACTION LOWER EXTREMITY TRACTION • Temporary traction for tibial shaft fx or calcaneal fx • Insert about 1.5 inches (4cms) inferior and posterior to medial malleolus • Do not skewer subtalar joint • Maintain slight elevation leg Calcaneal Traction
  71. 71. THANK YOU

×