traction & splints in orthopaedics

1. Traction & Splints
By
Dr. C Rajesh

2. O Definition : traction is defined as force
applied to overcome the muscle spasm

3. Types
O Based on method of application
Skin traction
Skeletal traction

4. O Based on mechanism
O Fixed Traction
By applying force against a fixed point
of body.
O Sliding Traction
By tilting bed so that patient tends to
slide in opposite direction to traction
force

5. counter traction
O To overcome the muscle spasm the force
applied in opposite direction of traction
force is called counter traction.
O

6. History
O Skin traction used extensively in Civil War
for fractured femurs
O Known as the “American Method”
O Skeletal traction by a pin through bone
introduced by Steinmann and Kirschner

7. O Hippocrates- treated fracture shaft of
femur and of leg with the leg straight in
extension
O Guy de chauliac- introduced continuous
isotonic traction in the fracture of femur

8. O
O Percival pott- fractured limb should be
placed in the position in which muscles
are most relaxed
O Josiah crosby – isotonic skin traction for
treatment of shaft of femur
O Thomas Bryant- Braynt’s traction for
treatment of fracture shaft of femur in
children
O Thomas – Thomas splint, used for
applying fixed traction

9.  Malgaigne introduced the 1st effective
traction which grasped the bone itself. He
used malgaigne’s 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.

10. Indications
O To reduce the fracture or dislocation
O To maintain the reduction
O To correct the deformity
O To reduce the muscle spasm

11. Advantages
O Decrease pain
O Minimize muscle spasms
O Reduces, aligns, and immobilizes
fractures
O Reduce deformity
O Increase space between opposing
surfaces

12. Disadvantages
O Costly in terms of hospital stay
O Hazards of prolonged bed rest
O Thromboembolism
O Decubitius ulcers
O Pneumonia
O Requires meticulous nursing care
O Can develop contractures

13. Traction suspension system
• Bed and Balkan beam
• Splints- Thomas splint, Bohler-Braun frame,
Fisk Splint
• Slings and padding
• Skin traction
• Skeletal traction- Steinmann pin, Denham pin
or Kirschner wire
• Bohler Stirrup
• Cord
• Pulleys
• Weights

14. Bed and balkans beam

15. Cords
O Sash cord generally used
O Easier recognition of each cord is possible
if cords of two different colours used

16. Knots
O Clover hitch
O Barrel hitch
O Reef knot
O Half hitch
O Two half hitches

17. Pulleys
O To control the direction of weight
O By altering site and by using more than 1 pulley the
force exerted by a given weight can be increased
O Pulleys of 5-6.25cm diameter with 6cm diameter
axles are preferable

18. Weights
Amount of weight required depends upon
O Wt of the appliance
O Wt of part of body suspended
O Amount of friction present in the system
O Mechanical advantage of the system
employed for suspension

19. Skin traction
O Applied over a large area of skin
O This spreads the load and is more
comfortable and efficient
O Traction force must be applied distal to
fracture site
O Maximum traction weight can be applied
with skin traction is 15lb ( 6.7kg )

20. O Two types
O Adhesive skin traction
O Nonadhesive skin traction

21. Adhesive skin traction
O Elastoplast skin traction kit
O Tractac
O Seton skin traction kit
O Orthotrac
O Skin- trac

23.  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.

24. Non adhesive skin traction
 Useful in thin and atrophic skin
 allergy to adhesive strapping
 Frequent reapplication may be necessary
 Attached traction wt. must not be more
than 10lb ( 4.5kg )

25. O Ventfoam skin traction bandage
O Specialist foam traction
O Notac traction

27. Contraindications
O Abrasions of the skin
O Lacerations of the skin in the area to
which traction is applied
O Impairment of circulation – varicose
ulcers, impending gangrene
O Dermatitis
O Marked shortening of bony fragments,
when traction weight is required will be
greater than can be applied through the
skin

28. Complications
O Allergic reaction to adhesive
O Excoriation of skin from stripping of the
adhesive strapping
O Pressure sore around the malleoli and
over the tendocalcaneus
O Common peroneal nerve palsy

29. Buck’s traction
O Used in temporary
management of
fractures of
O Femoral neck
O Femoral shaft in older
children
O Undisplaced fractures of
the acetabulum
O After reduction of a hip
dislocation
O To correct minor flexed
deformities of the hip or
knee
O In place of pelvic traction
in management of low
back pain
O Can use tape orpre-made boot
O Not more than 4.5kgs
O Not used to obtainor hold reduction

30. Hamilton Russell Traction
O Used in management of fractures of the
femoral shaft
O After arthroplasty operations of hip
O Buck’s traction with sling under the knee

32. Bryants traction
O Convenient and satisfactory for the
treatment of fractures of the shaft of femur
in children upto age of two years who
weight less than 35-40lb ( 15.9- 18.2kg )

33. O Apply adhesive strapping to both
lowerlimbs
O Tie the traction cords to an overhead
beam
O Tighten the traction cords sufficiently to
raise the buttocks just clear of the
mattress
O Counter traction is obtained by the weight
of the pelvis and lower trunk
O Check the vascular status of limbs
because of danger of vascular
compromise

35. Modified Bryant’s traction
O Sometimes used in initial management of
congenital dislocation of hip
O After 5days of application of bryants
traction abduction of both hips begun,
being increased by 10 degrees on
alternate days
O By three weeks hips should be fully
abducted

37. Forearm Skin Traction
O Adhesive strip with
Ace wrap
O Useful for elevation
in any injury
O Can treat difficult
clavicle fractures
with excellent
cosmetic result
O Risk is skin loss

38. Double Skin Traction
O Used for greater
tuberosity or prox
humeral shaft fx
O Arm abducted 30
degrees
O Elbow flexed 90
degrees
O 7-10 lbs on forearm
O 5-7 lbs on arm
O Risk of ischemia at
antecubital fossa

39. Dunlop’s Traction
O Used for
supracondylar and
transcondylar fractures
in children
O Used when closed
reduction difficult or
traumatic
O Forearm skin traction
with weight on upper
arm
O Elbow flexed 45
degrees

40. Finger traps
O Used for distal
forearm
reductions
O Changing fingers
imparts
radial/ulnar
angulation
O Can get skin
loss/necrosis
O Recommend no
more than 20
minutes

41. Head Halter traction
O Simple type cervical
traction
O Management of
neck pain
O Weight should not
exceed 2.3 kg
O Can only be used a
few hours at a time
O Canvas ( chin ) &
crile ( head )

42. Agnes Hunt traction
O To correct mild flexion deformity of hip

43. Pelvic traction
O Used in conservative management of
prolapse of intervertebral disc

44. Skeletal traction
O It should be reserved for those cases
in which skin traction is
contraindicated
O In patients with lacerated wounds
O In patients with external fixator in situ
O When the weight required for traction
is more then 6.5 kgs- Obese patients

45. Steinmann Pin
O 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

46. Denham Pin
O 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
O Used in cancellous bone like calcaneum
and osteoporitic bones

47. Kirschner wire
O They are easy to insert and minimize the
chance of soft tissue damage and
infections
O It easily cuts out of the bone if a heavy
traction weight is applied
O Most commonly used in upper limb eg.
Olecranon traction

48. Application
 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.

49.  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

50. Complications
O Introduction of infection into bone
O Distraction at fracture site
O Ligamentous damage
O Damage to epiphyseal growth plates
O Depressed scars

51. Proximal Tibial Traction
• Used for distal
2/3rd femoral
shaft fractures
• Tibial 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.

52. Upper Femoral Traction
O Lateral surface of
femur 1 inch below
the most prominent
part of femur
O Stretched capsule
and ligamentum
teres may reduce
acetabular
fragments

53. Distal Femoral Traction
O Alignment of
traction along
axis of femur
O Used for superior
force acetabular
fracture and
femoral shaft
fracture
O Used when strong
force needed or
knee pathology
present

54. • 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

55. Ninety-Ninety Traction
O Originally devised by Obletz
O Useful for subtrochantric and
proximal 3rd femur fracture
Especially in young children
Matches flexion of proximal fragment

56. Application
O Using a Tulloch – Brown U- loop
O Using a second steinmann pin
O Using a below knee pop cast

58. O Dangers of 90/90 traction :
O Those of skeletal traction
O Stiffness and loss of extension of the knee
O Flexion contracture of hip
O Injury to the lower femoral or upper tibial
epiphyseal growth plates in children
O Neurovascular damage

59. Perkin’s traction
Treatment of fractures of tibia
and of the femur from the
subtrochantric region distally.
 Basis of management is the use of
skeletal traction coupled with active
movements of the injured limb
 By encouraging early muscular
activity, the development of stiff
joint is frequently prevented by
both maintaining extensibility of
muscles , and preventing
stagnation of tissue fluid

60. Application of Perkin’s
traction
O A Hadfield split bed is required
O Under General anaesthesia and full aseptic conditions, a
Denham pin is inserted through the upper end of tibia
O A Simonis swivel is attached to end of each Denham pin
O Two traction cords are connected to each of swivel
O 4.6 kg weight is attached to each traction cord making a
total traction weight of 9.2 kg
O Foot end of the bed is elevated by one inch for each 0.46
kg of traction weight
O One or more pillow is placed under the thigh to maintain
the anterior bowing of the femoral shaft
O Length of the limb is checked with a tape measure and
total traction weight is increased or decreased as
necessary
O Active Quadriceps exercises are started immediately and
continued
O Knee flexion is started after a week of admission, under

62. Balanced Suspension with
Pearson Attachment
O Enables elevation
of limb to correct
angular
malalignment
O Counterweighted
support system
O Four suspension
points allow
angular and
rotational control

63. • Middle 3rd fracture
has mild flexion
proximal fragment
• 30 degrees elevation
with traction in line
with femur
• Distal 3rd fracture has
distal fragment flexed
posterior
• Knee should be flexed
more sharply
• Fulcrum at level of
fracture
• Traction at downward
angle
• Reduces pull of
gastrocnemius

64. Distal Tibial Traction
 Useful in certain
tibial plateau
fracture
 Pin inserted 5 cm
above the level of
the ankle joint,
midway between
the anterior and
posterior borders
of the tibia
 Avoid saphenous
vein
 Maintain partial
hip and knee

65. Calcaneal Traction
 Temporary traction
for tibial shaft
fracture or
calcaneal fracture
 Insert about 1 1/4
inches (3cms)
inferior and
posterior to medial
malleolus
 Do not skewer
subtalar joint or NV
bundle
 Maintain slight
elevation leg

66. Olecranon Pin Traction
 Supracondylar/dist
al humerus
fractures
 Greater traction
forces allowed
 Can make angular
and rotational
corrections
 Place pin 1.25
inches distal to tip
 Avoid ulnar nerve

67. Lateral Olecranon Traction
O Used for humeral
fractures
O Arm held in
moderate
abduction
O Forearm in skin
traction
O Excessive weight
will distract
fracture

68. • 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.

69. Metacarpal Pin Traction
 Used for obtaining
difficult reduction
forearm/distal
radius fracture
 Once reduction
obtained, pins can
be incorporated in
cast
 Pin placed radial to
ulnar through base
2nd/3rd MC
 Stiffness of
intrinsics is
common

70. • Point of Insertion:
2-2.5 cms proximal
to the distal end of
2nd metacarpal
• Technique: push
the 1st dorsal
interosseius 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

71. Gardner Tongs
O U shaped tongs,
used for spinal
traction
O In patients having
cervical injury
O Easy to apply
O Place directly
above external
auditory meatus
O In line with
mastoid process
O Just clear top of
ears

72. O Pin site care
important
O Weight ranges
from2.3 kg to 15.8
kg for c-spine
O Excessive
manipulation with
placement must be
avoided
O Poor placement can
cause
flexion/extension
forces
O Patient can get
occipital decubitus

73. Crutchfield Tongs
O Crutchfield tongs
fit into the
parietal bones
O A special drill
point with a
shoulder is used
to enable an
accurate depth of
hole to be drilled

74. O Sedate the patient
O Shave the scalp
locally
O Draw a line on the
scalp, bisecting the
skull from front to
back
O Draw a second line
joining the tips of
the mastoid
processes which
crosses the first
line at right angles
O Fully open out the
tongs

75.  With the fully open tongs lying equally on each side
of the antero-posterior line, press the points into
the scalp making dimples on the second line.
 Infiltrate the area of the dimples down to and
including the periosteum, with local anaesthetic
solution.
 Make small stab wounds in the scalp at the dimples.
 Using the special drill point, drill through the outer
table of the skull in a direction parallel to the points
of the tongs.
 Fit the points of the tongs into the drill holes.
 Tighten the adjustment screw until a firm grip is
obtained, and repeat daily for the first 3 to 4 days,
and then tighten when necessary
 Attach a traction cord to the two lugs.
 Attach a weight to the traction cord.
 Raise the head end of the bed to provide counter
traction

76. Management of patients in
traction
O Care of the patient
O Care of the traction suspension system
O Radiographic examination
O Physiotherapy
O Removal of traction

77. In The Patient
Care of the injured limb-
• Pain
• Parasthesia or Numbness
• Skin irritation
• Swelling
• Weakness of ankle, toe, wrist or finger
movement

78. Radiographic
Examination
O 2-3 times in first week
O Weekly for next 3 weeks
O Monthly until union occurs
O After each manipulation
O After each weight change

79. Removal Of Traction
 Elbow fracture with olecranon pin - 3
weeks
 Tibial fracture with calcaneal pin -
3-6 weeks
 Trochanteric fracture of femur - 6
weeks
 Femoral shaft fracture
 with application of cast brace and
partial weight bearing - 6 weeks
 without external support and
partial weight bearing - 12
weeks

80. Splints

81. • A splint is a rigid support with padding made
from metal, plaster or plastic to support,
protect, or immobilize an injured or inflamed
part of the body which helps prevent further
injury, and to minimize pain
Definition

82. • Fractures
• Sprains
• Joint infections
• Tenosynovitis
• Arthritis
Indications for Splinting

83. • To reduce/prevent contracture
• To increase grip strength
• To stabilize and rest joint in ligamentous injury
• To correct deformity
• To support and immobilize joints and limbs
postoperatively until healing has occured

84. Contraindications
 Compartment syndrome
 Skin at high risk for infection

85. • Plaster of Paris
– Made from gypsum - calcium sulfate
dehydrate
– Exothermic reaction when wet -
recrystallizes (can burn patient)
– Average setting time – 3-9 min
– Average drying time – 24-72 hours

86. Factors decreasing setting
time :- Hot water, Salt,
Borax, Resins
Factors increasing setting
time :- Cold water, sugar
Upper extremities :– use 8-
10 layers
Lower extremities :-12-15
layers up to 20 if big
person (increased risk of
burn!)

87. Advantage
• Easier to mold
• Less expensive
Disadvantage
• More difficult to apply
• Gets soggy when getting wet

88. Ready Made Splinting Material
(1) Plaster (OCL)
• 10 -20 sheets of plaster with padding and cloth cover
(2) Fiberglass (Orthoglass)
• Cure rapidly (20 minutes)
• Less messy
• Stronger, lighter, wicks moisture better
• Less moldable

89. O Disadvantage
O • More expensive
O • More difficult to mold

90. Prefabricated splints
• Plastic shells lined with air cells, foam or gel
components
• Same advantages and disadvantages as
fiberglass splints

91. Air splints
• Provide less support than plaster and fiberglass Splints
• Used for ankle sprains rather than fractures or
Dislocations
• Used to prevent eversion/inversion while permitting free
flexion and extension of ankle
• Provides clear view of
injury during x-ray

92. Vacuum splints
- Styrofoam chips contained inside an
airtight cloth, pliable sleeve
- Molds to shape of limb using a
handheld pump to draw out the air from
within the sleeve

93. Pre / Post - Splint Checks
• F – Function
• A – Arterial Pulse
• C – Capillary Refill
• T – Temperature (Skin)
• S - Sensation

94. Upper Extremity
• Shoulder And Arm
- Figure of eight
- Sling and Swathe
- Aeroplane splint
• Elbow/Forearm
– Long Arm Posterior
– Double Sugar - Tong
• Forearm/Wrist
– Volar Forearm / Cockup
– Sugar - Tong
• Hand/Fingers
– Ulnar Gutter
– Radial Gutter
– Thumb Spica
– Finger Splints
– Knuckle-bender splint

95. Lower Extremity
• Hip and Thigh
- Von Rosen’s Splint
- Thomas Splint
- Bohler-Braun Splint
• Knee
- Knee Immobilizer / Bledsoe
- Bulky Jones
- Posterior Knee Splint
• Ankle
- Posterior Ankle
- Stirrup
• Foot
- Denis-Brown splint
- Buddy taping
Spine
- Cervical Collar
- Four-post Collar
- SOMI (Sternal Occipital
Mandibular Immobilizer)
- Scoliosis
- Milwaukee Brace
- Boston Brace
- Taylor’s Brace

96. Upper
Extremity

97. • Indications:
– Clavicle fractures
• Most figure of eight splints are
prefabricated and Application is
simple.
• Read the product information insert
before applying the splint about the
correct application process.
• Apply with patient standing and
hands on iliac crest.
Shoulders should be abducted
(1) Figure of eight
• Shoulder and Arm

98. Figure of eight

99. (2) Sling and Swathe
• Indication:
– Shoulder and humeral injuries
• Slings supports weight of shoulder
• Swathe holds arm against chest to
prevent shoulder rotation
• Apply the sling and swath with the
patient standing.
• Place the injured arm in the sling
with the elbow at 90 degrees of flexion.
• Next place the strap that is attached to
the sling over the patient head so that
the weight of the arm is supported

100. • Apply the swath.
– This can be anything from
an ACE wrap to a prefabricated
swath. This is designed to hold
the patients affected arm that
is in the sling against the body.
• The swath should wrap around
the front and back of the sling
keeping the affected extremity
against the mid-abdomen
Sling and Swathe

101. (3) Aeroplane Splint
Indication- Brachial plexus injury

102. • Elbow/Forearm
(1) Long Arm Posterior
• Indications:
- Forearm and elbow injuries
- Olecranon and radial head fractures
- Distal humeral fracture
• Not recommended for unstable fractures
• Applied from palmer crease, wrapping around
lateral metacarpals, extending up to posterior arm
with elbow flexed at 90 degrees
NOTE - Doesn’t completely eliminate supination / pronation –either
add an anterior splint or use a double sugar-tong if complex or
unstable distal forearm fx.

103. Long Arm Posterior

104. (2) Double Sugar - Tong
• Indications :-
- Elbow and forearm fx
- prox/mid/distal radius and
ulnar fx.
Better for most distal
forearm and elbow fx
because limits
flex/extension and
pronation / supination.

105. (2) Double Sugar - Tong

106. • Forearm/Wrist
(1) Volar Forearm
• Indications:
- Distal forearm and wrist fractures
- Soft tissue hand / wrist injuries -
sprain, etc•
- Applied from distal
palmer crease to 2/3
forearm
• Allows elbow and
finger ROM
.

107. Volar Forearm / Cockup

108. Forearm Sugar - Tong
• Indications –
Wrist and distal forearm fractures
• Extends from MCP joints on dorsum of hand,
tracks along the forearm, wraps around back
of elbow to volar surface of the arm and
extends down to mid-palmer crease
• Immobilises wrist, forearm, and elbow

109. Forearm Sugar - Tong

110. • Hand/Fingers
• Indications:
– Phalangeal and metacarpal
fractures
• Most common use-Boxer
fractures
• 5th MCP fracture Soft tissue
injury to little and ring finger.
•Indications
- Fractures, phalangeal and
metacarpal and soft tissue
injuries of the index and
middle fingers.
(2) Radial Gutter Splint(1) Ulnar Gutter Splint

111. • Extends from DIP joint to the proximal 2/3 of
the forearm
• Should immobilize the ring and little finger
• MCP should be in 70 degrees of flexion, PIP
should be in 30 degrees of flexion and DIP in
no more than 10 degrees of
flexion
• Ulnar Gutter Splint

112. • Ulnar Gutter Splint

113. • Ulnar Gutter Splint

114. (3) Thumb Spica
Indications:
– Scaphoid fractures , thumb
phalanx fractures or dislocations
• Most Common use:
1) Gamekeepers thumb or skiers
thumb
2) Dequiervans tenosynovitis
• Extends from IP joint of
thumb incorporates the
thumb and extends
up 2/3 of the proximal lateral
forearm

115. (4) Finger Splints
Sprains - dynamic splinting
(buddy strapping).
Dorsal/Volar finger splints - phalangeal
fx, though gutter splints probably better
for proximal fxs.

116. Finger Splints
(a) Stack Splint
Use – management of mallet finger

117. (b) Aluminium Splint
Uses - phalangeal fx,
-mallet finger

118. (c) Oval-8 Finger splint

119. Oval-8 Finger splint

120. (d) Tripoint Splint
Uses – Boutonniere deformity , Swan neck deformity

121. Tripoint Splint

122. (5) Knuckle-bender Splint
Indication- Ulnar Nerve Palsy

123. Cockup splint

124. Lower
Extremity

125. (1) Von Rosen’s Splint
Indication – Congenital dislocation of the Hip
• ‘H’ shaped malleable splint
• Hip should be properly reduced before it
is splinted
• Object is to held hip somewhat flexed and
abducted
• Extreme positions are avoided and Joint
should allowed some movement in the
splint

126. • Uses- Fracture shaft of femur in children and in young
adults once the fracture becomes ‘sticky’
• encircles one or both arms or legs and the chest or trunk.
• It generally is strengthened with a reinforcement bar.
Hip Spica Cast

127. Hip Spica Cast

128. (3) Thomas Splint
• Devised by H.O. Thomas initially for T B of
the knee.
• Indication - Now commonly used for
immobilisation of hip and thigh injuries
• It has a ring and two bars joined distally.
• The ring is at an angle of 120 degree to the
inside bar
• The ring size is found by addition of 2
inches to the thigh circumference at the
highest point of the groin
• The length is the measurement from the
highest point on the medial side of the
groin up to the heel plus 6 inches.

129. Thomas Splint
- used as traction splint

130. (4) Bohler-Braun Splint
• Indication ;- Fracture femur – anywhere
• More convenient than Thomas splint since it has no
ring. As the ring of Thomas splints is a common cause of
discomfort, especially in old people.
• No in-built system of counter-traction , hence it Is not
suitable for transportation.

131. Knee Splint

132. (1) Posterior Ankle Splint
• Indications
- Distal tibia/fibula fx.
- Reduced dislocations
- Severe sprains
- Tarsal / metatarsal fx
• Use at least 12-15 layers of plaster.
• Placed from metatarsal heads on plantar
surface foot, extends up back of leg to level
of fibular neck
NOTE - Adding a coaptation splint (stirrup) to
the posterior splint eliminates inversion /
eversion - especially useful for unstable fx and
sprains.
• Ankle

133. (2) Stirrup Splint
• Indications
- Similar to posterior splint.
- Unstable ankle fx
• Less inversion /eversion and
actually less plantar flexion
compared to posterior
splint.
• Great for ankle sprains.
• 12-15 layers of 4-6 inch
plaster.

134. • The splint should be
long enough to
involve the leg from
below the medial side
of knee, wrap around
the under surface of
the heel, and back up
to the lateral side of
the same knee.
Stirrup Splint

135. Stirrup Splint

136. • Foot
Denis-Brown splint
Indication – Congenital Talipes Equino Varus (C.T.E.V.)
• Used after successful correction
of deformity ,to prevent relapse.
• used throughout the day before
child starts walking.
• Once child starts walking ,a DB
splints is used at night and CTEV
shoes during the day.

137. Denis-Brown splint

138. Buddy strapping
• Indications:
– Phalangeal fractures
of the toes
• Small piece of
wadding placed
between toes to
prevent maceration
• Fractured toe secured
to adjacent toe with
tape

139. • Use a small piece of
wadding and place
between the injured
toe and an adjacent
toe to prevent
maceration
• The fractured toe is
secured to the
adjacent toe with a
piece of tape
Buddy strapping

140. • Spine

141. Cervical Collar
• Flexible foam/Rigid/Adjustable
collar
• Encircles the neck to support the
skull against the thorax inferiorly
• Motion control and keeping warm
at cervical level
• Soft tissue injury, minor sprains
for first few days after injury
• Post operative immobilisation
Note :- They are not useful for very unstable injury pattern

142. Cervical Collar
• Soft Cervical Collar
• Commonly used for
mild soft tissue strains
and sprains

143. • Semi-Rigid Cervical Collar
• Can provide access to the
trachea
• Moderate Control of ROM
• Adjustable
Cervical Collar

144. (2) Four-post Collar
Indication – Neck immobilisation in cervical spine injury
• More stable than cervical collar
• Applying pressure to mandible , occiput , sternum and upper
thoracic spine
• They can be uncomfortable

145. • Rigid Frame Design
• Commonly used in stable fractures
and Moderate to Severe soft tissue
damage
• Limits Flexion and Extension
• Extends Inferior into the Thoracic
Region for greater control of all
cervical levels
(3) SOMI (Sternal Occipital
Mandibular Immobilizer)
Uses – cervical spine injury

146. Milwaukee Brace
Indication- Scoliosis
• Named after the city of Milwaukee where it was designed.
• It fits snugly over the pelvis below; chin and head pads promote
active postural correction and thoracic pad presses on the ribs
at the apex of the curves

147. Boston Brace
Indication-Scoliosis
• Used for low curves
• Made of semi-rigid plastic and foam

148. Lyon Brace
Indication-Scoliosis

149. (6) SpineCore Brace
Indication-Scoliosis

150. (7)Taylor’s Brace
Indication – Dorso-lumbar Immobilisation
• Anterior Compression
Fractures of the vertebral
body
• Semi rigid design
• Commonly used for
osteoporosis, trauma,
Degenerative spine disease