Splints and tractions

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Splints and tractions

  1. 1. SPLINTS ANDTRACTIONS IN ORTHOPAEDICS
  2. 2.  ANY MATERIAL USEDTO SUPPORT A FRACTURE  UNCONVENTIONAL-CRUDE,TEMPORARY & USED AS A FIRST AID MEASURE.EX:WOOD,BOARD  CONVENTIONAL-REFINED & SOPHISTICATED,SERVE BOTH AS FIRST AID & DEFINITIVE MEASURE.EX:POP SPLINT,THOMAS SPLINT.
  3. 3. PLASTER OF PARIS SEMI HYDRATED CALCIUM SULPHATE.  COMMERCIAL POP ROLLS-ROLLS OF MUSLIN STIFFENED BY STARCH,POP POWDER & AN ACCLERATOR SUBSTANCE LIKE ALUM
  4. 4.  Cheap,easily available,comfortable  Easy to mould,quick setting  Strong & light  Easy to remove  Permeable to radiography  Permeable to air,hence underlying skin can breath  Non-inflammable
  5. 5.  4 forms- Slab Cast Spica Functional cast brace
  6. 6.  Temporary splint USES  Initial stages of fracture treatment & during first aid  Immobilise the limb postoperatively & in infections It is made up of half by pop & half by bandage roll,hence can accommodate the
  7. 7. Swelling in the initial stages of fracture  Slab is prepared acc to the required length  3 methods of applying a slab  Dry method-slab prepared first & dipped in water
  8. 8.  Wet method-slab is prepared after diping the pop roll in water  Pattern method-slabs are fashioned in desired way before dipping it in water
  9. 9.  Pop roll completely encircles the limb  Definitive form of fracture treatment & corrects deformities  3 methods  Skin tight cast-cast is directly applied over the skin.can cause pressure sores.dificult to remove as hair may be incorporated into the cast.
  10. 10.  Bologna cast-cotton padding is applied to the limb before putting the cast  Three tier cast-stockinette is used first over which cotton padding is done before applying the pop cast.
  11. 11.  It encircles a part of the body  Eg:hip spica,thumb spica
  12. 12.  Its based on the principle that If function is allowed during closed method of fracture treatment,it stimulates osteogenesis,promotes soft tissue healing & prevents development of joint stiffness & rehabilitation  Mode of action-hydraulic action of muscle is brought to play.fracture brace allows movements of the joints & permits the load
  13. 13. To be transmitted to the muscle.The muscles which are surrounded by inelastic deep fascia if encased in a hard plaster cannot be stretched beyond the confines of cast. On movements & bearing weight,muscle forces are hence driven inward towards the fracture. This helps the fracture to be held firmly. Technique consists of applying an external splint to fractured limb.
  14. 14.  Correct size-8in for thigh,6in for leg,4in for forearm  Joint above & joint below should be included  Should be moulded with palm & not with fingers for fear of indentation.  Joint should be immobilised in functional position.  Plaster should be just fit & should not be too tight or too loose.
  15. 15.  Uniform thickness of plaster is preferred. STAGES OF PLASTERING  Application of pop slab  Cast setting stage-change of pop to gypsum.time takento form a rigid dressing after contact with water  Set wet cast  Cast drying by evaporation of excess water
  16. 16.  Due to tight fit  Pain  Pressure sore  Compartment syndrome  Peripheral nerve injuries  Cast syndrome  Due to improper application  Joint stiffness
  17. 17.  Plaster blisters & sores  Breakage  Due to plaster allergy  Allergic dermatitis  Cast disease manifested as muscle atrophy,osteoporosis,joint stiffness,muscle weakness,skin breakdown,compartment syndrome,blister formation.
  18. 18.  Parts  A padded metal oval ring with soft leather set at an angle 120 to the inner bar  2 side bars-one inner & other outer bar of unequal length.They bisect the oval ring.The outer bar longer than inner bar  Distal end-2 side bar joined in the form ofW.  Outer side bar is angled 2in below the padded ring to clear the prominent greater trochanter
  19. 19.  Immobilise fracture femur  First aid  Transportation of injured patient  In the treatment of joint diseases likeTB knee length of splint-measurement from the highest point on the medial side of the groin toheel plus 6in.
  20. 20.  Bohler’s modification of braun splint  Consists of heavy metallic frame with 3 pulleys  Proximal pulley prevents foot drop  Second pulley to apply traction in the line of femur  Third pulley to apply traction in the line of supracondylar area
  21. 21.  Communited trochantric fracture of femur  Fracture shaft of femur & supracondylar fracture of femur  Fracture shaft of tibia & fibula
  22. 22.  Makes nursing care difficult  Heavy frame  Associated with recumbant problems like bed sores,pneumonia,renal calculi
  23. 23.  Temporary splintage of fracture during transportation  It is made up of thick parallel wires made up of interlacing wires  It can be bent into different shapes in ordr to immobilise different parts of body
  24. 24.  Padding-well padded at the bony prominences & at the injury sites  Bandage-should be tied with optimum pressure  Exercises-active exercises of the joints & muscles should be permitted within the splints
  25. 25.  Daily checking & adjustments of splints are recommended  Neurovascular status-distal neurovascular status should be assessed daily
  26. 26.  Cervical spine  SOMI BRACE  4 post collar  Upper limb  Aeroplane splint-brachial plexus injury  Cock up splint-radial n palsy  Knuckle bender splint-ulnar n palsy
  27. 27.  Spine  Milwaukee brace-scoliosis  Boston brace  Lumbar belts & corsets-backache  Lower limb  Thomas splint,BB splint  Footdrop splint
  28. 28.  Tractions play an important role in the management of fractures in orthopaedics.  USES  To reduce fracture or dislocation  To retain fracture after reduction  To overcome muscle spasm  To control movement of injured part of body & to aid in healing
  29. 29.  TRACTION BY GRAVITY  Applies only to upper limb.  With a wrist sling weight of arm provides continuous traction to humerus
  30. 30.  Traction is applied over large area of skin.  Maximum weight that can be applied through skin traction is 5kg.  If weight is applied more than this,traction will slide down peeling off the skin.  Skin traction is applied to the limb distal to the fracture site
  31. 31.  Adhesive skin traction  Adhesive material is used for strapping which is applied anteromedial & posterolateral on either side of lowerlimbs.  Nonadhesive skin traction  Useful in thin & atrophic skin & in pts sensitive to adhesive strap.
  32. 32. BUCK’S EXTENSION  Commonest type of skin tractions applied to the lower limb  USES • Temporary trtmt of fracture neck of femur • Undisplaced fracture of acetabulam • After redn of hip dislocation
  33. 33.  In upper limbs  Indicated for supracondylar fractures,intercondylar fractures of humerus where elbow flexion causes circulatory embarrassement
  34. 34.  Fracture shaft of femur in children less than 2yrs  Legs of the child are tied to overhead beam. Hips are kept a little raised from bed so that weight of the body provides counter traction & fracture is reduced.
  35. 35.  Traction is given through a metal or pin driven through bone.  Reserved for cases where skin traction is contraindicated & where applied weight needed is more than 5kg.
  36. 36. STEINMANN’S PIN  Stainless steel rod 3-6mm dia  Upper end of tibia,supracondylar region of femur & calcaneum.  DENHAM’S PIN  Threaded in the centre & engeges the bony cortex  Useful in cancellous bone like calcaneum
  37. 37.  K-WIRE  Smith traction given by passing k-wire through olecranon in supracondylar fracture
  38. 38. FIXEDTRACTION  Pull is exerted against the fixed point.  Counter traction is applied by part of the body  Eg:thomas splint-ring of the splint lies against the ischial tuberosity & povides counter traction
  39. 39. SLIDINGTRACTION  Weight of the body acts as counter traction  Eg:traction given for pelvic fracture,where weight o body acts as counter traction.made effective by elevating the foot end of bed.
  40. 40.  Applied under anaesthesia  Aseptic precautions  Drive the pin from lateral to medial side in case of upper tibial traction, to avoid injurig lateral popliteal nerve.  Pin shold be at right angles to the limb & parallel to ground
  41. 41.  For femural shaft fracture, initial weight required is 10% of patient’s body weight.  For every 1lb of weight,end of bed should be raised by 1in.
  42. 42.  Proper functioning of traction unit to be ensured.traction weights should not be touching the ground.  Check the terminal part of the limb-its colour,warmth,sensations.  Any swelling of the fingers showstight bandage or slipped skin traction.  Proper positioning of the fracture should be ensured by check xrays
  43. 43.  Circulatory embarrassment  Nerve & vessel injury  Pin site- infection,migration,breakage, bending.  Injury to epiphysis in children  c/c osteomyelitis
  44. 44.  Head or cervical traction Head –halter Halopelvic  Upper limb Dunlop’s Metacarpal
  45. 45.  Lower limb Gallow’s Russel’s Buck’s pelvic

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