Review of traction, splints and plaster of paris for undergraduate students

1. TRACTION, SPLINTS AND POP
CAST
DR. SIDDHARTHA SINHA
ASSISTANT PROFESSOR, ORTHOPAEDICS

2. DEFINITION
TRACTION IS A METHOD BY WHICH PULLING FORCE IS GIVEN
ALONG LONGITUDINAL AXIS OF BONE.

3. USES OF TRACTION
• For fracture and dislocation and their
Reduction maintenance.
• For immobilization of painful inflamed joint.
• For prevention of deformity by
counteracting the muscle spasm associated
with painful joint condition.
• Correction of soft tissue contracture by
pulling them out.

4. COUNTER TRACTION
• A traction force applied to affected part of
body will overcome muscle spasm only if
another force acting in opposite direction i.e.
counter traction is applied at same time as
traction force.
• On the basis of action of counter traction
traction can be divided into two types
-Fixed traction
-Sliding traction

5. FIXED TRACTION
• Counter traction is
provided by part of the
body. e.g. Thomas splint-
the ring of splint comes to
lie against the ischeal
tuberosity and provides
counter traction.
• Maintains but does not
obtain reduction.

6. SLIDING OR BALANCED TRACTION
• Gravity may be utilized
to provide counter
traction by tilting the
bed so that patient
tends to slide in
opposite direction to
that of traction force.
• Can obtain and
maintain reduction.

7. SKIN TRACTION
• Maximum weight=15lb(6.7kg)
• Adhesive skin traction-here
adhesive material is used for
strapping which is applied
anteromedial and posterolateral
side of leg.
• Non adhesive skin traction-
useful in atrophic and in
patients sensitive to adhesive
strap. Grip is less secure than
adhesive strapping. Traction
weight = 10lb(4.5kg)

8. SKIN TRACTIONS
ADVANTAGE
• Traction applied over
large area of skin– even
distribution of forces
• Comfortable
DISADVANTAGE
• Can not be applied in
certain conditions
• Limited maximum weight
• Needs frequent
readjustment
• Can cause skin abrasions
if not properly applied

9. CONTRAINDICATIONS TO SKIN
TRACTION
• Abrasion/laceration
• Impaired circulation,
• Allergy/ Dermatitis
• Marked shortening of limb

10. COMPLICATIONS OF SKIN
TRACTION
• Allergy ( by adhesive)
• Excoriation,
• Pressure sores around the malleoli#
• Common peroneal nerve palsy.

11. COMMON SKIN TRACTIONS
• Bucks traction
• Dunlop traction
• Gallows traction.

12. SKELETAL TRACTION
• Traction is given through a
metal or pin driven through
the bone.
• Reserved for the cases in
which skin traction is
contraindicated and when
need for weight more than 5
kg.
• Pins used-Steinmann pin,
Denham pin, K-wires.

13. COMMON SITES OF SKELETAL TRACTION

15. COMPLICATIONS OF SKELETAL
TRACTION
• At time of application
• Anesthetic complications,
• Vasovagal shock
• injury to nerves, vessels, muscle, ligaments, tendon and
epiphysis (upper tibial epiphysis)
• After application
• Pin site infection
• Pin migration
• Pin breakage, bending, loosening
• Excess distraction of fracture fragments.
• Scarring
• Osteomyelitis

16. DAILY CARE OF THE PTS. WITH
TRACTION
• Traction should be as comfortable as possible.
• Proper functioning of traction unit must be
ensured
• Traction weights must not be touching the
ground.
• See that the ropes are in groove of the pulley
• Foot of the pt. or end of the traction device
should not be touching the pulley.

17. • Terminal part of the limb should have normal colour
and normal temp.-any numbness or tingling may point
to traction palsy.
• Any swelling over finger or toes may point to tight
bandage.
• Early pin tract infection can be detected by gentle
tapping at site of pin insertion.
• Proper positioning of the fracture should be ensured
by taking check x-ray with traction.

18. DAILY CARE CONTD…
• Physiotherapy of limb with traction.
• Watch for complications due to recumbancy - bed
sores, chest congestion, UTI, constipation.
• Diversion therapy- reading, crafts, games, use of
television.

19. SPLINTS
• Thomas splint
• Crammer wire splint
• BB splint

20. THOMAS SPLINT
• H.O. Thomas in 1876
• To assist ambulation in TB
knee
• Parts of Thomas splint
• Uses of Thomas splint
1. To immobilize fracture
femur anywhere
2. First aid measure
3. Transportation of injured
patients
4. Rx of joint diseases like TB
Knee

22. CRAMMER WIRE SPLINT
• Used for temporary
splintage of fracture
during transportation.
• Adv-can be bent into
different shapes in order
to immobilize different
parts of the body.
• Disadv- fracture hidden
due to wires in x-rays

23. BOHLER – BRAUN SPLINT
• It consists of heavy
metallic frame with
multiple pulleys

24. INDICATIONS OF B.B SPLINT
• -supracondylar/intercondylar fracture
femur
-comminuted trochanter fracture
femur
-tibial condyle fracture
•

25. DISADVANTAGES OF B-B SPLINT
• Nursing care difficult
• Heavy and cumbersome
• Pressure sores

26. CARE OF B-B SPLINT
• Padding- bony prominences(femoral condyles), thigh
and tendoachilis
• Bandage- not too tight
• Exercises- with splint
• Checking- adjustment of splint
• Neurovascular status

27. PLASTER OF PARIS
• By Mathysen 1852
• Chemical formula- CaSo4 . ½ H2O
(Gypsum salt)
• Types of POP
-Indigenous
-Commercial

28. PLASTER-OF-PARIS
• The name POP is derived from an accident to a house built on a
deposit of Gypsum, near Paris. The house burnt down. When rain fell
on baked mud of the floors it was noted that footprints in mud set
rock-hard.
• Plaster-of-paris bandages were first used by Matthysen, a Dutch
military surgeon in 1952.

29. • The POP bandage consists of a roll of muslin stiffened by dextrose or starch
and impregnated with the hemihydrate of calcium sulfate.
• When water is added, the calcium sulfate takes up its water of crystallization:
• 2 (CaSO₄. ½ H₂O) +3H₂O 2 (CaSO₄. 2H₂O ) + ∆

30. ORTHOPAEDIC USES OF CAST
1) To support fractured bones, controlling movement of
the fragments and resting the damaged tissues
2) To stabilise and rest joints in ligamentous injury
3) To support and immobilise joints and limbs post-
operatively until healing has occurred
4) To correct a deformity
5) To ensure rest of infected tissues
6) To make a negative mould of a part of body.

31. MATERIALS AVAILABLE FOR
CASTING
• Plaster-of-Paris
• Plaster-of-Paris with melamine resins
• Materials which undergo polymerisation:
a. water activated
b. non-water activated
• Low-temperature thermoplastics

32. • Slab
• Casts
• Spica
• Functional cast brace

33. • Setting time: time taken to change from powder form
to crystalline form.
• Drying time: time taken to change from crystalline
form to anhydrous form.
• Average setting time: 3-9 minutes
• Average drying time: 24-72 hours

34. FACTORS DECREASING
SETTING TIME
• Hot water
• Salt
• Borax
• Resin
FACTORS INCREASING
SETTING TIME
• Cold water
• Sugar
• Humidity

35. RULES OF APPLICATION OF
POP CASTS
• 6 inch for leg , 4 inch for
forearm.
• One joint above and one joint
below.
• Moulded with palm and not
with fingers to avoid
indentation.
• Joints should be immobilized
in functional position.

36. • Not too tight or too loose i.e. adequate padding
• Deep pop vertically in water till air bubble ceases to
come
• Uniform thickness of plaster is preferred

37. AFTER APPLICATION OF PLASTER
• Pain, Swelling and NVD.
• Notice any cracks in the plaster.
• Avoiding wetting of plaster.
• Graduated weight bearing for lower limb fractures.
• Physiotherapy of muscles within the plaster and joints outside the
plaster is necessary to ensure early rehabilitation.

38. ADVANTAGES
• Cost-effective
• Non-allergic
• Easily moulded to
different forms
DISADVANTAGES
• Radio-opaque so may
occlude # lines
• Heavy
• Easily breaks when
comes in contact with
water

39. COMPLICATIONS OF POP
• Due to tight fit
-pain
-pressure sores
-compartment syndromes
-peripheral nerve injuries
c/o unrelenting pain,stretch pain, swelling over fingers, inability to
move fingers, hyposthesia and bluish discolouration of the digits.
• Due to improper applications
-joint stiffness
-plaster blisters and sores
-breakage
• Due to plaster allergy
-allergic dermatitis

40. REMOVING PLASTER CAST
• Plaster shears
• Electric saw

41. EMERGENCY
• Dip in water and cut with scissors

42. RECENT ADVANCES
• Resin
• Strong but light
• Radiolucent
• Needs gloves for application
• Bivalve during removal
• Costly

43. REFERENCES
• https://musculoskeletalkey.com/fractures-of-the-femur-and-
injuries-about-the-knee/
• Stewards Traction and Orthopaedic Appliances (1st edition)
• The Closed Treatment of Common Fractures by Sir John
Charnley.
• Chapman’s orthopaedics surgery 3rd edition.
• Rockwood and Green’s Fracture in adults.
• Traction and Orthopaedic Appliances by Stewart.
• Essential Orthopaedics by J. Maheshwari

44. THANK YOU