Traction is used to overcome deforming forces on limbs affected by inflammation or fractures. There are two main types - skin traction and skeletal traction. Skin traction uses adhesive or non-adhesive strapping over a large area, while skeletal traction involves inserting pins or wires through bones. Traction must be counteracted to be effective, which can be done through fixed or sliding methods using appliances, body weight, or additional limbs. Common complications include injury, stiffness, infection, and pressure sores.
Tractions in orthopaedics by Dr O.O. AfuyeAlade Olubunmi
Traction is an act of drawing or exerting a pulling force on bones or other tissues to offer realignment. It is very important in the management of fractures in other to prevent unwanted complications.
This is short presentation of most common fracture in hip joint. Femoral neck fractures are the most common type of fractures around the hip joint- more common in elderly in weak osteoporotic bone. This presentation gives a brief idea about these fractures, investigations, methods of management in different age groups.
Tractions in orthopaedics by Dr O.O. AfuyeAlade Olubunmi
Traction is an act of drawing or exerting a pulling force on bones or other tissues to offer realignment. It is very important in the management of fractures in other to prevent unwanted complications.
This is short presentation of most common fracture in hip joint. Femoral neck fractures are the most common type of fractures around the hip joint- more common in elderly in weak osteoporotic bone. This presentation gives a brief idea about these fractures, investigations, methods of management in different age groups.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. TRACTION
When inflammation or fracture , controlling muscles in to spasm
Antagonist not powerful
Leads to deformity
For overcoming the deforming force
3. Uses
Against deforming force
Relieve pain
Allow limb to be rested in best functional position
Controls movement of affected part- helps in healing
5. Contraindications
Abrasions of skin
Laceration of skin where it to be applied
Impairment of circulation – varicose ulcers and impending gangrene
Dermatitis
Marked shortening of bony fragments – when weight needed more than that can be
applied through
7. METHODS OF APPLYING SKIN TRACTION
ADHESIVE SKIN TRACTION
NON ADHESIVE SKIN TRACTION
8. Adhesive skin traction
Prepare the skin by shaving washing and drying
Use adhesive strapping which can be stretched only
transversely
Avoid placing adhesive strapping over bony
prominences
Leave a loop of 2 inches ( 5cm) projecting beyond
the distal end of limb to allow the movement of
finger / foot
9. Always leave a free skin between the straps
Must not be too tight or too loose
Leave the heels free
Can be safely used for 4-6 weeks
It may be pulled down day by day
10. Non-Adhesive skin traction
This consists of lengths of soft, ventilated latex foam rubber,
laminated into a strong cloth backing.
In thin and atrophic skin and allergic to adhesive
It is applied like adhesive skin traction
As the grip is less secure, frequent reapplication may be
necessary
Max weight – 4.5 kg
11. Skeletal Traction
Metal pain or wire is driven through bone
Force applied through bone
Frequent for lower limb
where skin traction contraindicated
Series Complication - osteomyelitis
13. Denham pin
Same as Steinman
Short raised threaded length towards end
Engages the bony cortex and reduces pin sliding
K wire
Wire easily cuts through if heavy weight applied
More in upperlimb
14. Sites- Olecranon
Just deep to subcutaneous border of upper end of ulna
3cm distal to tip of olecranon
To avoid elbow joint
K wire from medial to lateral at right angle to long axis of ulna
15. Second and third metacarpals
2-2.5 cm proximal to distal end of 2nd metacarpal
Wire transvers 2 nd and 3rd metacarpal
Lie at right angle to long axis of radius
16. Upper end of femur – greater trochanter
Lateral surface of femur
2.5 cm below prominent part of GT
Mid way between anterior and posterior surface
Screw eye or CC screw used
17. Lower end of femur
Prolonged traction leads to fibrosis and knee stiffness
To be removed in 2 weeks
18. Point of insertion – 2 way determination
Proximal to upper limit of lateral femoral condyle
3cm proximal to joint line
Care to avoid knee joint
Lateral fold of knee capsule up to 2 cm above joint
2nd one –intersecting point line form upper pole of patella transversely and
line anterior to head of fibula
19. Upper end of tibia
2 cm behind and below the crest, just below the level of tubercle of tibia.
Pin to be driven from lateral to medial to avoid CPN
20. Lower end of tibia
5 cm above level of ankle joint
Mid way between anterior and posterior border of tibia
Calcaneum
2 cm below and behind lateral malleolus
Ie 3 cm below and behind medial malleolus
Can result in subtalar stiffness
21. Complications
Can introduce infection to bone.
Incorrect placement can cause
Cut out of bone – pain and failure of traction
Make control of rotation of limb difficult
Make the application of splint difficult
Result in uneven pull thus cause movement of pin
Can cause infection or ischemic necrosis
22. Distraction at fracture site
Ligamentous damage if applied for a long time
Damage to epiphyseal growth plates if in children
Depressed scars – can be prevented if pin track pinched at time of removal
Due to fibrous tissue with skin and periosteum
23. COUNTER TRACTION
Tractional force applied will overcome muscle spasm only if another force in opposite
way as tractional force
If no counter body will get pulled towards traction
TYPES
FIXED TRACTION
SLIDING TRACTION
24. Fixed traction
When counter traction acts through an appliance which obtains a purchase on a
part of body.
By applying force to a point in the body proximal to the attachment of muscle in
spasm
The length of the limb remains constant
Continous dimunition of traction force as the tone in the muscles diminish and
further no activation of muscle stretch reflex
Pull is exerted against a fixed point.
25. Fixed traction
Balances the pull of muscles
Muscular pull and hematoma decreases
Distraction and non union less likely to occur
Not dependent on gravity
Self contained
Patient may be lifted and moved with out risk of displacement.
27. Fixed traction in Thomas` splint
Maintain but not obtain reduction
Counter thrust passes up the side bars to padded ring around the root of the
limb.
The malleoli are well padded to avoid pressure sores.
28. The outer traction cord passes above and the inner cord passes below its
respective side bar, to hold the limb in medial rotation.
The traction cords are tied over the end of the Thomas spint.
A traction wt of 2.3kg attached to the Thomas`splint is sufficient to prevent
getting pressure sore at root of leg.
29. Advantages of Thomas splint:
Distraction at the # site less likely to occur
No need to tighten the traction cords repeatedly
Apparatus is self contained and can be moved without risk of displacement of #
30. Traction unit
Introduced by Charnley.
For the treatment of # Shaft Of Femur.
Consists of upper tibial steinman pin incorporated in a below knee cast which is then fit in to a
Thomas` splint
15cm wodden bar transversely in the sole
of the plaster midway between toes and
heel to control rotation
31. Advantages:
Compression of the tissue of the upper calf including common peroneal nerve does not occur
Equinus deformity at the ankle can't occur because the foot is supported by plaster cast
The tendo-calcaneus is protected by the padded cast
Rotation of the foot and the distal fragment is controlled
A fracture of the ipsilateral tibia can be treated conservatively at the same time.
32. ROGER ANDERSON WELL-LEG
TRACTION
used in management of #s of pelvis, femur, tibia.
Skeletal traction being applied to injured leg, while the well leg was employed for counter
traction.
But this method is valuable in correcting either abduction and adduction deformity at the
hip.
33. A/K PLASTER CAST
LIMB WHICH WILL
BE PUSHED UP
LARGE STIRRUP IN
PLASTER
BY ALTERING THE
POSITION OF SCREW
THE RELATIVE
POSITIONS OF TWO
STIRRUP CAN BE
ALTERED.
STEINMENN PIN
THROUGH LOWER
END OF THE TIBIA
OF
THE LIMB WHICH
IS
TO BE PULLED
DOWN.
34. PRINCIPLE:
With abduction deformity at the hip,the affected limb
to be longer.
When Traction is applied to the well limb and Affected limb is
simultaneously pushed Up (counter traction), the abduction
deformity is reduced.
Reversing the arrangement will reduce an
adductiondeformity.
35. Sliding Traction
Described by Haddy James
In his rib bandge attached to head of bed acted as a
counter traction
When weight of whole body or part of body acted as
counter traction – its sliding traction
Gravity utilized to provide counter traction by tilting
the bed
Obtained by raising bed over a wodden block
36. Initiall traction weight to reduce a fracture is more than traction weight required to maintain
traction
Traction weight depends on
Site
Age and weight of patient
Power and damage of muscles
Degree of friction
By trail and error method
37. For femoral shaft 10% of BW
The higher the traction weight higher the bed must be elevated
2.5 cm for every .5 kg of weight
38. BUCK’S TRACTION OR EXTENSION
Used in
Femoral neck fracture
Shaft fracture in children
Undisplaced acetabular fracture
Post reduction of dislocated hip
To correct minor ffd of hip and knee
39. Rarely reduce fracture
For pain relief
Lateral rotation of limb cannot be controlled
40. Application:
Apply adhesive strapping to above knee or in elderly ventofoam skin
Support the leg with pillow.
Pass the cord from spreader over pulley.
Attach 2.3-3.2kgs TO THE CORD.
Elevate the foot end of bed.
41. PERKIN`S TRACTION
Principle:
It is the use of skeletal traction without any external splintage coupled with active
movements of injured limb
Perkins showed that by encouraging early muscular activity stiffness of joint was
prevented by extensibility of muscles by reciprocal innervation
42. USE IN TREATMENT OF
Fracture tibia
Subtrochanteric and shaft femur #
43. Application
Under GA and aseptic precautions
Insert Denham pin through upper Tibia
Attach Simonis swivel to each end of pin
Connect 2 traction cords to each swivel
Pass each cord over separate pulley
For femur 4.6kg over each pulley
For tibia 2.3 kg over each pulley
44. Hamilton –Russel Traction
Indications:
Management of the fracture shaft of femur
After arthroplasty operations on the hip
Application:
Below knee skin traction
Pulley attached to spreader
Soft sling placed under knee and attach a cord
Weight
adults – 3.6 kg
chidren – 0.28- 1.8 kg
45. Advantage:
Based on law of parallelogram of forces that -the 2 pulley blocks at the foot of
the bed theoretically doubles the pull on the limb and the resultant traction is in
axis of 30° to the horizontal i.e. in line of shaft of femur
46. TULLOCH BROWN TRACTION
Application:
Steinman pin through the proximal tibia.
Support legs on slings suspended from light duralumin u
loop which is slipped over the ends of steinman pin.
47. Attach the nissen stirrup to the steinman pin it enables leg to be suspended
and rotation of movements controlled.
Foot supported in perspex foot plate & foot end elevated.
48. NINETY/NINETY TRACTION
Devised by Obletz (1946)
Used
# femur with wounds over post aspect of thigh (operative & post op management)
Subtrochanteric and proximal third # femur
Used in both children and adults
Here both hip and knee are flexed to 90 degree.
49. Skeletal traction is applied through lower femur or upper tibia
3 methods of supporting leg in 90/90 traction
53. As the union of fracture occurs, encourage active hip and knee exercise-extension
, gradually lower the limb into a more horizontal position.
54. DANGERS OF 90/90 TRACTION
Those of skeletal traction.
Stiffness and loss of extension of the knee.
Flexion contracture of hip.
Injury to the lower femoral or upper tibial epiphyseal growth plates in children.
Neuro vascular damage
55. Sliding Traction in a Fisk Splint
It is a modification of Thomas splint where in a knee flexion piece is attached to
Thomas splint.
Active flexion and extension of the knee is possible, but little movement occurs at
the hip
The patient as soon as possible begins assisted movement of the lower limb
which is moved as one unit as though the patient were walking.
Uses: In femoral shaft fractures and tibial condyle fracture.
56.
57. BRYANT`S TRACTION(GALLOWS)
Used in # Shaft of femur in children <2 yrs
Apply adhesive strapping to both lower
limbs
Tie traction cords to an over head beam
Tighten the traction cord to raise the
buttocks just clear the mattress
Counter traction obtained by weight of
pelvis
58. Vascular complication of Bryants traction may occur in either the injured or normal limb.
A careful check must be done in both limbs during first 24-72 hrs.
By checking color and temp of limbs.
Dorsiflexion of both ankle passively.
Bryants traction in children :
under 2yrs - safe
2-4yrs - vascular complications more(can be prevented by using posterior splint).
Over 4yrs - absolutely contraindicated.
59. Modified Bryant`s traction
In the initial management of CDH when
diagnosed over the age of 1 year.
After 5 days abduction of hip is started
Abduction is increased by 10* on alternate days
By 3wks hips should be fully abducted
60. COMPLICATIONS:
The child will become restless and scream repeatedly with pain.
The pain is due to stretching of capsule and impingement of femoral head on superior lip of
acetabulam.
61. SLIDING TRACTION IN
BOHLERBRAUNFRAME
In management of tibia and femoral fractures
Most proximal pulley-to prevent foot drop.
2 nd pulley-to apply traction in line of Femur.
3 rd pulley-to apply traction in line of supracondylar
area of femur and high tibial traction.
4 th pulley-to apply traction in line of leg as in low
tibial or calcaneal traction.
3.2 -4.5kg can be arrched
62. DISADVANTAGES:
Bohler Braun frame rests on pts bed and cannot move with the patient.
Nursing care is more difficult.
Movement of proximal #fragments in relation with distal fragment which is cradled in
splint. This predisposes to deformity.
63. Lateral upper femoral traction
Used alone or along with traction in long axis of femur in management of
central fracturedislocation of Hip.
If only superior rim of acetabulum is fractured combined with Buck's OR
Russell traction
If posterior rim of acetabulum is fractured and if reduction of dislocated
femoral head is unstable, combined with vertical skeletal traction in lower
end of femur or upper end of tibia.
Maximum attachable weight - 4.5-9kg
64.
65.
66. PELVIC TRACTION
In pelvic traction special canvas harness is buckled
around the patients pelvis.
Long cords attach the harness to the foot of the bed.
Foot end of the bed raised-provides sliding traction.
Used in conservative management of IVDP. To ensure
that the patient lies quietly in bed
Buck`s traction may also be employed
67. Dunlop's traction
Indication-
Supracondylar
transcondylar fractures of Humerus in children.
This method is useful if flexion of the elbow
causes circulatory embarrassment with loss of
radial pulse
68. Apply skin traction to fore arm
Place the pt supine
Abduct the shoulder to 45*
Pass the traction cord over a pulley so that elbow flexed to 45*
Place padded sling over distal humerus
Attach 0.5-1 kg wt to traction cord and padded sling so that it elbow is
just above the bed
Elevate same side of bed
Check circulation
69. OLECRANON TRACTION
Indications:
Supracondylar fracture of humerus
Comminuted fracture of lower end of the humerus
Unstable fracture of the shaft of the humerus
Weight – 1.3- 1.8 kg
70. METACARPAL PIN TRACTION
Indications
Comminuted fracture of forearm bones - especially for a comminuted #
of lower end of the radius
Maximum attachable weight is - 1.3-1.8kg
Complications:
Fibrosis in the interosseous muscles causing stiffness of fingers.
General complications of skeletal traction.
Limb to kept in normal latera rotation while inserting. So that the pin wont impinge on pillow or bed while sleeping and result in medial rotation deformity. Skin to be incised with scapel before only when power drill are used. Otherwise don’t incise skin. Slight hammering canalso be done. Not advisable in loer end femur as splintering cal occur.
When fracture muscles pull distal frag proximally. So to overcome this traction . Bt for traction to work counter needed to keep it down.
Transverse frcture is best. Oblique and spiral can also be reduced. Check about sore on root of limb. Do by giving taction to split. 2.3kg.
Tobruk splint when cast from groin to foot and skin traction the lase taken out through malloeouls and tied to Thomas splint.
For this daily length of the limb must be measured with that of normal limb to see the increase in length. Once the weght attained is same as other one reduce to weight to maintain traction.
Perkin believed tht tarctionaligned fragments , neutralized the pull of muscles, prevented rotation and angulation provided that fracture site is brigned by the orgin of muscles
Upper tibia for femur, mid tibia for tibia condyles 2.5 cm from fractured site, calcaneum for other tibia fractures. After application start active quardriceps then after 1 week start knee flexion.
In psudoarthrosis, cup arthroplasty and femoral shaft. Foot plate prevent equinus and can be started physio of foot
Mainly in prox 3rd fracture femur and mid femur because the prox fragment chance f getting displaced are more. Because of muscle force and high chamnce patient moves. For them this applied.
Wile applying ask the assiatnt to keep the limb medially rotated like patella facing upwards. This avoids femoral anteversion and femoral neck will b lyig horizontally. Advance drill up to 3.75 to 5 c to femorl neck. For 4-6 weeks.
Traction force through strainer or k wire. Greater gorce can be applied, rotation at frac can be controlled by moving forearm along longitudinal axis of humerus, and angulation can be changed by varying direction of pull of traction weights.