This slide contains all information you need to know about splints and tractions as a medical student.

1. SPLINTS AND
TRACTIONS
DEEKSHYA DEVKOTA
INTERN
SHREE BIRENDRA HOSPITAL

2. Splints
01

3. ● MAIN PURPOSE: prevent further
trauma and reduce pain
● Almost any rigid material can be used as
a splint in emergency
“SPLINT IS ANY RIGID DEVICE USED TO IMMOBILIZE THE INJURED
PART OF THE BODY”

4. ● Splints may also be used in postoperative
period for support/rest
● Can be used as a definite treatment to treat
fractures/deformity in the form of POP
cast/slab

5. ● Transportation
● Used for traction
● Deformity correction e.g. Dennis brown splint in CTEV
● Prevention of deformity e.g. Cockup splint in radial nerve palsy
● To provide rest to acutely inflamed joint as knee brace in TB knee,
ankle brace in ankle sprain
● In postoperative period as immobilizers
Indications

6. Cramer wire splint- for temporary splintage of # during transportation

7. Thomas splint
• Devised by H.O. Thomas initially for immobilization for TB
of knee
• Now used commonly for immobilization of hip and thigh
fractures
• Fixed and sliding traction can be given to Thomas splint

8. Bohler-Braun Splint-
Pulley A- calcaneal/tibial traction
Pulley B- femoral traction
Pulley C- to change the line of traction
Used for tibial and femoral fractures

9. Foot drop splint
Knee brace
Volkmann’s splint
Lumbar corset
Tennis elbow brace

10. ● Splint must be applied properly and adequately padded at bony prominences and
fracture site
● Bandage of the splint mustn’t be too tight nor too loose
● Patient must be encouraged to exercise the muscles actively and the joints inside the
splint as much as permitted
● Any compression of nerve/vessel (tight bandage/inadequate padding) should be
detected early and managed
Care of a patient in a splint

11. ● Daily checking and adjustments if required should be made and regular x-rays
should be taken to ensure good position of the fracture
● Assessment of compartment pressure- Always keep an eye on development of
compartment syndrome (Dx made on clinical suspicion of tense swelling and
pain on passive stretching of a limb)
● Encourage active toe/finger movement to reduce swelling
Care of a patient in a splint

12. TRACTIONS
01

13. TRACTIONS
❑ Traction counters forces that doesn’t allow
reduction/alignment to happen
❑ Traction is applied to the limb distal to the fracture—exert a
continuous pull in the long axis of the bone with a
counterforce in the opposite direction

14. ❑ It should always be opposed by counter traction otherwise it
merely pulls the patient off the bed
❑ Traction requires constant care and vigilance and is
associated with hazards of prolonged bed rest
❑ In modern orthopedics, traction is generally used as a
temporary measure to bridge the time from fracture to
definite treatment

15. ● Immobilization of a painful, inflamed joint/ fractures
● To achieve a normal anatomical orientation in cases of fractures and
dislocations when surgery is delayed or not possible due to medical
reasons
● To reduce muscle spasms, deformities and relieve pain
● Correction of soft tissue contractures by stretching them out
Indications of traction

16. FIXED TRACTION
SLIDING/BALANCED TRACTION
TYPES OF TRACTION
• Counter-traction is provided by the traction system itself over a
body part
• Weight of the body acts as counter-traction, made effective by
elevating the foot end of the bed
COMBINED TRACTION

17. Fixed traction

18. Sliding traction

19. METHODS OF APPLYING TRACTION
Traction by gravity Skin traction Skeletal traction

20. ❑ Only applicable for upper limb injuries
❑ With a wrist sling the weight of the arm
provides continuous traction to the humerus
TRACTION BY GRAVITY

21. ❑ Non invasive method
❑ Skin traction will not sustain a pull more than 4-5 kg
❑ It involves applying splints, bandages or adhesive tapes to the skin directly
overlying the fracture and putting weight to it
SKIN TRACTION

22. ❑ Skin allergies from adhesive material
❑ Skin excoriation
❑ Abrasions to the skin
❑ Pressure sores
❑ Compression of superficial nerves (adequate padding is necessary)
Complications of skin traction

23. ❑ Invasive procedure
❑ It involves placing a pin, wire or screw in the fractured bone and attaching weights in
order to pull the bone into correct position
❑ May be applied over general/local/spinal anesthesia
❑ Usually used when greater force needs to be applied to the affected area
❑ Force is directly added to the bone so more weight can be added with less risk of
damaging surrounding soft tissues
SKELETAL TRACTION

24. Sites for skeletal traction
• Calcaneum
• Distal tibia
• Proximal tibia
• Distal femur
• Greater trochanter
• Olecranon

25. Implants used to apply
skeletal traction
Bohler’s stirrup

26. ● Adverse reaction to anesthesia
● Bleeding from pin tract site
● Infection of the pin tract
● Damage to the surrounding tissues
● Neurovascular injury by the pin insertion
● Hazards of prolonged bed rest
Complications of skeletal traction

27. Which traction to apply?
❑ Skin traction should be used as whenever possible
❑ If traction is required for immobilization and
surgery is planned soon, skin traction is ideal
❑ If >5 kg weight is needed skin traction cant be used
❑ For reduction purpose, minimum weight required
is 10% of the body weight so skeletal traction is
ideal

28. ● Traction should be as comfortable as possible
● Proper functioning of the traction unit must be ensured and traction weights
must not touch the ground
● Terminal part of the limb in traction must be warm, of normal color and
with intact sensations (tingling/numbness- traction palsy of the nerve)
● Any swelling must be checked (tight bandage/slipped skin traction)
Care of a patient in traction

29. ● Pain on gentle tapping at the site of pin insertion may signify pin tract
infection
● Proper position of fracture should be ensured by taking x-rays in
traction
● Physiotherapy must be continued to minimize muscle wasting
● Watch out complications of prolonged bed rest like bed sores,
thromboembolism, constipation etc,
Care of a patient in traction

30. References
● Fundamentals of Orthopedics, Mukul Mohindra, 1st Edition, 2016
● Apley and Solomon’s System of Orthopaedics and Trauma, 10th Edition
● Essential Orthopaedics, 6th Edition
● MBBS Viva Made Easy by Dr. Amit Joshi, 2nd Edition

31. Thank you!
Do you have any
questions?