This document discusses splints and tractions used in orthopedics. It describes various types of splints like POP, Thomas splint, Bohler-Braun splint, and braces. POP splints are cheap, easily available and comfortable. Thomas splints are used to immobilize the knee. Traction is used to restore alignment to fractures and reduce pain. There are different types of traction like skin traction and skeletal traction applied using pins. Daily care of patients involves ensuring proper traction and preventing complications.

1. SPLINTS AND TRACTIONS IN
ORTHOPEDICS
MODERATORS:-
Dr.J.Venkateshwarlu(Professor & HOD)
Dr.K.Kishore Kumar ( Associate Professor)
Dr.K.Ram Mohan (Assistant Professor)
Dr.Sirish (Assistant Professor)
- Presented by
Dr.P.GAYATRI

2. SPLINTS
• ANY MATERIAL USED TO 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. INDICATIONS
•Fractures, sprains and dislocations
•Joint infections
•Acute arthritis/ gout
•Acute tenosynovitis

4. CONTRAINDICATIONS
•Compartment syndrome
•Need for open reduction
•Infected skin condition or when there is a high
risk of infection

5. POP
•Calcium sulphate dehydrate
•When wet it crystallises
•Exothermic reaction
•Average setting time- 3 to 9 minutes
•Average drying time: 24-72 hrs

6. POP – AN IDEAL SPLINT
• 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

7. POP
ADVANTAGES :
•Easier to mold
•Less expensive
DISADVANTAGES :
•More difficult to apply
•Gets soggy and soft when it gets wet

8. CRAMMER WIRE SPLINT
• Used for temporary
quick splintage of a limb
for transport.
• Two thick parallel wires
with ladder like thin
wires.
• Malleable, can easily be
bent to the contour of
limb.

9. THOMAS SPLINT
● Devised by Hugh. Owen
Thomas.
● Initially used for
immobilisation for
tuberculosis of the
knee.

10. PARTS OF THOMAS SPLINT
• Ring at an angle of 120
degrees
• Two side bars
• Outer bar bent to
accommodate the
greater trochanter.
● Leg supported on slings
tied to the side bars.

11. BOHLER – BRAUN SPLINT
• Proximal pulley to
prevent foot drop.
• 2nd pulley- traction in
line with the femur.
• 3rd Pulley- traction in
line for traction in line
with the leg.

12. BOHLER BRAUN SPLINT - ADVANTAGES
• Traction unit is self
contained..
• Limb in comfortable
position
• Angle of traction
changeable
• Wound care possible
• Multipurpose application
• Simultaneous traction
through Calcaneal/distal
tibia and proximal
tibia/distal femur possible

13. DENNIS BROWN SPLINT
• Used in the treatment
of club foot.

14. COCK-UP SPLINT
• Wrist splint.
• Used in the injuries
around wrist such as :
• Distal radial & ulnar
fractures
• Wrist drop
• Carpal tunnel
syndrome.

15. ALUMINIUM FINGER SPLINT
• Used in the treatment
of mallet finger

16. VOLKMANN’S SPLINT
• Used in the treatment
of Volkmann’s ischemic
contracture.

17. AEROPLANE SPLINT
• Used in Brachial plexus
injury

18. SOMI BRACE
• Sternal-occipital-
mandibular-immobilizer
brace.
• Used in atlanto-axial
instability caused by
rheumatoid arthritis.

19. LUMBAR CORSET
• Used in the treatment
of Lower back pain
• Immobilisation after
lumbar laminectomy.

20. ASH BRACE
• Anterior spinal
hyperextension brace.
• Flexion immobilisation
to treat thoracicand
vertebral lumbar body
fractures T6 – L1
• Reduction of kyphosis
in patients with
osteoporosis.

21. MILWAUKEE BRACE
• Used in scoliosis

22. TAYLOR’S BRACE
• Commonly used for
osteoporosis ,
degenerative spine
disease.

23. CARE OF A PATIENT ON SPLINT
• Padding on the fracture site
• Padding on bone prominences
• Active mobilisation of muscles and joints
• Watch out for effects of compression on nerves/
vessels
• Daily check and adjustments of weights
• Check pressure points and perineum for pressure
points
• Care of back

24. PRE-POST CHECKS WITH SPLINTS -
FACTS
• Function
• Arterial pulsations
• Capillary refill
• Temperature
• Sensations

25. TRACTIONS
• Traction is a method of restoring alignment to
a fracture through gradual neutralisation of
muscular forces.
• Traction is pulling effect exerted on a part of
skeletal system.
• Involves use of weights connected to patient
with ropes, pulleys, slings, etc.

26. OBJECTIVES OF TRACTION
• Reduction of fracture/ dislocation
• Reduce/ relieve pain
• Immobilisation of painful joint
• Prevention of deformity, counteracting muscle
spasm
• Correction of small defects.

27. PRINCIPLES OF EFFECTIVE TRACTION
• Traction must produce a pulling
effect on the body
• Counter traction must be
maintained
• The traction and counter pull
must be in the opposite
directions
• Splints and slings must be
suspended without
interference
• Ropes must move freely
through each pulley
• Precise amount of weight must
be applied
• The weights must hang free.

28. TYPES OF TRACTION
• FIXED TRACTION : Counter-traction is provided by
a part of the body.
• Eg: thomas splint-ring of the splint lies against
the ischial tuberosity & povides counter traction.
• SLIDING TRACTION : Weight of the body under
influence of gravity provides counter-traction.
• Eg: traction given for pelvic fracture, where
weight of the body acts as counter traction ,
made effective by elevating the foot end of bed.

30. METHODS OF APPLYING TRACTION
• SKIN TRACTION
• SKELETAL TRACTION

31. SKIN TRACTION
• Traction is applied over large area of skin.
• Maximum weight that can be applied through
skin traction is 6.7kg.
• If weight is applied more than this, traction
will slide down peeling off the skin.
• Skin traction is applied to the limb distal to
fracture site.

32. TYPES OF SKIN TRACTION
• ADHESIVE SKIN
TRACTION: Adhesive
material is used for
strapping which is applied
anteromedial&
posterolateralon either
side of lowerlimbs.
• NONADHESIVE SKIN
TRACTION : Useful in thin
& atrophic skin & in pts
sensitive to adhesive
strap.

33. IMPORTANT SKIN TRACTIONS
• BUCK’S EXTENSION :
Commonest type of skin
tractions applied to the
lower limb.
• USES :
• Temporary treatment of
fracture neck of femur
• Undisplaced fracture of
acetabulam
• After reduction of hip
dislocation.

34. DUNLOP’S TRACTION
• In upper limbs
• Indicated for
supracondylar fractures,
intercondylar fractures
of humerus where
elbow flexion causes
circulatory
embarrassement

35. GALLOW’S TRACTION
● 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.

36. SKIN TRACTION
• CONTRAINDICATIONS
OF SKIN TRACTION
• Patients with loose skin
• Wounds on the limb
• Circulation problem-
gangrene/ varicose
veins
• Skin infection
• COMPLICATIONS OF
SKIN TRACTION
• Allergy
• Muscular atrophy
• Paralysis
• Oedema

37. SKELETAL TRACTION
● 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.

39. PINS USED FOR SKELETAL TRACTION
• STEINMANN’S PIN
• Stainless steel rod 3-
6mm diameter
• Upper end of tibia,
supracondylar region of
femur & calcaneum.

40. PINS USED FOR SKELETAL TRACTION
• DENHAM’S PIN
• Threaded in the centre
& engages the bony
cortex.
• Useful in cancellous
bone like calcaneum.

41. PINS USED FOR SKELETAL TRACTION
• K – WIRE
Smith traction given by
passing k-wire through
olecranon in
supracondylar fracture.

42. RULES FOR APPLYING SKELETAL
TRACTION
● Applied under anaesthesia
● Aseptic precautions
● Drive the pin from lateral to medial side in case of
upper tibial traction ,to avoid injury to lateral popliteal
nerve.
● Pin should be at right angles to the limb & parallel to
ground.
● For femur 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.

44. ADVANTAGES OF APPLYING TRACTION
• Regain normal length and alignment of involved bone.
• Relieves pain and muscle spasm
• Restricts movements while the injury heals
• Maintains functional position until the healing is complete.
• Allows other activities
• Prevents further structural damage and deformity
• Relieves pressure on nerves (esp spine)
• Prevent or reduce skeletal deformities or muscle
contractures.
• Provides a fusiform tamponade around a bleeding vessel.

45. DISADVANTAGES OF TRACTION
•Costly in terms of hospital stay
•Hazards of prolonged bed rest
• Thromboembolism
•Decubitus ulcer
•Require extensive nursing care

46. COMPLICATIONS OF TRACTION
• Circulatory embarrassment
• Nerve & vessel injury
• Pin site-infection,migration,breakage,
bending.
• Injury to epiphysis in children.
• Pressure sores.

47. DAILY CARE OF A PATIENT IN
TRACTION
• 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 shows tight bandage
or slipped skin traction.
• Proper positioning of the fracture should be
ensured by check x-rays.
• Physiotherapy of limb should be continued to
minimise muscle wasting.