This ppt will give basic idea about traction.

1. Traction
by Dr.Ramesh Charan
under guidance of Dr.B.L.Khajotia sir

2. Definition : traction is defined as force applied to
overcome the muscle spasm
TYPES
1. Based on method of application
 Skin traction
 Skeletal traction
2. Based on mechanism of traction
 Fixed Traction
By applying force against a fixed point of body.
 Sliding Traction
When the weight of all or part of the body, acting
under the influence of gravity , is utilized for counter
traction

3. History
 Malgaigne introduced the 1st effective traction which grasped
the bone itself. He used malgaigne’s hooks
 Fritz-Steinmann introduced a method of applying skeletal
traction to the femur by means of two pins driven into the
femoral condyles.
 Lorenz- Bohler ‘The Father of Traumatology’ popularised
skeletal traction by means of Steinmann pins after he devised
Bohler stirrup.

4. Indications
O To reduce the fracture or dislocation
O To maintain the reduction
O To correct the deformity
O To reduce the muscle spasm

5. Advantages
O Decrease pain
O Minimize muscle spasms
O Reduces, aligns, and immobilizes fractures
O Reduce deformity
O Increase space between opposing surfaces

6. Counter traction
The resistance or back pull
made to traction or pulling on a limb;
for example; in the case of traction made on the leg,
countertraction may be effected by raising the foot o
f the bed so that the weight of the body pulls against
the weightattached to the limb.

7. Pulleys
O To control the direction of weight
O By altering site and by using more than 1 pulley the
force exerted by a given weight can be increased

8. Weights
Amount of weight required depends upon
O Weight of the appliance
O Weight of part of body suspended
O Amount of friction present in the system
O Mechanical advantage of the system employed
for suspension

9. Skin traction
O Applied over a large area of skin
O This spreads the load and is more comfortable
and efficient
O Traction force must be applied distal to
fracture site
O Maximum traction weight can be applied with
skin traction is 15lb ( 6.7kg )

10. Two types
1. Adhesive skin traction
• Elastoplast skin traction kit
• Seton skin traction kit
2. Non-adhesive skin traction
• Useful in thin and atrophic skin
• Allergy to adhesive strapping
• Frequent reapplication may be necessary
• Attached traction wt. must not be more than
10lb ( 4.5kg )
• Below knee traction

11. Precautions
 Prepare the skin by shaving as well as
washing & applying tincture benzoin which
protects the skin and acts as an additional
adhesive.
 Avoid placing adhesive strapping over bony
prominences, if not, cover them with cotton
padding and do the strapping.
 Leave a loop of 5 cm projecting beyond the
distal end of limb to allow movement of
fingers and foot.

12. Contraindications
O Abrasions of the skin
O Lacerations of the skin in the area to which
traction is applied
O Impairment of circulation – varicose ulcers,
impending gangrene
O Dermatitis

13. Complications
O Allergic reaction to adhesive
O Excoriation of skin from stripping of the
adhesive strapping
O Pressure sore around the malleoli and over the
tendo-calcaneus
O Common peroneal nerve palsy
O Blistering of skin

14. USES
 It is used in temporary management of fractures of
O Femoral neck
O Femoral shaft in older children
O Un displaced fractures of the acetabulum
O After reduction of a hip dislocation
O To correct minor flexed deformities of the hip or
knee
O In place of pelvic traction in management of low
back pain
 Can use tape or pre-made boot
 Not more than 4.5 kgs
 Used to obtain or hold reduction

15. Tractions in routine use
O Gallows traction
O Russels traction
O Bryants traction
O Agnes hunt traction
O 90-90 Traction
O Dunlops raction
O Head halters traction
O Pelvic traction

16. 1. Gallows traction
• Legs of the child is tied to an overhead beam
• Hips are kept a little raised from the bed so that the
weight of the body provides counter traction
• Used for #shaft of femar in childrens less then 3yr old
2. Hamiltons Russels traction
• Buck’s traction with sling under the knee
• Used in management of fractures of the femoral shaft
• After arthroplasty operations of hip
3. Bryant’s traction
• fractures of the shaft of femur in children upto age of
two years who weight less than 35-40lb ( 15.9- 18.2kg)

17. Gallow’s Russel’s

20. Modified Bryant’s traction
O Sometimes used in initial management of
congenital dislocation of hip
O After 5days of application of Bryant’s traction
abduction
of both hips begun
being increased by
10 degrees on
alternate days
O By three weeks hips
should be fully abducted

21. 4. Agnes Hunt traction
• To correct mild flexion deformity of hip eg;
poliomyelitis
5. 90-90 Traction
• Fracture of shaft femur in children subtrochanter
and proximal third fracture
• Used in fixed flexion contracture of knee
O Using a Tulloch – Brown U- loop
O Using a second steinmann pin
O Using a below knee pop cast

22. Dunlop’s Traction
O Used for supracondylar
and trans-condylar
fractures of humerus in
children
O Used when closed
reduction difficult
O Forearm skin traction
with weight on upper
arm
O Elbow flexed 45 degrees

23. Double Skin Traction
O Used for # of greater
tuberosity or proximal
humeral shaft
O Arm abducted 30
degrees
O Elbow flexed 90 degrees
O 7-10 lbs on forearm
O 5-7 lbs on arm
O Risk of ischemia at
antecubital fossa

24. Finger traps
O Used for distal
forearm reductions
O Changing fingers
imparts radial/ulnar
angulation
O Can get skin
loss/necrosis
O Recommend no more
than 20 minutes

25. O Head halters traction
• Simple type cervical traction
• Management of neck pain
• Weight should not exceed 2.3 kg
• Can only be used a few hours at a time

26. O Pelvic traction
Used in fractures of pubis rami,pelvic diastasis
,iliac blade ,acetabulum
O Can also be used in the conservative
management of PIVD
O Halopelvic traction
• Used in scoliosis

27. Skeletal traction
O It should be reserved for those cases in which
skin traction is contraindicated
O In patients with lacerated wounds
O In patients with external fixator in situ
O When the weight required for traction is more
then 6.5 kgs

28. O Steinmann pin
• Rigid stainless steel pins of varying lengths 4 – 6
mm in diameter. Bohler’s stirrup is attached to
Steinmann pin which allows the direction of the
traction to be varied without turning the pin in
the bone

29. O Denham’s pin
• Identical to Stienmann pin except for a short
threaded length in the center . This threaded
portion engages the bony cortex and reduce
the risk of the pin sliding
• Used in cancellous bone like calcaneum and
osteoporitic bones

30. O Kirschner’s wire
• They are easy to insert and minimize the chance of
soft tissue damage and infections
• It easily cuts out of the bone if a heavy traction
weight is applied
• Most commonly used in upper limb eg. Olecranon
traction

31. How to Apply
 Use GA or LA
 Paint the skin with iodine and spirit
 Mount the pin/wire on the hand drill
 Hold the limb in same degree of lateral rotation as
the normal limb and with ankle at right angles.
 Identify the site of insertion and make a stab wound
 Hold the pin horizontally at right angles to the long
axis of the limb.

32.  Apply small cotton woolen pads soaked in tincture around
the pins to seal the wound
 The pin should pass only through skin, SC tissue and bone
avoiding muscles and tendons

33. O Proximal tibial traction
• Used for distal 2/3rd femoral shaft fractures
• Tibial pin allows rotational moments
• Easy to avoid joint and growth plate
• 2cm distal and posterior to tibial tubercle
• Pin should be driven from the lateral to the medial
side to avoid damage to the common peroneal nerve
O Distal tibial traction
• Pin is inserted 5cm above the level of the ankle joint
mid way between the anterior and posterior border
of the tibia
• Avoid saphenous vein
• Mantain partial hip and knee function

34. O Distal femoral traction
• Alignment of traction along axis of femur
• Used for acetabular fracture and femoral shaft
fracture
• Used when strong force needed or knee pathology
present

35. O Calcaneal traction
• Inserted from medial side
• Temporary traction for tibial shaft fracture or
calcaneal fracture
• Insert about 3cms inferior and posterior to medial
malleolus

36. O Upper femoral traction(Trochanteric hook)
• Hook driven into the neck of femur
• Stretched capsule and ligamentum teres may reduce
acetabular fragments upon application of suitable weight
to the hook

37. O Perkins traction
• Denham pin is inserted through the upper end of tibia
• Simoni’s swivel is attached to Denham pin
• Two traction cords are connected to each of swivel
• 4.6 kg weight is attached to each traction cord making a total
traction weight of 9.2 kg
• Foot end of the bed is elevated by one inch for each 0.46 kg of
traction weight
• One or more pillow is placed under the thigh to maintain the
anterior bowing of the femoral shaft
• Length of the limb is checked with a tape measure and total
traction weight is increased or decreased as necessary
• Active Quadriceps exercises are started immediately and
continued
• Knee flexion is started after a week of admission, under
supervision

39. Olecrenon tip traction
• Supracondylar/distal humerus fractures
• Greater traction forces allowed
• Can make angular and rotational corrections
• Place pin 1.25 inches distal to tip
• Avoid ulnar nerve

41.  Point of insertion:
• just deep to the SC border of the upper end of
ulna (3cms)
• This avoids ulnar joint and also an open
epiphysis
 Technique:
• Pass K-wire from medial to lateral side - pass
the wire at right angles to the long axis of the ulna
to avoid ulnar nerve.

42. Metacarpal Pin Traction
 Used for obtaining difficult
reduction forearm/distal
radius fracture
 Once reduction obtained,
pins can be incorporated in
cast
 Pin placed radial to ulnar
through base 2nd/3rd MC
 Stiffness of intrinsics is
common

47. Gardner Tongs
O U shaped tongs, used for spinal traction
O In patients having cervical injury
O Easy to apply
O Place directly above external auditory meatus
O In line with mastoid process
O Weight ranges from2.3 kg to 15.8 kg for c-spine
O Poor placement can cause flexion/extension forces
O Patient can get occipital decubitus

48. Gardens crutchfeilds

49. Crutchfield Tongs
O Crutchfield tongs fit into the parietal bones
O A special drill point with a shoulder is used to enable
an accurate depth of hole to be drilled
O Sedate the patient
O Shave the scalp locally
O Draw a line on the scalp, bisecting the skull from front
to back
O Draw a second line joining the tips of the mastoid
processes which crosses the first line at right angles
O Fully open out the tongs

50. Care of patients in traction
O Look for blisters or any skin changes
O Check distal neurosensory function
O Check distal pulse(NBC)
O Active toe/finger movement
O Elevation of limb
O Care of the traction suspension system
O Radiographic examination
O Physiotherapy

51. THANK YOU