Traction is used to stretch or align bones and relieve pressure on joints and nerves. There are two main types - fixed traction which uses a fixed point of counterpressure, and sliding traction which uses gravity. Skin traction applies force over a large skin area while skeletal traction uses pins inserted into bones. Common sites for skeletal traction include the proximal tibia, distal tibia, and calcaneus. Traction is used to treat fractures, deformities, joint inflammation and pain. Precautions must be taken to prevent complications like infection, nerve injury, or distraction at the fracture site.

1. TRACTION IN
ORTHOPAEDICS
PRESENTER – DR.SUDHANSHU KOTHADIA

2. Principle of Traction

3. WHAT IS TRACTION ?
Orthopedist’s great "master tool“.
Traction - the application of a force
to stretch certain parts of the body
in a specific direction

4. WHY DO WE NEED TRACTION ?
Inflammation of a joint
Pain and muscle spasm
Defomity

5. fracture of bone
Abnormal Mobility
Pain

6. TRACTION
The purpose of traction is to:
 To regain normal length and alignment of
involved bone.
 To reduce and immobilize a fractured bone.
 To relieve or eliminate muscle spasms.
 To relieve pressure on nerves, especially
spinal.
 To prevent or reduce skeletal deformities or
muscle contractures.

7. TRACTION
 Controls pain.
 Reduces fracture.
 Maintain reduction.
 Prevents & corrects deformity.

8. TRACTION
Based on principle
Fixed traction
Sliding traction

9. FIXED TRACTION
 Traction is applied to the leg against a fixed point
of counter pressure.
– Fixed traction in Thomas’s splint
– Roger Anderson well-leg traction
– Halo-Pelvic Traction

10. THOMAS SPLINT
 Used for # shaft of femur
 Counter traction provided by ischeal
Tuberosity
 Girth should be taken at uppermost part of
thigh near ischeal tuberocity and add 5 cm to
it.
 Measure from Crotch to Heal and it should
be 15-23 cm beyond heal.
 Ring should be angled at 120° to inner side
bar.

11. SLIDING TRACTION
 When the weight of all or part of the body,
acting under the influence of gravity, is
utilized to provide counter-traction.

12. SLIDING TRACTION
 Exact weight required is determined by
trial.
 For the fracture of femoral shaft an
initial weight of 10% of body weight
 Foot end is elevated so that the body
slides in opposite direction.
 1 inch (2.5 cm) for each 1 lb (0.46 kg)
of traction weight

13. TRACTION to limbs

14. TYPES OF TRACTION ON
APPLICATION
Skin traction
–Adhesive
–Non – adhesive
Skeletal Traction

15. SKIN TRACTION

16. SKIN TRACTION
 Traction force is applied over a large
area of skin
 Applied over limb distal to fracture site
 Anteromedial and posterolateral part
should be covered with cotton and
malleoli should be covered with cotton.
 “Coning effect”

17. SKIN TRACTION
 Adhesive skin traction:
– Maximum weight 6.7 kg
 Non-adhesive skin traction
– Maximum weight should not exceed 4.5
kg
– Used in thin and atrophic skin,
– skin sensitive to adhesive strapping,

18. COMMON SKIN TRACTIONS
 Buck’s Traction
 Hamilton Russel Traction
 Tulloch Brown Traction
 Gallow’s or Brayant’s Traction
 Modified Brayan’s Traction
 Pelvic Traction
 Dunlop Traction

19. Buck’s Traction
 Often used
preoperatively for
femoral fractures
 Can use tape
 No more than 5 kgs
 Not used to obtain or
hold reduction

20. HAMILTON RUSSEL TRACTION
 Below knee skin traction is applied
 A broad soft sling is placed under the
knee

21. BRYANT’S (GALLOW’S )
TRACTION
 the treatment of fracture shaft femur in
children up to age of 2 yrs.
 Weight of child should be less than 15-
18 kg
 Above knee skin traction is applied
bilaterally
 Tie the traction to the over haed
beam.

22. MODIFIED BRYANT’S
TRACTION
 Sometimes used as a initial
management of developmental
dysplasia of hip (1 YR)
 After 5 days of Bryant’s traction,
abduction of both hips is begun
increased by about 10 degree
alternate days.
 By three weeks hips should be
fully abducted.

23. PELVIC TRACTION
 Used for conservative management of PIVD
 The amount by which foot end should be
elevated depends upon patient’s weight ,
more heavy the patient, more should be
elevation.

24. DUNLOP TRACTION
 T/t of supracondylar & transcondylar
fracture of humerus
 Useful when flexion of elbow causes
circulatory embarrassment with loss of
radial pulse
 Apply skin traction to forearm
 Abduct shoulder about 45 degree
 the elbow is flexed 45 degree.

25. Dunlop Traction

26. SKIN TRACTION
COMPLICATIONS Of Adhesive Skin Traction :
 Allergic reactions to adhesives.
 Excoriation of skin.
 Pressure sores over bony prominences
and tendoachillis.
 Common peroneal nerve palsy.

27. SKELETAL TRACTION

28. SKELETAL TRACTION
 pin or wire
 more frequently used in lower limb
fractures
 Should be reserved for those cases in
which skin traction is insufficient.
 Generally used when more weight is
needed to give traction.
 To treat fractures conservatively.

29. SKELETAL TRACTION
 SITES
– Upper tibial
– Lower femoral
– Lower tibial
– Calcaneus
– Olecrenon
– Metacarpel

30. Proximal Tibial Traction
 Used for distal 2/3rd
femoral shaft fx
 Easy to avoid joint and
growth plate
 2 cm distal and
posterior to tibial
tubercle

31. Distal Tibial Traction
 Useful in certain tibial
plateau fx
 Pin inserted 5 cm
proximal to tip medial
malleolus , midway
between ant and post
border of tibia.
 Avoid saphenous vein
 Place through fibula to
avoid peroneal nerve
 Maintain partial hip and
knee flexion

32. Calcaneal Traction
 Temporary traction for
tibial shaft fx or
calcaneal fx
 Insert about 2 cm below
and behind the lateral
malleolus
 Do not skewer subtalar
joint or NV bundle
 Maintain slight elevation
leg

33. SOME SKELETAL
TRACTIONS
 Lateral or Upper Femoral Traction
 Nintey / Nintey traction
 Olecrenone traction
 Perkin’s Traction

34. LATERAL UPPER FEMORAL
TRACTION
 For the management of central
fracture dislocation of the hip
 about 2.5 cm from most prominent
part of greater trochanter mid way
between ant. And post. surface of
femur
 threaded screw eye
 Attach weight upto 9 kgs
 Traction to continued for about 4-6
wks

35. NINETY / NINETY TRACTION
 Used for sub trochanteric fractures and
those in the proximal third of the shaft
of the femur
 Management of fractures with posterior
wound is easier
 Traction is given through lower femoral
pin, which is more efficient, or by upper
tibial pin.

37. NINETY / NINETY TRACTION
 Complications of 90/90 traction:
– those related with skeletal traction.
– Stiffness and loss of extension of knee.
– Flexion contracture of hip.
– Injury to epiphyseal plate in children.
– Neurovascular damage

38. SKELETAL TRACTION
COMPLICATIONS
 Infection
 Cut out
 Distraction at fracture site
 Physeal damage
 Nerve Injury

39. SLIDING TRACTION WITH
BOHLER BROWN SPLINT:
 Used for the fracture of tibia or femur.
 Skeletal traction is usually applied, but
skin traction can be given b/k.

40. SPINAL TRACTIONS

41. CERVICAL TRACTIONS
 SKIN TRACTION Head Halter traction
 SKELETAL TRACTION
Crutchfield tongs
Cone or Barton tongs

42. Head Halter traction
 Simple type cervical
traction
 Management of neck
pain
 Weight should not
exceed 3 kg initially
 Can only be used a few
hours at a time
 Head end should be
elevated to give counter
traction

43. Crutchfield Tongs
 Must incise skin and
drill cortex to place
 Rotate metal traction
loop so touches skull in
midsagittal plane
 Place at the line
connecting tips of
mastoid processes on
both sides.

44. CERVICAL TRACTIONS
LEVEL MAX. WT
C2 4.5-5.4 Kg
C3 4.5-6.7Kg
C4 6.7-9.0Kg
C5 9.0-11.3Kg
C6 9.0-13.5Kg
C7 11.3-15.8Kg

45. SUSPENSIONS

46. SUSPENSION
 Done for better nursing care
 To increase the mobility of patient
 To prevent dangers of immobilization
 Suspension system consists of traction cords
pulleys and weight
 Commonly Balken Beam frame is used for
suspension purpose.

47. BALKEN BEAM FRAME
 Commonly Used to suspends splints.
 one or two Balken Frames are used
 Today balken frames are made up of Metal
tubes
 Two uprights are on each side of bed and are joined by two
long horizontal bars.
 Other short horizontal bar may be there joined to two
uprights on same side or to long horizontal bar.

48. TRACION CORDS
 Used to suspend weights to give traction
 Cords perform two functions – traction and
suspension
 For this color code system is available –
- red or green for traction cords
- white for suspension cords.

49. PULLEYS
 Function of pulley is to control the direction of
weight attached to end of the cord over
pulley.
 Large pulley wheels of 6cm in diameter and
6mm in diameter of axles are preferable
 Majority of pulleys are prepared from Tufnol

50. WEIGHTS
 The amount of weight required to suspend
an appliance depends upon -
- weight of appliance
- weight of part of body suspended in
appliance
- the amount of friction present in system.

51. CHARNLEY’S TRACTION
UNIT
 BK POP incorporating the Steinmann or Denham
pin
 Common peroneal nerve and calf muscles
protected
 External rotation of the foot and distal fragments is
controlled
1. The tendo achilles is protected from pressure sores
2. Ipsilateral tibia # can be managed