Splinting & traction

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Dr. Ashish GohiyaMS (Orth), FIAS, FIOS (UK)

Associate Professor Department of Orthopaedics & Traumatology

Gandhi Medical College, Bhopal

Earthquake

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Tsunami

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Mumbai Blast

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Taj Attack

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Why do we Splint

•To stabilize the extremity

•To decrease pain

•To avoid further injury

•To treat the injury

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Which limbs need splinting

Physical signs of a fracture: Swelling Tenderness Deformity (seen or felt) Impaired function Abnormal movement in a limb Crepitus or grating between the bone ends Pain on stressing the limb by bending or

longitudinal compression

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On- Site Splinting

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Air Splints

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Air Splints

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Emergency splints

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Thomas Splint

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Sir Hugh Owen Thomas

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Bohler Braun Splint

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Plaster

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Above elbow Below elbow

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Above knee Below knee

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Complications of Splinting

• Abrasions

• Sores

• Neurovascular compromise (tight fitting splints)

• Contact dermatitis

• Pressure ulcers

• Thermal burns

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The pain is worsening after

splint application

Remove Splint /Plaster

Watch for 5 P’s

Compartment syndrome

Pain

Pallor

Pulse less Paralysis

Paresthesia

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Traction

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Trauma to bone, joint, soft tissue

Spasm of muscles

Deformity & impaired function

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TRACTION

Control movement of the part

Controls pain

Reduces Fracture

Maintains reduction

Prevents and

corrects deformity

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National PG Instructional Course,

Bhopal

TRACTION

•Based on duration •Continuous traction•Intermittent traction

•Cervical•pelvic

TRACTION

•Based on principle •Fixed traction•Sliding traction

COUNTER TRACTION

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

SLIDING TRACTION

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

SLIDING TRACTION

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

TRACTION

•Based on application •Skeletal traction•Skin traction

•Adhesive •Non – adhesive

TRACTION

Skin Traction

Adhessive Non- Adhessive

Skeletal Traction

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Skin Traction

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SKIN TRACTION

COMPLICATIONS

• Allergic reactions to adhesives.

• Excoriation of skin.

• Pressure sores over bony prominences and tendoachillis.

• Common peroneal nerve palsy.

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2 cm distal & posterior to tibial tuberosity

UPPER TIBIAL PIN

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LOWER FEMORAL PIN

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LOWER TIBIAL PIN

5 cm proximal to ankle joint

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CALCANEAL PIN

2.5 cm distal & posterior to Lateral Malleolus

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SKELETAL TRACTION

COMPLICATIONS

• Infection

• Cut out

• Application of splint difficult

• Distraction at fracture site

• Ligament damage

• Physeal damage

• Depressed scars

HAMILTON RUSSEL TRACTION

TOMBERLIN TRACTION

• variation of Russell traction

• Pearson attachment is attached to a tibial Steinmann pin and held in place by a traction bow

NINETY / NINETY TRACTION

GALLOW’S TRACTION

• Children up to age of 2 yrs.

• Weight of child should be less than 15- 18 kg

• B/L Above knee

GALLOWS TRACTION

National PG Instructional Course, Bhopal

MODIFIED BRYANT’S TRACTION

DDH (1 YR) After 5 days Abduction increased by about 10 degree alternate days

DUNLOP TRACTION

Uses ?

LATERAL UPPER FEMORAL TRACTION

2.5 cm

Screw eye

AGNES HUNT TRACTION

FOR THE CORRECTION OF FLEXION DEFORMITYOF THE HIP.

ROGER ANDERSON WELL LEG TRACTION

CHARNLEY’S TRACTION UNIT

Any Questions ?

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• What is traction ?

• How it works ?

• Where it is used ?

• What are the types of traction ?

• How the traction is applied ?

• What are the complications of traction ?

• Few named tractions ?

? ? ? ? ? ?

Summary

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On Site

Emergency Splints

Any hard thing

Use other limb

Summary

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In Hospital

Thomas Splint

BohlerBrown splint

Plaster Slab

Summary

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Traction

Skin Traction

Skeletal Traction