4.Lower Limb
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Transcript of 4.Lower Limb
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Lower-limbtraction
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Limb traction is useful for reducing and
immobilizing femoral shaft fractures supracondylar and intercondylar
fractures of the femur
condylar fractures of the upper end
of the tibia grossly infected or contaminated
fractures of the tibia
and severe fractures of the anklemortise with subluxation ordislocation or both
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Neglected dislocations of the hip and
kneegross deformities and displacements
due to traumatic, infectious
or rheumatoid conditions of the hipand knee
and deformities after poliomyelitis
can all be corrected by continuous
traction.
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Skin traction Technique
Sedate the patient (anaesthesia isunnecessary).
Clean the limb with soap and water, anddry it
Prepare the skin with an antisepticsolution, preferably methylated spirit,and let it dry
. If a commercial traction set (complete
with adhesive tapes, traction cords,spreader bar, and foam protection forthe malleoli) is not available, improvisethe apparatus as described below.
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Open a roll of adhesive strapping on a cleandry table and spread it with the adhesivesurface up. (Use a size appropriate to the size
of the patient; for an adult, a 7.5-cm wide, non-elastic tape is usually suitable.) For above-knee traction, measure a length of strappingthat is twice the length of the limb from thegreater trochanter to the sole of the foot . Addan extra 35 - 40 cm to accommodate thespreader and to leave enough space (10 - 15cm) between the sole and the spreader topermit movement at the ankle. For below-knee
traction, the length of strapping should bemeasured from the tibial condyles. For thetreatment of compound fractures, tractionshould be applied just distal to the site offracture and the strapping should be cut
accordingly.
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Place a square, wooden spreader of
approximately 7.5 cm (with a central
hole) in the middle of the length ofstrapping that you have spread on the
table.
Cut another length of strapping about 35-40 cm long and centre it on the spreader
with the adhesive surface down. The
spreader is now sandwiched between
the two strappings
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Holding the patients ankle and foot, pull the
limb steadily, elevating it from the bed.
Instruct an assistant to hold the spreaderwith a loop of strapping projecting 10 - 15
cm beyond the sole of the foot
Apply the strapping to the medial and lateralsides of the limb, still elevated and held in
moderate traction
Protect the malleoli, Achilles tendon
insertion, and the head and neck of the
fibula by placing strips of felt or cotton-wool
padding under the strapping at these sites
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For above-knee traction, the adhesive
strapping should extend proximally to
the groin on the medial side and to thegreater trochanter on the lateral side
To avoid causing deformity due to
external rotation, place the lateralstrapping slightly posterior, and the
medial strapping slightly anterior to the
mid-lateral and mid-medial lines,
respectively
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Ensure that the strapping lies flat on thesurface of the limb. Do nor cover the
anterior border of the tibia or encircle thelimb with strapping
Now apply a crepe or ordinary gauzebandage firmly over the strapping
beginning 2 - 5 cm proximal to the malleoli.Continue bandaging up the limb, over thestrappings, up to the groin (or asappropriate to the level of traction). Elevate
the end of the patients bed and attach atraction cord through the spreader with therequired weight . this should normally notexceed 5 kg
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Contraindications
Do not apply skin traction to a limb with
abrasions, lacerations, ulcers of the
skin, loss of sensation, impending
gangrene, atrophic skin, or peripheralvascular disease. Skin traction is also
contraindicated in the treatment of
marked overriding of fracture fragmentsor of gross, long-standing deformities
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Complications
Possible complications include allergic reaction
to the adhesive material (usually zinc oxide);blister formation or excoriation of the skin fromthe strapping slipping; pressure sores over themalleoli; and common peroneal nerve palsy.
Most of these complications can be avoided bycorrect application of the adhesive strapping.The most important cause of common peronealnerve palsy is lateral rotation of the limb,
resulting in compression of the nerve at theupper end of the fibula. Avoid this by keepingthe patients knee joint moderately flexed (up to10).
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Different kinds of skin traction
Bucks ExtensionAffection of the hip and femor
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Bryant traction
Affection of hip and femor below 3yrs
old
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Boot cast traction
For post poliomyelitis with residualparalyis of hip and knee
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Modified bucks extension traction
Affection of the hip and femor
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Pelvic girdle
For lumbo-sacral affection andherniated nucleus pulposus
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Hammock suspension traction
Affection of the pelvis and malgainedfracture
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Skeletal traction
Balanced skeletal tractionAffection of the hip and/or femur
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Ninety-ninety degrees traction
Subtrochanteric and proximal 3rd
fractue of femor
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Balance Skeletal Traction (BST)
http://localhost/var/www/apps/conversion/tmp/scratch_8/2.balance%20skeletal%20traction.pptxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/2.balance%20skeletal%20traction.pptx