Splinting & tractiongohiyaorthoclinic.com/.../2015/07/traction-and-splints.pdfBohler Braun Splint...
Transcript of Splinting & tractiongohiyaorthoclinic.com/.../2015/07/traction-and-splints.pdfBohler Braun Splint...
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 ?
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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