overall review of splints and tractions in orthopedics.

1. SPLINTS AND TRACTIONS IN
ORTHOPEDICS
MODERATORS:-
Dr.J.Venkateshwarlu(Professor & HOD)
Dr.K.Kishore Kumar ( Associate Professor)
Dr.K.Ram Mohan (Assistant Professor)
Dr.Sirish (Assistant Professor)
- Presented by
Dr.P.GAYATRI

2. SPLINTS
• ANY MATERIAL USED TO SUPPORT A
FRACTURE.
• UNCONVENTIONAL-CRUDE,TEMPORARY &
USED AS A FIRST AID
MEASURE.EX:WOOD,BOARD.
• CONVENTIONAL-REFINED &
SOPHISTICATED,SERVE BOTH AS FIRST AID &
DEFINITIVE MEASURE.EX:POP SPLINT,THOMAS
SPLINT.

3. INDICATIONS
•Fractures, sprains and dislocations
•Joint infections
•Acute arthritis/ gout
•Acute tenosynovitis

4. CONTRAINDICATIONS
•Compartment syndrome
•Need for open reduction
•Infected skin condition or when there is a high
risk of infection

5. POP
•Calcium sulphate dehydrate
•When wet it crystallises
•Exothermic reaction
•Average setting time- 3 to 9 minutes
•Average drying time: 24-72 hrs

6. POP – AN IDEAL SPLINT
• Cheap ,easily available ,comfortable
• Easy to mould , quick setting
• Strong & light
• Easy to remove
• Permeable to radiography
• Permeable to air,hence underlying skin can
breath
• Non-inflammable

7. POP
ADVANTAGES :
•Easier to mold
•Less expensive
DISADVANTAGES :
•More difficult to apply
•Gets soggy and soft when it gets wet

8. CRAMMER WIRE SPLINT
• Used for temporary
quick splintage of a limb
for transport.
• Two thick parallel wires
with ladder like thin
wires.
• Malleable, can easily be
bent to the contour of
limb.

9. THOMAS SPLINT
● Devised by Hugh. Owen
Thomas.
● Initially used for
immobilisation for
tuberculosis of the
knee.

10. PARTS OF THOMAS SPLINT
• Ring at an angle of 120
degrees
• Two side bars
• Outer bar bent to
accommodate the
greater trochanter.
● Leg supported on slings
tied to the side bars.

11. BOHLER – BRAUN SPLINT
• Proximal pulley to
prevent foot drop.
• 2nd pulley- traction in
line with the femur.
• 3rd Pulley- traction in
line for traction in line
with the leg.

12. BOHLER BRAUN SPLINT - ADVANTAGES
• Traction unit is self
contained..
• Limb in comfortable
position
• Angle of traction
changeable
• Wound care possible
• Multipurpose application
• Simultaneous traction
through Calcaneal/distal
tibia and proximal
tibia/distal femur possible

13. DENNIS BROWN SPLINT
• Used in the treatment
of club foot.

14. COCK-UP SPLINT
• Wrist splint.
• Used in the injuries
around wrist such as :
• Distal radial & ulnar
fractures
• Wrist drop
• Carpal tunnel
syndrome.

15. ALUMINIUM FINGER SPLINT
• Used in the treatment
of mallet finger

16. VOLKMANN’S SPLINT
• Used in the treatment
of Volkmann’s ischemic
contracture.

17. AEROPLANE SPLINT
• Used in Brachial plexus
injury

18. SOMI BRACE
• Sternal-occipital-
mandibular-immobilizer
brace.
• Used in atlanto-axial
instability caused by
rheumatoid arthritis.

19. LUMBAR CORSET
• Used in the treatment
of Lower back pain
• Immobilisation after
lumbar laminectomy.

20. ASH BRACE
• Anterior spinal
hyperextension brace.
• Flexion immobilisation
to treat thoracicand
vertebral lumbar body
fractures T6 – L1
• Reduction of kyphosis
in patients with
osteoporosis.

21. MILWAUKEE BRACE
• Used in scoliosis

22. TAYLOR’S BRACE
• Commonly used for
osteoporosis ,
degenerative spine
disease.

23. CARE OF A PATIENT ON SPLINT
• Padding on the fracture site
• Padding on bone prominences
• Active mobilisation of muscles and joints
• Watch out for effects of compression on nerves/
vessels
• Daily check and adjustments of weights
• Check pressure points and perineum for pressure
points
• Care of back

24. PRE-POST CHECKS WITH SPLINTS -
FACTS
• Function
• Arterial pulsations
• Capillary refill
• Temperature
• Sensations

25. TRACTIONS
• Traction is a method of restoring alignment to
a fracture through gradual neutralisation of
muscular forces.
• Traction is pulling effect exerted on a part of
skeletal system.
• Involves use of weights connected to patient
with ropes, pulleys, slings, etc.

26. OBJECTIVES OF TRACTION
• Reduction of fracture/ dislocation
• Reduce/ relieve pain
• Immobilisation of painful joint
• Prevention of deformity, counteracting muscle
spasm
• Correction of small defects.

27. PRINCIPLES OF EFFECTIVE TRACTION
• Traction must produce a pulling
effect on the body
• Counter traction must be
maintained
• The traction and counter pull
must be in the opposite
directions
• Splints and slings must be
suspended without
interference
• Ropes must move freely
through each pulley
• Precise amount of weight must
be applied
• The weights must hang free.

28. TYPES OF TRACTION
• FIXED TRACTION : Counter-traction is provided by
a part of the body.
• Eg: thomas splint-ring of the splint lies against
the ischial tuberosity & povides counter traction.
• SLIDING TRACTION : Weight of the body under
influence of gravity provides counter-traction.
• Eg: traction given for pelvic fracture, where
weight of the body acts as counter traction ,
made effective by elevating the foot end of bed.

30. METHODS OF APPLYING TRACTION
• SKIN TRACTION
• SKELETAL TRACTION

31. SKIN TRACTION
• Traction is applied over large area of skin.
• Maximum weight that can be applied through
skin traction is 6.7kg.
• If weight is applied more than this, traction
will slide down peeling off the skin.
• Skin traction is applied to the limb distal to
fracture site.

32. TYPES OF SKIN TRACTION
• ADHESIVE SKIN
TRACTION: Adhesive
material is used for
strapping which is applied
anteromedial&
posterolateralon either
side of lowerlimbs.
• NONADHESIVE SKIN
TRACTION : Useful in thin
& atrophic skin & in pts
sensitive to adhesive
strap.

33. IMPORTANT SKIN TRACTIONS
• BUCK’S EXTENSION :
Commonest type of skin
tractions applied to the
lower limb.
• USES :
• Temporary treatment of
fracture neck of femur
• Undisplaced fracture of
acetabulam
• After reduction of hip
dislocation.

34. DUNLOP’S TRACTION
• In upper limbs
• Indicated for
supracondylar fractures,
intercondylar fractures
of humerus where
elbow flexion causes
circulatory
embarrassement

35. GALLOW’S TRACTION
● Fracture shaft of femur
in children less than
2yrs.
● Legs of the child are
tied to overhead beam.
Hips are kept a little
raised from bed so that
weight of the body
provides counter
traction & fracture is
reduced.

36. SKIN TRACTION
• CONTRAINDICATIONS
OF SKIN TRACTION
• Patients with loose skin
• Wounds on the limb
• Circulation problem-
gangrene/ varicose
veins
• Skin infection
• COMPLICATIONS OF
SKIN TRACTION
• Allergy
• Muscular atrophy
• Paralysis
• Oedema

37. SKELETAL TRACTION
● Traction is given through
a metal or pin driven
through bone.
● Reserved for cases
where skin traction is
contraindicated &
where applied weight
needed is more than
5kg.

39. PINS USED FOR SKELETAL TRACTION
• STEINMANN’S PIN
• Stainless steel rod 3-
6mm diameter
• Upper end of tibia,
supracondylar region of
femur & calcaneum.

40. PINS USED FOR SKELETAL TRACTION
• DENHAM’S PIN
• Threaded in the centre
& engages the bony
cortex.
• Useful in cancellous
bone like calcaneum.

41. PINS USED FOR SKELETAL TRACTION
• K – WIRE
Smith traction given by
passing k-wire through
olecranon in
supracondylar fracture.

42. RULES FOR APPLYING SKELETAL
TRACTION
● Applied under anaesthesia
● Aseptic precautions
● Drive the pin from lateral to medial side in case of
upper tibial traction ,to avoid injury to lateral popliteal
nerve.
● Pin should be at right angles to the limb & parallel to
ground.
● For femur shaft fracture, initial weight required is 10%
of patient’s body weight.
● For every 1lb of weight, end of bed should be raised by
1in.

44. ADVANTAGES OF APPLYING TRACTION
• Regain normal length and alignment of involved bone.
• Relieves pain and muscle spasm
• Restricts movements while the injury heals
• Maintains functional position until the healing is complete.
• Allows other activities
• Prevents further structural damage and deformity
• Relieves pressure on nerves (esp spine)
• Prevent or reduce skeletal deformities or muscle
contractures.
• Provides a fusiform tamponade around a bleeding vessel.

45. DISADVANTAGES OF TRACTION
•Costly in terms of hospital stay
•Hazards of prolonged bed rest
• Thromboembolism
•Decubitus ulcer
•Require extensive nursing care

46. COMPLICATIONS OF TRACTION
• Circulatory embarrassment
• Nerve & vessel injury
• Pin site-infection,migration,breakage,
bending.
• Injury to epiphysis in children.
• Pressure sores.

47. DAILY CARE OF A PATIENT IN
TRACTION
• Proper functioning of traction unit to be ensured
traction weights should not be touching the
ground.
• Check the terminal part of the limb-its colour,
warmth, sensations.
• Any swelling of the fingers shows tight bandage
or slipped skin traction.
• Proper positioning of the fracture should be
ensured by check x-rays.
• Physiotherapy of limb should be continued to
minimise muscle wasting.