Traction in Orthopaedic

1. Traction in
Orthopaedics
Dr. Sumit Pensia
Resident orthopaedics
JLNMC,Ajmer

2. • Definition : traction is defined as force applied
to overcome the deforming force origenated
by muscle spasm
• Relive pain
• Aids in healing of bone and soft tissue

3. Types
• Based on method of application
Skin traction
Skeletal traction

4. • Based on countertraction mechanism
• Fixed Traction
By applying force against a fixed point
of body proximal to attachments of
musle in spasm.
• Sliding Traction
By tilting bed so that patient tends to
slide in opposite direction to traction

5. Indications
• To reduce the fracture or dislocation
• To maintain the reduction
• To correct the deformity
• To reduce the muscle spasm

6. Advantages
• Decrease pain
• Minimize muscle spasms
• Reduces, aligns, and immobilizes
fractures
• Reduce deformity
• Increase space between opposing
surfaces

7. Disadvantages
• Needs more hospital stay
• Hazards of prolonged bed rest
– Thromboembolism
– Decubitius ulcers
– Pneumonia
• Requires meticulous nursing care
• Can develop contractures

8. 1.Skin traction
• Applied over a large area of skin
• This spreads the load and is more comfortable
and efficient
• Traction force must be applied distal to
fracture site
• Maximum traction weight can be applied with
skin traction is 15lb ( 6.7kg )

9. Types of skin traction
• Adhesive skin traction
• Nonadhesive skin traction

10. A. Adhesive skin traction
• Elastoplast skin traction kit
• Tractac
• Seton skin traction kit
• Orthotrac
• Skin- trac

11. How to apply
Prepare the skin by shaving as well as washing &
applying tincture benzoin which protects the
skin and acts as an additional adhesive.
Avoid placing adhesive strapping over bony
prominences, if not, cover them with cotton
padding and do the strapping.
Leave a loop of 5 cm projecting beyond the
distal end of limb to allow movement of toes
and foot.
Max. traction weight can be 15lb(6.7kg)

12. B.Non adhesive skin traction
 Useful in thin and atrophic skin
 allergy to adhesive strapping
Frequent reapplication may be necessary
Attached traction wt. must not be more than 10lb
( 4.5kg )

13. Contraindications
• Abrasions of the skin
• Lacerations of the skin in the area to which
traction is applied
• Impairment of circulation – varicose ulcers,
impending gangrene
• Dermatitis
• Marked shortening of bony fragments, when
traction weight is required will be greater than
can be applied through the skin

14. Complications
• Allergic reaction to adhesive
• Excoriation of skin from stripping of the
adhesive strapping

15. Complications
Pressure sore around the malleoli and over
the tendocalcaneus

16. Complications
Common peroneal nerve palsy
due to rotation and encircling
bandage

17. Buck’s traction
• Used in temporary
management of
fractures of
– Femoral neck
– Femoral shaft in older children
– Undisplaced fractures of the
acetabulum
– After reduction of a hip
dislocation
– To correct minor flexed
deformities of the hip or knee
– In place of pelvic traction in
management of low back pain
• Weight not more
than 4.5 kgs
• Elevate the foot end
of bed

18. Hamilton Russell Traction
• Used in management of fractures of the
femoral shaft
• Buck’s traction with sling under the knee

19. Bryants (Gallows) traction
• Convenient and satisfactory for the treatment
of fractures of the shaft of femur in children
upto age of two years who weight less than
35-40lb ( 15.9- 18.2kg )

20. • Apply adhesive strapping to both lowerlimbs
• Tie the traction cords to an overhead beam
• Tighten the traction cords sufficiently to raise
the buttocks just clear of the mattress
• Counter traction is obtained by the weight of
the pelvis and lower trunk
• Check the vascular status of limbs because of
danger of vascular compromise

22. How to check state of circulation
• Observe colour and temp. of both feet
• Passive dorsiflexion of ankle,it should be
painless and full movement
• If dorsiflexion is limited or painful,muscle
ischemia may be present
• Immediate lower the limb and remove
bandage

23. Modified Bryant’s traction
• Sometimes used in initial management of
congenital dislocation of hip
• After 5days of application of bryants traction
abduction of both hips begun, being increased
by 10 degrees on alternate days
• By 3 weeks hips should be fully abducted

25. Dunlop’s Traction
• Forearm skin traction
with weight on upper
arm
• Used for
supracondylar and
transcondylar
fractures in children
• Used when closed
reduction difficult
• Upper arm abducted
45 degree and Elbow
is flexed 45 degrees

26. 2.Skeletal traction
• It should be reserved for those cases
in which skin traction is
contraindicated
• In patients with lacerated wounds
• In patients with external fixator in situ
• When the weight required for traction
is more then 6.7 kgs- Obese patients

27. Steinmann Pin
• Rigid stainless steel pins of varying lengths 4 –
6 mm in diameter. Bohler stirrup is attached to
steinmann pin which allows the direction of
the traction to be varied without turning the
pin in the bone

28. Denham Pin
• Identical to stienmann pin except
for a short threaded length in the
center . This threaded portion
engages the bony cortex and
reduce the risk of the pin sliding
• Used in cancellous bone like
calcaneum and osteoporitic bones

29. Kirschner wire
• They are easy to insert and
minimize the chance of soft tissue
damage and infections
• It easily cuts out of the bone if a
heavy traction weight is applied
• Most commonly used in upper
limb eg. Olecranon traction

30. Proximal Tibial Traction
• Used for distal
2/3rd femoral
shaft fractures
• Easy to avoid
joint and growth
plate
• 2cm distal and
posterior to
tibial tubercle
• Pin should be
driven from the
lateral to the
medial side to
avoid damage to
the common
peroneal nerve.

31. Application of skeletal traction
insertion of ST pin in lower limb
Use GA or LA
Shave the skin
Use full aseptic precaution
Paint the skin with iodine and spirit
Mount the pin/wire on the hand drill
Cont.

32. Hold the limb in same degree of lateral rotation as
the normal limb and with ankle at right angles.
Identify the site of insertion and make a stab
wound
Hold the pin horizontally at right angles to the
long axis of the limb.
Apply small cotton woolen pads soaked in tincture
around the pins to seal the wound

33. Complications
• Introduction of infection into bone
• Distraction at fracture site
• Ligamentous damage
• Damage to epiphyseal growth plates
• Depressed scars

34. Lateral Upper Femoral Traction
• Lateral surface of
femur 1 inch
below the most
prominent part of
greater
trochanter,mid
way b/w ant &
post surface of
femur

36. Distal Femoral Traction
• Alignment of
traction along
axis of femur
• Used for
femoral shaft
fracture

37. • Draw 1st line from before
backwards at the level of
the upper pole of
patella,2nd line from
below upwards anterior to
the head of the fibula,
where these two lines
intersect is the point of
insertion of a Steinmann
pin
• Just proximal to lateral
femoral condyle. In an
average adult this point
lies nearly 3 cm from the
lateral knee joint line

39. Distal Tibial Traction
 Useful in certain
tibial plateau
fracture
 Pin inserted 5 cm
above the level of
the ankle joint,
midway between
the anterior and
posterior borders
of the tibia
 Avoid saphenous
vein
 Maintain partial
hip and knee
flexion

40. Calcaneal Traction
 Temporary traction
for tibial shaft
fracture
 Insert about 1 1/4
inches (3cms)
inferior and
posterior to medial
malleolus or ¾ inch
below behind
lat.malleolus.
 Cure must be taken
to avoid entering
subtalar joint

41. Olecranon Pin Traction
 Supracondylar/distal
humerus fractures
 Greater traction
forces allowed
 Can make angular
and rotational
corrections
 Place pin 1.25 inches
distal to tip
 Avoid ulnar nerve

42. • Point of
insertion:
just deep to the
SC border of the
upper end of
ulna (3cms)
This avoids ulnar
joint and also an
open epiphysis
• Technique:
Pass K-wire from
medial to lateral
side - pass the
wire at right
angles to the
long axis of the
ulna to avoid
ulnar nerve.

43. Metacarpal Pin Traction
 Used for obtaining
difficult reduction
forearm/distal
radius fracture
 Once reduction
obtained, pins can
be incorporated in
cast
 Pin placed radial to
ulnar through base
2nd/3rd MC
 Stiffness of
intrinsics is
common

44. • Point of Insertion:
2-2.5 cms proximal
to the distal end of
2nd metacarpal
• Technique: push
the 1st dorsal
interosseius and
palpate the
subcutaneous
portion of the
bone. Pass the K-
wire at right angles
to the longitudinal
axis of the radius,
the wire traversing
2nd and 3rd
metacarpal
diaphysis

45. Crutchfield Tong

46. • Draw a line bisecting skull back to front
• Draw 2nd line joining tips of mastoid
process

47. Management of patients in
traction
• Care of the patient
• Care of the traction suspension
system
• Radiographic examination
• Physiotherapy
• Removal of traction

48. Care of the injured limb-
• Pain
• Parasthesia or Numbness
• Skin irritation
• Swelling
• Weakness of ankle, toe,
wrist or finger movement

49. Radiographic Examination
• 2-3 times in first week
• Weekly for next 3 weeks
• Monthly until union occurs
• After each manipulation
• After each weight change

50. Removal Of Traction
 Elbow fracture with olecranon pin
- 3 weeks
 Tibial fracture with calcaneal pin -
3-6 weeks
 Trochanteric fracture of femur - 6
weeks
 Femoral shaft fracture
 with application of cast brace and
partial weight bearing - 6 weeks
 without external support and
partial weight bearing - 12
weeks

51. THOMAS SPLINT WITH TRACTION

52. Uses of thomas splint
• Commonly used for immobilisation of hip and
thigh injuries
• Immobilise fracture femur
• First aid
• Transportation of injured patient
• In the treatment of joint diseases like TB knee

53. Parts of thomas splint
 A padded metal oval ring with
soft leather set at an angle 120
to the inner barThe ring size is
found by addition of 2 inches
to the thigh circumference at
the highest point of the groin
 2 side bars-one inner & other
outer bar of unequal length.
They bisect the oval ring. The
outer bar longer than inner
bar.

54.  Outer side bar is angled 2
inch below the padded ring
to clear the prominent
greater trochanter
 Distal end-2 side bar joined
in the form of W.
• The length is the
measurement from the
highest point on the medial
side of the groin up to the
heel plus 6 inches

55. Thomas Splint
- used as traction splint

56. Thank you