Different types of physiotherapy, traction and splints

1. Mr. Mahesh Chand
Nursing Tutor
Manikaka Topawala Institute of Nursing Changa
maheshchand.nur@charusat.ac.in

2. OBJECTIVES
At the end of the seminar student will understand
different treatment modalities used in orthopedic
such as:
 Physiotherapy
 Tractions
 Splints

3. PHYSIOTHERAPY

4. •Physiotherapy is a branch of medical
science where physical measures such as
heat, light, ultrasound, water, electricity and
exercises are used in the diagnosis and
treatment of orthopaedic injuries.
PHYSIOTHERAPY

5. PHYSIOTHERAPY
Passive Physiotherapy directed toward the
alleviation of symptoms
Active Physiotherapy directed toward restoration
of function by activity

6. •Aims
To treat disability and deformity.
To correct disability and deformity
To prevent disability and deformity

7. CATEGORIES
Depending on severity of the ailment
1. Short term physiotherapy
2. Long term physiotherapy

8. Short Term Physiotherapy
•Includes patients with minor neuromuscular-skeletal
lesions like
-Simple soft tissue injuries
-Simple fractures
-Non traumatic lesions

9. Long term physiotherapy
Refers to more complicated diseases of
musculoskeletal origin
Includes condition like-
Fractures of major bones
Spinal trauma resulting in physical disability and
complications like paraplegia, quadriplegia etc.
Surgical procedures involving major joints
Chronic conditions like RA

10. Short And Long Term Goals
Protect the involved area
Reduce pain and inflammation
Reduce intra or extra capsular effusion
Increase range of joint movement
Increase musculotendinous flexibility
Increase muscle strength power
Restore normal biomechanical functions
Increase balance and proprioception

11. Exercises

12. Active exercises
After Trauma
After Surgery
Immobilization in plaster

13. Exercises
Isometric Exercises when the limb is in plaster
Isotonic Exercises to improve muscle power

14. Orthopaedic Appliances
Wrist cricumductor
Wall bars
Shoulder abduction ladder
Shoulder pulley set

15. Orthopaedic Appliances
Wrist gripper
Dumbell
Skates roller

16. Orthopaedic Appliances
Quadriceps board
Hip circumductor
Heel exerciser

17. Orthopaedic Appliances
Ankle exerciser Parallel walking bar
Training stairs

18. Massage
It is defined as the scientific manipulation of the soft
tissue which is performed by using the palmar aspect of
the hand. It aims to increase the blood circulation and
relief from pain.
Therapeutic effects
Increase fluid exchange in tissue without changing volume
of fluid pressure
Reduced swelling
Decreases toxins
Increased flexibility
Remodeling of connective tissue
Decrease spasm in muscles

19. Classification
Stroking manipulation
Pressure manipulation
Percussion manipulation
Shaking manipulation

20. Electrotherapy
Faradic current Flat Feet
To improve quadriceps power
Reeducation of muscle after
tendon transfer
Galvanic current After nerve palsies to prevent
fibrosis

21. Ultrasonic Therapy
Act by mechanical and thermal effects
Cervical spondylosis
Backache
Lossening of scar

22. Short Wave diathermy
Pain reduction and swelling
Healing of wound is acclerated
Reduction and modification of inflammation
Acute traumatic haematoma and synovitis treatment
SHORT WAVE DIATHERMY

23. Microwave Diathermy
Frequency is between 300MHZ to 300GHZ
Blood circulation is increased
Relief of pain
Used in acute traumatic and rheumatic condition

24. Interferential therapy
Uses medium frequency current
Used in rheumatism
Arthritis
Muscle sprain
Neuralgia
Sports injury

25. Paraffin Wax
Used to relieve pain after trauma
Degenerative trauma disease
Chronic stages of inflammatory arthropathy
PARAFFIN WAX BATH

26. Laser Therapy
Reduce inflammation
Reduce oedema
Increase RNA level
Stimulate fibroblast
Increased vascularisation of wound

27. Cryotherapy
To promote clotting and haemostasis
To reduce pain and odema
To reduce spasticity

28. TENS
Transcutaneous Electrical Neural
Stimulation
Used for pain relief
Chronic musculosekeltal pain
Osteoarthritis
Can be used by patient themselves
Costly

29. Hydrotherapy
Neck pain
Spinal injury
Arthritis
Multiple sclerosis
Post operative orthopedics
Sports injury
Rheumatology

30. Chanchal kumar singh
ORTHO JR -1
JIPMER

31. Traction is the application of a pulling
force to a part of the body ,which can
overcome the effect of original deforming
force and thus can be used to reduce a
fracture or dislocation of a joint.

32. Skin traction
The traction force applied over a large area of skin
- Adhesive and Non-adhesive skin tractions.
Skeletal traction
Applied directly to the bone either by a pin or wire through
the bone. (eg- Steinmann pin, denham pin, kirschner wire)

33. Decrease pain
Minimize muscle spasms
Reduce, align, and immobilize fractures
Reduce deformity
Increase space between opposing surfaces

34. Costly in terms of hospital stay.
Hazards of prolonged bed rest.
Thromboembolism
Pneumonia
Requires meticulous nursing care.
Can develop contractures.

35.  Bed and Balkan beam
 Splints
 Slings and padding
 Skin traction
 Skeletal traction
 Stirrups
 Cord
 Pulleys
 Weights

36. Countertraction must be used to achieve effective
traction.
Countertraction is the force acting the opposite
direction.
Usually, the patient's body weight and bed
position adjustments supply the needed
countertraction.

38. Standard bed has 4-
post traction frame.
Ideal bed for traction
with multiple injuries
is adjustable height
with Bradford frame.
Mattress moves
separate from frame.

39. Bradford frame
enables bedpan
and linen
changes
without
moving pt.
Alternatively
bed can be
flexible to allow
bending at hip
or knee.

40. To control the direction of weight
By altering site and by using more than 1 pulley
the force exerted by a given weight can be
increased
Pulleys of 5-6.25cm diameter with 6cm diameter
axles are preferrable.

42. The traction force is applied over a large area, this
spreads the load and is more comfortable and
efficient.
Force applied is transmitted from skin to the
bones via superficial fascia, deep fascia and
intermuscular septa.
For better efficiency the traction force is applied
only to the limb distal to the fracture.

43.  Skin damage can result from too much
of traction force.
 Maximum weight recommended for
skin traction is 6.7 kgs
 Depending on size and weight of the
patient

45.  It may be used as a means of reducing or
maintaining the reduction of a fracture.
It should be reserved for those cases in
which skin traction is contraindicated.

46. Can treat most fractures.
Requires bed rest.
Usually reserved for comatose or multiply injured
patient or settings where surgery can not be done.
E.g.: Forearm skin traction, skin traction, Dunlop’s
traction, Olecranon Pin traction, Lateral olecranon
traction, metacarpal pin traction, finger traps.

47. Can be used to treat most lower extremity fractures of the
long bones
Requires bed rest
Used when surgery can not be done for one reason or
another
Uses skin and skeletal traction.
E.g. Pelvic traction, Buck’s Traction, Upper femoral traction,
Split Russell’s traction, Bryant traction, 90-90 traction,
Agnes hunt traction, Distal femoral traction, Proximal
tibial traction, Perkin’s traction.

48. CARE OF PATIENT IN
TRACTION
Traction should be made comfortable.
Proper functioning of traction unit must be ensured.
Sensations over toes and fingers should be normal.
Proper position of fracture ensured by taking check x-
rays in traction.
Physiotherapy of limb should be continued to
minimise muscle wasting.

50. Any material used to support a fracture is known as
splint.

51. Temporary immobilization of sprains, fractures, and
reduced dislocations
Control of pain
Prevention of further soft tissue or neurovascular
injuries

52. • Used for temporary
splintage of fractures
during transportation.
•Made of 2 thick
parallel wires with
interlacing wires.
•Can be bent into
different shapes.

53. Devised by Hugh. Owen Thomas.
Initially used for immobilisation for
tuberculosis of the knee.

54. •Bohler’s
modification of
braun splint.
•Consisted of
only 1 pulley.

55. Use-Club foot(CTEV)

66. Splint should be properly applied, well padded at
bony prominences and at the fracture sites
Bandage of the splint shouldn’t be too tight nor
too loose.
Patient should be encouraged to actively exercise
the muscles and the joints inside the splint as
much as permitted.
Any compression of nerve or vessel should be
detected early and managed accordingly.
Daily checking and adjustments should be made.