1. TRACTION IN ORTHOPAEDICS
PRESENTER – DR.SUDHANSHU KOTHADIA

2. Principle of Traction

3. WHAT IS TRACTION ?
Orthopedist’s great "master tool“.
Traction - the application of a force to stretch certain parts of the body in a specific direction
No matter how complicated a fracture might appear to be, traction will often times pull the fragments into alignment very nicely.

4. Inflammation of a joint
WHY DO WE NEED TRACTION ?
Inflammation of a joint
Pain and muscle spasm
Defomity

5. fracture of bone
Abnormal Mobility
agonist and antagonist muscle.
Pain

6. TRACTION The purpose of traction is to:
To regain normal length and alignment of involved bone.
To reduce and immobilize a fractured bone.
To relieve or eliminate muscle spasms.
To relieve pressure on nerves, especially spinal.
To prevent or reduce skeletal deformities or muscle contractures.

7. TRACTION Controls pain. Reduces fracture. Maintain reduction.
Prevents & corrects deformity.

8. TRACTION
Based on principle
Fixed traction
Sliding traction

9. 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
Halo-Pelvic Traction
the traction cords are tied to the distal end of the splint and the counter-traction force passes along the side bars of the splint to the ring and hence to the body proximal to the attachment of the muscles in spasm.

10. THOMAS SPLINT Used for # shaft of femur
Counter traction provided by ischeal Tuberosity
Girth should be taken at uppermost part of thigh near ischeal tuberocity and add 5 cm to it.
Measure from Crotch to Heal and it should be cm beyond heal.
Ring should be angled at 120° to inner side bar.

11. SLIDING TRACTION
When the weight of all or part of the body, acting under the influence of gravity, is utilized to provide counter-traction.
Initially more weight for reduction then reduce

12. 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

13. TRACTION to limbs

14. TYPES OF TRACTION ON APPLICATION
Skin traction
Adhesive
Non – adhesive
Skeletal Traction

15. SKIN TRACTION

16. SKIN TRACTION Traction force is applied over a large area of skin
Applied over limb distal to fracture site
Anteromedial and posterolateral part should be covered with cotton and malleoli should be covered with cotton.
“Coning effect”

17. SKIN TRACTION Adhesive skin traction: Non-adhesive skin traction
Maximum weight 6.7 kg
Non-adhesive skin traction
Maximum weight should not exceed 4.5 kg
Used in thin and atrophic skin,
skin sensitive to adhesive strapping,

18. COMMON SKIN TRACTIONS Buck’s Traction Hamilton Russel Traction
Tulloch Brown Traction
Gallow’s or Brayant’s Traction
Modified Brayan’s Traction
Pelvic Traction
Dunlop Traction

19. Buck’s Traction Often used preoperatively for femoral fractures
Can use tape
No more than 5 kgs
Not used to obtain or hold reduction

20. HAMILTON RUSSEL TRACTION
Below knee skin traction is applied
A broad soft sling is placed under the knee

21. BRYANT’S (GALLOW’S ) TRACTION
the treatment of fracture shaft femur in children up to age of 2 yrs.
Weight of child should be less than kg
Above knee skin traction is applied bilaterally
Tie the traction to the over haed
beam.

22. MODIFIED BRYANT’S TRACTION
Sometimes used as a initial management of developmental dysplasia of hip (1 YR)
After 5 days of Bryant’s traction, abduction of both hips is begun increased by about 10 degree alternate days.
By three weeks hips should be fully abducted.

23. PELVIC TRACTION Used for conservative management of PIVD
The amount by which foot end should be elevated depends upon patient’s weight , more heavy the patient, more should be elevation.

24. DUNLOP TRACTION
T/t of supracondylar & transcondylar fracture of humerus
Useful when flexion of elbow causes circulatory embarrassment with loss of radial pulse
Apply skin traction to forearm
Abduct shoulder about 45 degree
the elbow is flexed 45 degree.

25. Dunlop Traction

26. SKIN TRACTION COMPLICATIONS Of Adhesive Skin Traction :
Allergic reactions to adhesives.
Excoriation of skin.
Pressure sores over bony prominences and tendoachillis.
Common peroneal nerve palsy.

27. SKELETAL TRACTION

28. SKELETAL TRACTION pin or wire
more frequently used in lower limb fractures
Should be reserved for those cases in which skin traction is insufficient.
Generally used when more weight is needed to give traction.
To treat fractures conservatively.

29. SKELETAL TRACTION SITES Upper tibial Lower femoral Lower tibial
Calcaneus
Olecrenon
Metacarpel

30. Proximal Tibial Traction
Used for distal 2/3rd femoral shaft fx
Easy to avoid joint and growth plate
2 cm distal and posterior to tibial tubercle

31. Distal Tibial Traction
Useful in certain tibial plateau fx
Pin inserted 5 cm proximal to tip medial malleolus , midway between ant and post border of tibia.
Avoid saphenous vein
Place through fibula to avoid peroneal nerve
Maintain partial hip and knee flexion

32. Calcaneal Traction
Temporary traction for tibial shaft fx or calcaneal fx
Insert about 2 cm below and behind the lateral malleolus
Do not skewer subtalar joint or NV bundle
Maintain slight elevation leg

33. SOME SKELETAL TRACTIONS
Lateral or Upper Femoral Traction
Nintey / Nintey traction
Olecrenone traction
Perkin’s Traction

34. LATERAL UPPER FEMORAL TRACTION
For the management of central fracture dislocation of the hip
about 2.5 cm from most prominent part of greater trochanter mid way between ant. And post. surface of femur
threaded screw eye
Attach weight upto 9 kgs
Traction to continued for about 4-6 wks

35. NINETY / NINETY TRACTION
Used for sub trochanteric fractures and those in the proximal third of the shaft of the femur
Management of fractures with posterior wound is easier
Traction is given through lower femoral pin, which is more efficient, or by upper tibial pin.

37. NINETY / NINETY TRACTION
Complications of 90/90 traction:
those related with skeletal traction.
Stiffness and loss of extension of knee.
Flexion contracture of hip.
Injury to epiphyseal plate in children.
Neurovascular damage

38. SKELETAL TRACTION COMPLICATIONS Infection Cut out
Distraction at fracture site
Physeal damage
Nerve Injury

39. SLIDING TRACTION WITH BOHLER BROWN SPLINT:
Used for the fracture of tibia or femur.
Skeletal traction is usually applied, but skin traction can be given b/k.

40. SPINAL TRACTIONS

41. CERVICAL TRACTIONS SKIN TRACTION Head Halter traction
SKELETAL TRACTION
Crutchfield tongs
Cone or Barton tongs

42. Head Halter traction Simple type cervical traction
Management of neck pain
Weight should not exceed 3 kg initially
Can only be used a few hours at a time
Head end should be elevated to give counter traction

43. Crutchfield Tongs Must incise skin and drill cortex to place
Rotate metal traction loop so touches skull in midsagittal plane
Place at the line connecting tips of mastoid processes on both sides.

44. CERVICAL TRACTIONS LEVEL MAX. WT C2 4.5-5.4 Kg C3 4.5-6.7Kg C4

45. SUSPENSIONS

46. SUSPENSION Done for better nursing care
To increase the mobility of patient
To prevent dangers of immobilization
Suspension system consists of traction cords pulleys and weight
Commonly Balken Beam frame is used for suspension purpose.

47. BALKEN BEAM FRAME Commonly Used to suspends splints.
one or two Balken Frames are used
Today balken frames are made up of Metal tubes
Two uprights are on each side of bed and are joined by two long horizontal bars.
Other short horizontal bar may be there joined to two uprights on same side or to long horizontal bar.

48. TRACION CORDS Used to suspend weights to give traction
Cords perform two functions – traction and suspension
For this color code system is available –
- red or green for traction cords
- white for suspension cords.

49. PULLEYS
Function of pulley is to control the direction of weight attached to end of the cord over pulley.
Large pulley wheels of 6cm in diameter and 6mm in diameter of axles are preferable
Majority of pulleys are prepared from Tufnol

50. WEIGHTS
The amount of weight required to suspend an appliance depends upon -
- weight of appliance
- weight of part of body suspended in appliance
- the amount of friction present in system.

51. CHARNLEY’S TRACTION UNIT
BK POP incorporating the Steinmann or Denham pin
Common peroneal nerve and calf muscles protected
External rotation of the foot and distal fragments is controlled
The tendo achilles is protected from pressure sores
Ipsilateral tibia # can be managed

52. THANK U