3. Outline
• Introduction
• Functions
• Methods in Tractions
-skin traction (indications/contraindications/complications)
-skeletal traction (indications/application technique/pins/common
sites/traction and site of fracture/contraindications/complications)
• Types of traction
• Post traction care
4. TRACTION
-Traction is a method of restoring alignment to a fracture through
gradual neutralisation of muscular forces
-Traction is applied to the limb distal to the fracture, so as to exert a
continuous pull in the long axis of the bone
5. Functions
• Reduction of fractures and dislocations.
• Reduce / relieve pain
• Preventing deformities.
• Correction of soft tissue contractures
• Ensure immobilisation
• Minimize muscle spasms
6. General guidelines between skin traction and
skeletal traction
SKIN TRACTION SKELETAL TRACTION
AGE Children and Adults Adults
APPLIED WITH Adhesive plaster Pin,wire
APPLIED Skin Bone
Force to maintain
reduction
<5kg >5kg
DURATION Short long
7. Skin traction indications
• Temporary management of # of NOF and IT #
• Management of femoral shaft fracture
• Undisplaced # of acetabulum
• After reduction of dislocation of hip
• To correct minor fixed flexion deformity of hip and knee
8. Skin traction contraindications
• Abrasion and lacerations of skin in the area to which traction
is to be applied
• Disturbance in blood circulation such as varicose vein or
impending gangrene
• Dermatitis
9. Skin traction complications
• Allergic reactions
• Excoriation of skin
• Pressure sores
• Common peroneal nerve palsy
12. Skeletal traction
Indications
• For those cases in which skin traction is
contraindicated
• Patients with external fixator in situ
• Weight required for traction is more than 5kg
13. Skeletal traction application
• Under GA or LA
• Area cleaned and draped
• Mount the pin/wire on the hand drill
• Identify the site of insertion and make a stab wound
• Hold pin horizontally at right angles to the long axis of limb
• Apply small cotton woolen pads soaked with povidone around the pins to
seal the wound
• Pin should pass only through skin, SC tissue and bone avoiding muscles
and tendons
14. Pins used
• Steinmann pin
• Denham pin - strong stout wires with a threaded portion in the
middle. Used in cancellous bone like calcaneum and osteoporotic
bone
15. COMMON SITES FOR SKELETAL
TRACTION
• Olecranon
• Greater trochanter
• Lower end of femur
• Upper end of tibia
• Lower end of tibia
• Calcaneum
23. Skeletal traction complications
• Mal union
• Deformities
• Ligamentous damage
• Introduction of Infection into bone
• Damage to epiphyseal growth plates
• Nerve injuries
24. •Fixed traction: By applying force against a fixed point of body
•Traction by gravity: Only apply to fractures of upper limb
•Balanced Traction: The pull is exerted against an opposing force,
provided by the weight of body when the foot of bed is raised
Types of traction based on mechanism
25. 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 xrays in
traction.
• Physiotherapy of limb should be continued to minimise
muscle wasting.
26. SPLINT - a device used for support or immobilization
of a limb or the spine.
• Any material used to support a fracture is known as splint.
• Unconventional.
• Conventional.
28. Functions:
• Temporary immobilization of sprains, fractures, and reduced
dislocations
• Control of pain
• Facilitates patient transportation
• Prevention of further soft tissue or neurovascular injuries
• Decreases risk of converting a minor injury to a major injury
29. Indications for Splinting
• Not just for fractures
• Sprains
• Joint Infections
• Tenosynovitis
• Lacerations over joints
• Puncture wounds and animal bites of the hands and feet
30. Complications of splinting
• Rarely occur if applied correctly
• Most common are sores, abrasions, and secondary infections from
loose or ill-fitting splints.
• Less common-neurovascular compromise from tight fitting splints,
contact dermatitis, and thermal burns from heating of plaster.
31. Preparation
• Define injury and what splint is required
• Splint in position of function
• Clean and repair skin lesions prior to splint application
• Document neurovascular examination before splint
application
• Anticipate ability for child to remove clothes after splint is
applied
32. What kind of splints?
• Fiberglass splints
• Prefabricated splints
• Air splints
•Plaster splints(POP)
34. Fiberglass Splints
Advantage
• Easier to apply
• Set more quickly
• Lighter
• Water resistant
Disadvantage
• More expensive
• More difficult to mold
35. Prefabricated splints
• Plastic shells lined with air cells, foam, or gel components
• Same advantages and disadvantages as fiber glass splints
Prefabricated splint for wrist joint Prefabricated splint for knee
joint
36. Air/Pneumatic splint
• An air splint is used to immobilize a fracture using an inflatable
support.
• They are plastic structures preformed in a factory to fit a specific part
of the body.
• Typically, an air splint wraps around an arm or leg and holds the bones
still while the patient is moved to hospital.
• This type of splint is not generally used for longterm support of a
fracture as it is less secure and provides less structural support than
plaster splints or fiberglass splints.
40. Long Arm Posterior Splint
• Indications
– Elbow and forearm injuries:
– Distal humerus fx
– Both-bone forearm fx
– Unstable proximal radius or ulna fx
(sugar-tong better)
• Doesn’t completely eliminate
supination / pronation -either add an
anterior splint or use a double sugar-
tong if complex or unstable distal
forearm fx.
41. Forearm Sugar Tong
• Indications
– Distal radius and ulnar
fx.
• Prevents pronation /
supination and immobilizes
elbow.
42. Double Sugar Tong
• Indications
– Elbow and forearm fx -
prox/mid/distal radius and ulnar fx.
– Better for most distal forearm and
elbow fx because limits
flex/extension and pronation /
supination.
10
90
43. Forearm Volar Splint aka ‘Cockup’
Splint
• Indications
– Soft tissue hand / wrist injuries -
sprain, carpal tunnel night splints, etc
– Most wrist fx, 2nd -5th metacarpal fx.
– Most add a dorsal splint for increased
stability - ‘sandwich splint’ (B).
– Not used for distal radius or ulnar fx -
can still supinate and pronate.
44. Radial and Ulnar Gutter
•Indications
• Fractures, phalangeal and
metacarpal, and soft tissue
injuries of the little and ring
fingers.
•Indications
• Fractures, phalangeal and
metacarpal, and soft tissue
injuries of index and long fingers.
45. Thumb Spica
• Indications
– Scaphoid fx - seen or suspected
(check snuffbox tenderness)
– De Quervain tenosynovitis.
• Notching the plaster (shown) prevents
buckling when wrapping around thumb.
• Wine glass position.
47. Knee Immobilizer /Posterior Knee Splint
Indications:
• Short term immobilization
of soft tissue and
ligamentous injuries to the
knee or calf.
• Allows slight flexion and
extension - may add
posterior knee splint to
further immobilize the
knee.
48. Posterior Ankle Splint
• Indications
– Distal tibia/fibula fx.
– Reduced dislocations
– Severe sprains
– Tarsal / metatarsal fx
• Use at least 12-15 layers of plaster.
• Adding a coaptation splint (stirrup) to
the posterior splint eliminates inversion
/ eversion - especially useful for
unstable fx and sprains.
49. Stirrup Splint
• Indications
– Similiar to posterior splint.
– Less inversion /eversion and
actually less plantar flexion
compared to posterior splint.
– Great for ankle sprains.
– 12-15 layers of 4-6 inch plaster.
50. Complications
• Burns
– Thermal injury as plaster dries
– Hot water, Increased number of
layers, extra fast-drying, poor padding
- all increase risk
– If significant pain - remove splint to
cool
• Ischemia
– Reduced risk compared to casting but
still a possibility
– Do not apply Webril and ace wraps
tightly
– Instruct to ice and elevate extremity
– Close follow up if high risk for swelling,
ischemia.
– When in doubt, cut it off and look
– Remember - pulses lost late.
• Pressure sores
– Smooth Webril and plaster well
• Infection
– Clean, debride and dress all wounds
before splint application
– Recheck if significant wound or
increasing pain
51. CRAMER-WIRE SPLINT
• Ladder splint.
• Used for temporary
splintage of fractures
during transportation.
• Made of 2 thick parallel
wires with interlacing
wires.
• Can be bent into different
shapes.
52. THOMAS SPLINT
Uses:
• Immobilization for the
injuries of the hip and
thigh
• Transportation of
patient with lower limb
injuries(eg: Femur
fracture)
• Devised by Hugh.
Owen Thomas.
• Initially used for
immobilisation for
tuberculosis of the
knee.
55. Uses
• With traction:
-for lower limb injury with displacement/fragment overlap
• Without traction:
-soft tissue injury over the lower limb
ADVANTAGES
• Angle of traction can be changed without changing traction arrangements.
• Simultaneous tractions possible.
DISADVANTAGES
• Not suitable for transportation
56. CARE OF A PATIENT IN A SPLINT
• 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.
60. Mechanism
• Anhydrous calcium sulfate
• When mixed with H20
• Exothermic rehydration to the cystalline form (gypsum)
2(CaSO4 .1/2 H2O) + 3H2O-> 2 (CaSO4.2H2O) + Δ
• Average time taken to change from powder form to crystalline
form :3-9min
• Time taken to change from crystalline form to anhydrous
form: 24-72hrs
61. Functions
• Reduce pain
• Reduce further damage to vessels and nerves
• Facilitates patient transportation
• Immobilization of fracture site
62. Advantage
• Easier to mold
• Less expensive
Disadvantage
• More difficult to apply
• Gets soggy when getting wet
63. Rules of applications
-one joint above and one joint below
-moulded with palm
-joints should be immobilised in functional position
-not too tight or too loose
-Upper extremities - use 8-10 layers
-Lower extremities - 12-15 layers, up to 20 if big person (increased risk of burn!)
64. POP application technique
• Orthoban is rolled on it evenly
• POP is soaked in H2O until all the air bubbles
escape then hold on one end and gently
remove excess water from the plaster
• Apply POP evenly and smoothly
• Immediately mould the cast away from bony
points
65. Complications
• Tight cast – compartment syndrome
Prevention - elevate the limb
• Pressure sores
Prevention - padding all bony prominence before applying cast
• Skin abrasions/lacerations
(complication of removing POP)
• loose cast (not able to hold fracture securely)
Solution - replace cast
• Joint stiffness
Solution – physiotherapy
• Allergic dermatitis
Solution - fiberglass
66. POP care
• Not to expose POP cast to extreme heat /moisture
• Do not insert anything underneath cast
• Cover when taking bath
• Come back STAT if there is excessive swelling , bluish
or white discoloration of fingers /toes,numb, excessive
pain,crack
67.
68. References
http://www.orthobullets.com
Orthopedics and fractures 4th ed. – T. Duckworth, C.M. Blundell
Apley’s concise system of orthopedics and fractures – Louis Solomon
ALL YOU NEED TO KNOW ABOUT SPLINTING - Konstantinos Gus
Agoritsas
http://www.citizencorps.gov/cert/training_downloads.shtm
Introduction to splinting - Jeff Harris
emedicine.medscape.com/article/109769-overview
