Splints and tractions

SPLINTS ANDTRACTIONS
IN ORTHOPAEDICS

 ANY MATERIAL USEDTO 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.

PLASTER OF PARIS
SEMI HYDRATED CALCIUM SULPHATE.
 COMMERCIAL POP ROLLS-ROLLS OF
MUSLIN STIFFENED BY STARCH,POP
POWDER & AN ACCLERATOR SUBSTANCE
LIKE ALUM

 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

 4 forms-
Slab
Cast
Spica
Functional cast brace

 Temporary splint
USES
 Initial stages of fracture treatment & during
first aid
 Immobilise the limb postoperatively & in
infections
It is made up of half by pop & half by bandage
roll,hence can accommodate the

Swelling in the initial stages of fracture
 Slab is prepared acc to the required length
 3 methods of applying a slab
 Dry method-slab prepared first & dipped in
water

 Wet method-slab is prepared after diping the
pop roll in water
 Pattern method-slabs are fashioned in
desired way before dipping it in water

 Pop roll completely encircles the limb
 Definitive form of fracture treatment &
corrects deformities
 3 methods
 Skin tight cast-cast is directly applied over
the skin.can cause pressure sores.dificult to
remove as hair may be incorporated into the
cast.

 Bologna cast-cotton padding is applied to the
limb before putting the cast
 Three tier cast-stockinette is used first over
which cotton padding is done before applying
the pop cast.

 It encircles a part of the body
 Eg:hip spica,thumb spica

 Its based on the principle that If function is
allowed during closed method of fracture
treatment,it stimulates
osteogenesis,promotes soft tissue healing &
prevents development of joint stiffness &
rehabilitation
 Mode of action-hydraulic action of muscle is
brought to play.fracture brace allows
movements of the joints & permits the load

To be transmitted to the muscle.The muscles
which are surrounded by inelastic deep fascia
if encased in a hard plaster cannot be
stretched beyond the confines of cast. On
movements & bearing weight,muscle forces
are hence driven inward towards the fracture.
This helps the fracture to be held firmly.
Technique consists of applying an external
splint to fractured limb.

 Correct size-8in for thigh,6in for leg,4in for
forearm
 Joint above & joint below should be included
 Should be moulded with palm & not with
fingers for fear of indentation.
 Joint should be immobilised in functional
position.
 Plaster should be just fit & should not be too
tight or too loose.

 Uniform thickness of plaster is preferred.
STAGES OF PLASTERING
 Application of pop slab
 Cast setting stage-change of pop to
gypsum.time takento form a rigid dressing
after contact with water
 Set wet cast
 Cast drying by evaporation of excess water

 Due to tight fit
 Pain
 Pressure sore
 Compartment syndrome
 Peripheral nerve injuries
 Cast syndrome
 Due to improper application
 Joint stiffness

 Plaster blisters & sores
 Breakage
 Due to plaster allergy
 Allergic dermatitis
 Cast disease manifested as muscle
atrophy,osteoporosis,joint stiffness,muscle
weakness,skin breakdown,compartment
syndrome,blister formation.

 Parts
 A padded metal oval ring with soft leather set
at an angle 120 to the inner bar
 2 side bars-one inner & other outer bar of
unequal length.They bisect the oval ring.The
outer bar longer than inner bar
 Distal end-2 side bar joined in the form ofW.
 Outer side bar is angled 2in below the padded
ring to clear the prominent greater
trochanter

 Immobilise fracture femur
 First aid
 Transportation of injured patient
 In the treatment of joint diseases likeTB knee
length of splint-measurement from the highest
point on the medial side of the groin toheel plus
6in.

 Bohler’s modification of braun splint
 Consists of heavy metallic frame with 3
pulleys
 Proximal pulley prevents foot drop
 Second pulley to apply traction in the line of
femur
 Third pulley to apply traction in the line of
supracondylar area

 Communited trochantric fracture of femur
 Fracture shaft of femur & supracondylar
fracture of femur
 Fracture shaft of tibia & fibula

 Makes nursing care difficult
 Heavy frame
 Associated with recumbant problems like bed
sores,pneumonia,renal calculi

 Temporary splintage of fracture during
transportation
 It is made up of thick parallel wires made up
of interlacing wires
 It can be bent into different shapes in ordr to
immobilise different parts of body

 Padding-well padded at the bony
prominences & at the injury sites
 Bandage-should be tied with optimum
pressure
 Exercises-active exercises of the joints &
muscles should be permitted within the
splints

 Daily checking & adjustments of splints are
recommended
 Neurovascular status-distal neurovascular
status should be assessed daily

 Cervical spine
 SOMI BRACE
 4 post collar
 Upper limb
 Aeroplane splint-brachial plexus injury
 Cock up splint-radial n palsy
 Knuckle bender splint-ulnar n palsy

 Spine
 Milwaukee brace-scoliosis
 Boston brace
 Lumbar belts & corsets-backache
 Lower limb
 Thomas splint,BB splint
 Footdrop splint

 Tractions play an important role in the
management of fractures in orthopaedics.
 USES
 To reduce fracture or dislocation
 To retain fracture after reduction
 To overcome muscle spasm
 To control movement of injured part of body
& to aid in healing

 TRACTION BY GRAVITY
 Applies only to upper limb.
 With a wrist sling weight of arm provides
continuous traction to humerus

 Traction is applied over large area of skin.
 Maximum weight that can be applied through
skin traction is 5kg.
 If weight is applied more than this,traction
will slide down peeling off the skin.
 Skin traction is applied to the limb distal to
the fracture site

 Adhesive skin traction
 Adhesive material is used for strapping which
is applied anteromedial & posterolateral on
either side of lowerlimbs.
 Nonadhesive skin traction
 Useful in thin & atrophic skin & in pts
sensitive to adhesive strap.

BUCK’S EXTENSION
 Commonest type of skin tractions applied to
the lower limb
 USES
• Temporary trtmt of fracture neck of femur
• Undisplaced fracture of acetabulam
• After redn of hip dislocation

 In upper limbs
 Indicated for supracondylar
fractures,intercondylar fractures of humerus
where elbow flexion causes circulatory
embarrassement

 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.

 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.

STEINMANN’S PIN
 Stainless steel rod 3-6mm dia
 Upper end of tibia,supracondylar region of
femur & calcaneum.
 DENHAM’S PIN
 Threaded in the centre & engeges the bony
cortex
 Useful in cancellous bone like calcaneum

 K-WIRE
 Smith traction given by passing k-wire
through olecranon in supracondylar fracture

FIXEDTRACTION
 Pull is exerted against the fixed point.
 Counter traction is applied by part of the
body
 Eg:thomas splint-ring of the splint lies against
the ischial tuberosity & povides counter
traction

SLIDINGTRACTION
 Weight of the body acts as counter traction
 Eg:traction given for pelvic fracture,where
weight o body acts as counter traction.made
effective by elevating the foot end of bed.

 Applied under anaesthesia
 Aseptic precautions
 Drive the pin from lateral to medial side in
case of upper tibial traction, to avoid injurig
lateral popliteal nerve.
 Pin shold be at right angles to the limb &
parallel to ground

 For femural 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.

 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 showstight
bandage or slipped skin traction.
 Proper positioning of the fracture should be
ensured by check xrays

 Circulatory embarrassment
 Nerve & vessel injury
 Pin site- infection,migration,breakage,
bending.
 Injury to epiphysis in children
 c/c osteomyelitis

 Head or cervical traction
Head –halter
Halopelvic
 Upper limb
Dunlop’s
Metacarpal

 Lower limb
Gallow’s
Russel’s
Buck’s
pelvic

Splints and tractions

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Splints and tractions