ORTHOPAEDICS TRACTION

BY - DR. Shivam
DEFINATION OF TRACTION
• Traction is the application of a pulling force to a limb or
part of the body to align bones, reduce fractures, or
relieve pressure.
PURPOSE OF TRACTION
• Fracture reduction

• Pain relief

• Correction of deformities

• Immobilization
Types of Traction
• Skin Traction (TRACTION FORCE APPLIDE THROUGH SKIN)

• Skeletal Traction (TRACTION FORCE APPLIED THROUGH BONES)

SKIN TRACTION
• Traction force is applied over large area of skin. this
spreads the load and is comfortable and efficient
• in treatment of fractures, traction force must be applied
only to the distal to the fracture site , otherwise efficiency
of traction force is reduced.
• maximum traction weight which can be applied with skin
traction is 6.7kg(15lb)
Types of skin traction
• Adhesive skin traction
- Non adhesive skin traction
Adhesive skin traction
• kits for use in adults or children can be obtained commercially.
• Elastoplast Skin Traction Kits* are available from Smith and Nephew Ltd.
• Some patients are allergic to adhesive strapping. For these patients other
• preparations which do not utilize an adhesive containing zinc oxide can be
used,
• for example Tractac* (Johnson & Johnson Ltd) which uses an acrylic
adhesive
• and Seton Skin Traction Kit* (Seton Products Ltd). Two other preparations to
• which allergic reactions have not been reported are Orthotrac* (OEC
• Orthopaedic Ltd) and Skin-Trac* (Zimmer, USA)
APPLICATION OF ADHESIVE STRAPPING
• - Shave the limb (shaving is not required with Tractac,
• Orthotrac and Skin-Trac).
• Protect the malleoli/ulnar head and radial styloid process from
• friction with a strip of felt, foam rubber or a few turns of a
• crepe or elasticated bandage under the strapping.
• - Starting at the ankle/wrist, but leaving a loop projecting 2.
• inches (5.0 cm) beyond the distal end of the limb to allow
• free movement of the foot/fingers, apply the widest possible
• strapping to each side of the limb.
• Lower limb. The strapping is applied to the lateral and medial
• aspects of the limb. On the lateral aspect the strapping must
• lie slightly behind and parallel to a line between the lateral
• malleolus and the greater trochanter. On the medial aspect
• the strapping must lie slightly in front of the above line to
• encourage medial rotation of the limb
• - Avoid wrinkles and creases. If necessary, nick the strapping
• to ensure that it lies flat.
• - Avoid bony prominences
• malleoli, tibial crest, patella, ulnar
• head, radial styloid process, humeral epicondyles.
• - Apply a crepe or elasticated bandage firmly over the
• strapping starting at the ankle/wrist, and continuing up the
• limb . The bandage must not be applied tightly
• around the limb. A tight bandage may cause skin and
• vascular complications.
• - Check that a spreader and traction cords are present.
• - Attach the required traction weigh
NON ADHESIVE SKIN TRACTION
• They are applied in the same way as adhesive strapping, but as their
• grip is less secure than that of adhesive strapping, frequent reapplications may be
• necessary. The traction weight used should not exceed 10lb (4.5kg).
CONTRAINDICATIONS OF SKIN TRACTION
• 1. Abrasions of the skin
• 2. Lacerations of the skin in the area to which the traction is to
• be applied
• 3. Impairment of circulation
• gangrene
• 4. Dermatitis
• varicose ulcers, impending GANGRENE
• 5. Marked shortening of the bony fragments, when the traction
• weight required will be greater than can be applied through
• the skin.
COMPLICATIONS OF SKIN TRACTION

• 1. Allergic reactions to the adhesive.

• 2. Excoriation of the skin from slipping of the adhesive
• strapping.
• 3. Pressure sores around the malleoli and over the tendo
• calcaneus.
• 4. Common peroneal nerve palsy
SKETETAL TRACTION
• Skeletal traction, a metal pin or wire is driven through the
bone. By this means the traction force is applied directly
to the skeleton.
• Skeletal traction is seldom necessary in the management
of upper limb fractures. It is used frequently in the
management of lower limb fractures. It may be employed
as a means of reducing or of maintaining the reduction of
a fracture.
• EXAMPLES- Steinmann pin,Denham pin, K-wire traction
COMPLICATIONS OF SKELETAL TRACTION
• 1. Introduction of infection into bone.
• 2. Incorrect placement of the pin or wire may
• -Allow the pin or wire to cut out of the bone causing pain and the failure of the traction system.
• -Make control of rotation of the limb difficult.
• -Make the application of splints difficult.
• 3. Distraction at the fracture site as very large traction forces
• can be applied through skeletal traction.
• 4. Ligamentous damage if a large traction force is applied
• through a joint for a prolonged period of time.
• 5. Damage to epiphyseal growth plates when used in children.
• 6.Depressed scars
COUNTER TRACTION
• Applying a traction force to a part of the body is to counteract the deforming effects
of muscle spasm.
• The muscles in spasm tend to draw the distal part of the body in a proximal
direction. A traction force applied to the affected part of the body will overcome
muscle spasm only if another force acting in the opposite direction - counter-traction
is applied at the same time as the traction force.
• If counter-traction is not applied, the whole body will tend to be pulled in the direction
of the traction force, and muscle spasm will not be overcome.
• FIXED TRACTION (One method of obtaining counter-traction is by applying a force
against a fixed point on the body, proximal to the attachments of the muscles in
spasm)
• SLIDING TRACTION (GRAVITY IS UTILIZED TO PROVIDE COUNTER TRACTION
)
THANK YOU