Traction

TRACTION & SPLINTS
DR. ASHISH GOHIYA

ASST. PROFESSOR
DEPT. OF ORTHOPAEDICS
GANDHI MEDICAL COLLEGE
BHOPAL
www.esnips.com/web/agohiya
TRACTION
 Orthopedist’s great "master tool“.

 Traction - the application of a force to
stretch certain parts of the body in a
specific direction
Inflammation of a joint or
fracture of bone
Muscles undergo spasm
Deformity & impaired function
TRACTION
 Traction controls movements of an

injured part of the body – aids in
healing.
 Traction and counter traction still form
the basis of reduction of fractures and
dislocations
TRACTION
 Controls pain.
 Reduces fracture.
 Maintain reduction.
 Prevents & corrects deformity.
TRACTION
 Based on duration
 Continuous traction
 Intermittent traction
– Cervical
– pelvic
TRACTION
 Based on principle
Fixed traction
Sliding traction
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
SLIDING TRACTION
 When the weight of all or part of the body,

acting under the influence of gravity, is
utilized to provide counter-traction.
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
SLIDING TRACTION
 Buck’s traction or Extension
 Perkin’s traction
 Hamilton Russell traction
 Tulloch Brown traction
 Ninety /Ninety tractionRryant’s ( or Gallows)
traction
 Modified Bryant’s traction
 Sliding traction with Bohl;er-Braun frame
 Lateral upper femoral traction
 Agnes Hunt traction
 Pelvic traction
 Dunlop traction
 Olecrenon traction
TRACTION
 Based on application
Skeletal traction
Skin traction
– Adhesive
– Non – adhesive
SKIN TRACTION
 Traction force is applied over a large

area of skin
 Applied over limb just proximal to
fracture site
 “Coning effect”
SKIN TRACTION
 Adhesive skin traction:

– Maximum weight 15 lb or 6.7 kg
 Non-adhesive skin traction
– Maximum weight should not exceed 10
lb or 4.5 kg
– thin and atrophic skin,
– skin sensitive to adhesive strapping,
SKIN TRACTION
COMPLICATIONS
 Allergic reactions to adhesives.
 Excoriation of skin.
 Pressure sores over bony prominences

and tendoachillis.
 Common peroneal nerve palsy.
SKELETAL TRACTION
 pin or wire
 more frequently used in lower limb
fractures
 Should be reserved for those cases in
which skin traction is contraindicated or
insufficient
SKELETAL TRACTION
 SITES
– Olecranon
– Metacarpal
– Upper end femur
– Lower end of femur
– Upper end of tibia
– Lower end of tibia
– calcaneus
SKELETAL TRACTION
COMPLICATIONS
 Infection
 Cut out
 Application of splint difficult
 Distraction at fracture site
 Ligament damage
 Physeal damage
 Depressed scars
HAMILTON RUSSEL TRACTION
 Below knee skin traction is applied

 A broad soft sling is placed under the
knee
 Both the cord one of knee sling and
other of b/k skin traction are attached
through a system of pulleys to suspend
single weight
HAMILTON RUSSEL TRACTION
 By the arrangement of pulleys at the

distal end, a 10-pound weight exerts a
20-pound pull
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.
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
SLIDING TRACTION WITH A
THOMAS’S SPLINT AND KNEE
FLEXION PIECE
 fracture of femur
 Knee flexion piece allows easier
mobilization of the knee
 Always keep the hinge at the level of
addutor tubercle.
 Keep the knee flexed at about 20- 30
degree
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.
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 15-
18 kg
 Above knee skin traction is applied
bilaterally
 Tie the traction to the over haed beam
BRYANT’S (GALLOW’S )
TRACTION
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.
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
 Traction to continued for about 4-6 wks
PELVIC TRACTION
 special canvas harness is buckled around the
patient's pelvis
 Long cords or straps attached to the harness
to the foot of the bed
 Used for conservative management of PIVD
CERVICAL TRACTIONS
 Halter traction
 Crutchfield tongs
 Cone or Barton
tongs
CERVICAL TRACTIONS
 Halter traction
 Crutchfield tongs
 Cone or Barton
tongs
CERVICAL TRACTIONS
LEVEL MAX. WT
C2 4.5-5.4 Kg
C3 4.5-6.7Kg
C4 6.7-9.0Kg
C5 9.0-11.3Kg
C6 9.0-13.5Kg
C7 11.3-15.8Kg
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.
Dunlop Traction
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
4. The tendo achilles is protected from pressure sores
5. Ipsilateral tibia # can be managed
SPLINTS
 An appliance, either rigid or flexible,

used to hold in position a displaced or
movable part or to keep in place and
protect an injured part.
 Splints support and protect injured
bones and soft tissue
 reduces pain, swelling, and muscle
spasm.
 airplane s. a static orthosis that holds the
upper limb in abduction at the level of the
shoulder; used following burns in the axillary
region and for short periods following surgery
to the shoulder or brachial plexus.
 banjo traction s. a dynamic orthosis to aid
extension of the fingers using a banjo-
shaped steel bar attached to the fingers with
rubber bands and plastic rings.
 Cramer's s. a flexible wire splint
consisting of parallel stout wires
between which smaller wires are
stretched like the rungs of a ladder
 Coaptation s.’s small splints adjusted
about a fractured limb for the purpose
of producing coaptation of fragments
 Liston's s. a simple straight splint, often
made of wood with padding, for fracture of
the femur; it is adapted to the side of the
body and lower limb.
 Thomas s. a knee-ankle-foot orthosis
consisting of two rigid rods attached to an
ovoid ring that fits around the thigh; used in
emergencies or for transporting patients, or
combined with other apparatus to provide
traction.
 Keller-Blake s. a hinged half-ring
modification of the Thomas splint for
fracture of the femur
 Denis Browne s. a splint consisting of
a pair of metal foot splints joined by a
cross bar; used in talipes equinovarus.

Traction

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Traction

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TRACTION & SPLINTS

DR. ASHISH GOHIYA

 Orthopedist’s great "master tool“.

Muscles undergo spasm

Deformity & impaired function

 Traction controls movements of an

 Traction is applied to the

 When the weight of all or part of the body,

 Exact weight required is determined by

 Traction force is applied over a large

 Adhesive skin traction:

 Pressure sores over bony prominences

 Below knee skin traction is applied

 By the arrangement of pulleys at the

 Used for sub trochanteric fractures and

 Complications of 90/90 traction:

 T/t of supracondylar & transcondylar

 An appliance, either rigid or flexible,

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