Traction

Indications

 

Relieve pain

Reduce deformity

Hold fracture reduced

Allow movement while relieving pain

 

Types

 

Skin

Skeletal

Fixed

 

Reduction Principles

 

1. Apply traction in the long axis of the limb

2. Reverse the mechanism that produced the fracture

3. Align the fragment that can be controlled with the one that cannot

 

Skin Traction

 

Applied over large area of skin - spreads load

 

Never more than 10lb (4.5 kg)

 

Contraindications

- circulatory impairment

- lacerations or abrasions on skin 

- marked bony shortening - requiring greater reduction force

 

Skeletal traction

 

Indications

- lower limb fractures 

- cervical spine

   

Sites

 

Distal femur

- entry medial to prevent injury femoral artery on exit

- just proximal to adductor tubercle

- above intercondylar notch

- below Hunter's canal

- perpendicular to distal femur

- flex knee, insert knife, turn 90o so there is a transverse nick in ITB so knee can flex if needed

 

Proximal tibia

- 2 cm posterior to crest and 2 cm inferior to tibial tuberosity

- insert laterally to avoid injury to CPN on exit

 

Distal tibia

- 5cm proximal to ankle joint in middle of tibia on lateral

 

Calcaneus

- 2 cm below and behind tip of lateral malleolus

 

Skull tongs

- 1.5 to 2 cm above superior tip of pinna

 

HTB

- roll patient and put on back piece

- apply front piece and attach

- apply halo pins x 4

- outer edge of eyebrows

- close eyes tightly to prevent inability to closure

- above and posterior to ears

- 8 pound / sq inch

- ensure below equator of head

- attach to thoracic brace

 

Fixed traction

 

Definition

 

Force applied against fixed point of body

- i.e. ischial tuberosity

 

Thomas splint (1876)

- counter traction

- up against ischial tuberosity

- need 2 cm clearance about thigh

- needs to be 15 cm longer than leg

- need slings to support leg and bandage over top

 

Balanced traction

- attach Thomas splint

- leg sits on padded slings on splint

- skin traction on calf

- tie to distal aspect of Thomas splint

- this is tensioned by winding about paddle pop stick

- weight hung off end of Thomas splint over pulley on edge of bed to pull away from ischium

- rope tied to Thomas splint and hung from top pulley with weight attached, this pulls the Thomas splint off the bed

- need safety rope attached to weight

- needs daily pressure care and regular oiling

 

Hamilton Russell traction

- also known as Australian traction

- first described by Dr Hamilton Russell of Melbourne in the 1920's