Transcript TRACTION IN ORTHOPEDIC

Conservative Treatment
of Fractures
BY
DR. TARIF AL-AKHRAS
Objectives
• Traction:
– Methods. Types
– Indications / contraindications
– Complications
• Casting:
– Types
– Indications / contraindications
– Complications
TRACTION IN
ORTHOPEDICs
TRACTION
• Traction treatment involves
the use of puling force to a
part of the body to overcome
muscle spasm, shortening
and some time the effect of
gravity
TRACTION
• As well as acting on
limbs, traction can be
applied to the pelvis and
spine.
TRACTION
• By controlling movement
of the injured part,
traction enables bone and
soft tissue to heal and
can be used as a method
of treatment.
TRACTION
It is used for :
• Restoring and maintaining of bone
alignment following fracture.
• Resting inflamed joint and
maintaining them in functional
position.
• Gradually correcting deformity due to
contracted soft tissue.
• Relieving pain due to muscle spasm.
TRACTION
TYPE OF TRACTION :
1. Manual traction
2. Skin traction
3. Skeletal traction
4. Traction by gravity
TRACTION
• Manual traction
Exerted directly when the
physician pulls on the part
during manipulation to
obtain closed reduction of a
fracture or dislocation.
TRACTION
SKIN TRACTION UTTILIZED
• In children
• In temporary management in
adult ( femoral fracture or
dislocation )
TRACTION
Contraindication to skin traction
• Diseases predisposing skin to damage
and poor healing
(DM, varicose ulcers and use steroid drug).
• Any wounds, sores or rash in the area
where traction to be applied.
• Marked swelling in the area.
• A history of hypersensitive skin.
• Any suspicion of circulation problem.
TRACTION
Advantages of
skin traction
•
•
Easy to apply
No hazard of
bone infection or
epiphyseal plate
injury
http://www.narang.com/
TRACTION
Different type of skin traction
Foam traction/
TRACTION
Different type of skin traction
http://www.complete-healthcare.co.uk/
TRACTION
Different type of skin traction
www.harzomedequip.com
fixed traction
Cervical skin traction
http://www.complete-healthcare.co.uk/
TRACTION
Skeletal traction
Achieved by inserting Kirschner wire
or Steinman pin directly into the
bone
TRACTION
TRACTION
The most commonly used
sites for pin insertion are :
•
•
•
•
•
Upper tibia
Femoral condyle
Calcaneum
Olecranon
Skull
TRACTION
Complication of skletal traction
• Infection:
TRACTION
predisposing factor
• Poor insertion technique
• Loosening of the pin
• Tension of the skin and
subcutaneous tissues leading to
ncrosis
traction
• Over distraction of the bone
fragments
• Nerve damage: can result from
the use of heavy traction forces
• Breaking of the pins or wire
•Plaster of
Paris
Plaster of Paris
• POP was first used in
orthopedics by Mathysen, a
Dutch surgeon in 1852
• It commercially available
since 1931
Plaster of Paris
its chemical formula
(CaSO4)2H2O+3H2O
Hemihydrated calcium
sulfate
2(CaSO4×H2O)+heat
Hydrated calcium
Sulfate
( plaster of Paris)
(gypsum)
Plaster of Paris
It used in four form
•
•
•
•
Slab
Cast
Spica
Functional cast brace
Plaster of Paris
Slab
• It is a temporary splint made up
of half by POP and half by
bandage roll.
• Used in the initial stages of
fracture treatment, during first
aid and to immobilize the limbs
postoperatively
Plaster of Paris
Cast
• The POP roll completely
encircles the limb.
• It is used as definitive form of
fracture treatment and also to
correct deformity.
Plaster of Paris
Spica
This is encircles
apart of the
body, e.g.
thumb spica
hip spica
http://www.aafp.org/
Plaster of Paris
Rules of application of POP
 Choose the correct size of the roll.
 A joint above and joint below should
be included.
 The joint should be immobilized in
functional postoins.
 The plaster should not be too tight or
too loose
Complications off
Plaster of Paris
Due to tight fit
• Pain
• Pressure sore
• Compartmental syndrome
• Peripheral nerve injury
Complications off
Plaster of Paris
Due to improper aplication
 Joint stifnes
 Blisters and sores
 breakage
Due to plaster allergy
• Allergic dermatitis
Plaster of Paris
Plaster of Paris
http://www.stanfordchildrens.org/
www.stanfordchildrens.or
Fiber glass cast
• Advantage
The materials are strong, light weight, cool ,
water resistant and radiolucent
•
Disadvantage
expensive, sharp edge
Fiber glass cast
Fiber glass cast