traksi

                 1. Traction Splinting Plaster of Paris Prepared by Dr.Poh & Dr.Wong June ‘14 2. Fractures Principles of treatment 1. Reduce – restore the alignment of bone fragments • Manipulation • Mechanical traction • Operative reduction 2. Hold/Maintain reduction • Sustained traction • Traction by gravity • Balanced traction • Fixed traction • Cast splintage • Functional bracing • Internal fixation • External fixation 3. Rehabilitation/Exercise 3. Outline • Introduction • Functions • Methods in Tractions -skin traction (indications/contraindications/complications) -skeletal traction (indications/application technique/pins/common sites/traction and site of fracture/contraindications/complications) • Types of traction • Post traction care 4. TRACTION -Traction is a method of restoring alignment to a fracture through gradual neutralisation of muscular forces -Traction is applied to the limb distal to the fracture, so as to exert a continuous pull in the long axis of the bone 5. Functions • Reduction of fractures and dislocations. • Reduce / relieve pain • Preventing deformities. • Correction of soft tissue contractures • Ensure immobilisation • Minimize muscle spasms 6. General guidelines between skin traction and skeletal traction SKIN TRACTION SKELETAL TRACTION AGE Children and Adults Adults APPLIED WITH Adhesive plaster Pin,wire APPLIED Skin Bone Force to maintain reduction <5kg >5kg DURATION Short long 7. Skin traction indications • Temporary management of # of NOF and IT # • Management of femoral shaft fracture • Undisplaced # of acetabulum • After reduction of dislocation of hip • To correct minor fixed flexion deformity of hip and knee 8. Skin traction contraindications • Abrasion and lacerations of skin in the area to which traction is to be applied • Disturbance in blood circulation such as varicose vein or impending gangrene • Dermatitis 9. Skin traction complications • Allergic reactions • Excoriation of skin • Pressure sores • Common peroneal nerve palsy 10. Simple skin traction/Buck’s traction 11. Apply the overlying bandages spirally, overlapping by half. 12. Skeletal traction Indications • For those cases in which skin traction is contraindicated • Patients with external fixator in situ • Weight required for traction is more than 5kg 13. Skeletal traction application • Under GA or LA • Area cleaned and draped • Mount the pin/wire on the hand drill • Identify the site of insertion and make a stab wound • Hold pin horizontally at right angles to the long axis of limb • Apply small cotton woolen pads soaked with povidone around the pins to seal the wound • Pin should pass only through skin, SC tissue and bone avoiding muscles and tendons 14. Pins used • Steinmann pin • Denham pin - strong stout wires with a threaded portion in the middle. Used in cancellous bone like calcaneum and osteoporotic bone 15. COMMON SITES FOR SKELETAL TRACTION • Olecranon • Greater trochanter • Lower end of femur • Upper end of tibia • Lower end of tibia • Calcaneum 16. Tractions and site of fracture 17. Olecranon Pin Traction- used for supracondylar and distal humerus fracture 18. Upper femoral traction-used for medial or anterior force acetabular fracture Distal tibial traction – used for certain tibial plateau fracture 22. • Proper position of fracture ensured by taking check xrays in traction. 27. • Conventional. abrasions. Prefabricated splints • Plastic shells lined with air cells. • They are plastic structures preformed in a factory to fit a specific part of the body. Complications of splinting • Rarely occur if applied correctly • Most common are sores.                  19. •Fixed traction: By applying force against a fixed point of body •Traction by gravity: Only apply to fractures of upper limb •Balanced Traction: The pull is exerted against an opposing force. and reduced dislocations • Control of pain • Facilitates patient transportation • Prevention of further soft tissue or neurovascular injuries • Decreases risk of converting a minor injury to a major injury 29.used for tibial shaft fracture and calcaneal fracture 23. Calcaneal traction. • Proximal tibial traction – used for distal femoral shaft fracture 21. Indications for Splinting • Not just for fractures • Sprains • Joint Infections • Tenosynovitis • Lacerations over joints • Puncture wounds and animal bites of the hands and feet 30. Fiberglass/Orthoglass Splints 34. • Sensations over toes and fingers should be normal. 26. an air splint wraps around an arm or leg and holds the bones still while the patient . What kind of splints? • Fiberglass splints • Prefabricated splints • Air splints •Plaster splints(POP) 33. CARE OF PATIENT IN TRACTION • Traction should be made comfortable. contact dermatitis. 31. foam. Functions: • Temporary immobilization of sprains. Air/Pneumatic splint • An air splint is used to immobilize a fracture using an inflatable support.a device used for support or immobilization of a limb or the spine. Distal Femoral Traction – Used For Superior Force Acetabular Fracture And Femoral Shaft Fracture 20. and thermal burns from heating of plaster. • Typically. SPLINT . • Any material used to support a fracture is known as splint. • Unconventional. or gel components • Same advantages and disadvantages as fiber glass splints Prefabricated splint for wrist joint Prefabricated splint for knee joint 36. • Less commonneurovascular compromise from tight fitting splints. provided by the weight of body when the foot of bed is raised Types of traction based on mechanism 25. fractures. • Proper functioning of traction unit must be ensured. • Physiotherapy of limb should be continued to minimise muscle wasting. Skeletal traction complications • Mal union • Deformities • Ligamentous damage • Introduction of Infection into bone • Damage to epiphyseal growth plates • Nerve injuries 24. Outlines • Functions • Indications • Complications • Preparation • Types • Care of patient on splinting • POP 28. Fiberglass Splints Advantage • Easier to apply • Set more quickly • Lighter • Water resistant Disadvantage • More expensive • More difficult to mold 35. Preparation • Define injury and what splint is required • Splint in position of function • Clean and repair skin lesions prior to splint application • Document neurovascular examination before splint application • Anticipate ability for child to remove clothes after splint is applied 32. and secondary infections from loose or ill-fitting splints. may add posterior knee splint to further immobilize the knee.all increase risk – If significant pain . • Wine glass position. – Most add a dorsal splint for increased stability . phalangeal and metacarpal. • Notching the plaster (shown) prevents buckling when wrapping around thumb. 49.can still supinate and pronate. Increased number of layers. 46. – Less inversion /eversion and actually less plantar flexion compared to posterior splint.especially useful for unstable fx and sprains. – Great for ankle sprains. and soft tissue injuries of index and long fingers. Specific Splints and Orthoses Upper Extremity • Elbow/Forearm – Long Arm Posterior – Double Sugar . Knee Immobilizer /Posterior Knee Splint Indications: • Short term immobilization of soft tissue and ligamentous injuries to the knee or calf. Air splint on upper limb 39. Long Arm Posterior Splint • Indications – Elbow and forearm injuries: – Distal humerus fx – Both-bone forearm fx – Unstable proximal radius or ulna fx (sugar-tong better) • Doesn’t completely eliminate supination / pronation -either add an anterior splint or use a double sugar-tong if complex or unstable distal forearm fx. 47.              is moved to hospital. Double Sugar Tong • Indications – Elbow and forearm fx .‘sandwich splint’ (B). and soft tissue injuries of the little and ring fingers. •Indications • Fractures. Air splints 38. 45.Tong • Hand/Fingers – Ulnar Gutter – Radial Gutter – Thumb Spica – Finger Splints Lower Extremity • Knee – Knee Immobilizer – Posterior Knee Splint • Ankle – Posterior Ankle – Stirrup 40. 41.seen or suspected (check snuffbox tenderness) – De Quervain tenosynovitis.Tong • Forearm/Wrist – Volar Forearm / Cockup – Sugar . – Reduced dislocations – Severe sprains – Tarsal / metatarsal fx • Use at least 12-15 layers of plaster. carpal tunnel night splints. 50. – Not used for distal radius or ulnar fx . 10 90 43. though gutter splints probably better for proximal fxs. Posterior Ankle Splint • Indications – Distal tibia/fibula fx. Forearm Volar Splint aka ‘Cockup’ Splint • Indications – Soft tissue hand / wrist injuries sprain.dynamic splinting (buddy taping).prox/mid/distal radius and ulnar fx. Forearm Sugar Tong • Indications – Distal radius and ulnar fx. 37. 44. – 12-15 layers of 4-6 inch plaster. Radial and Ulnar Gutter •Indications • Fractures. etc – Most wrist fx. Complications • Burns – Thermal injury as plaster dries – Hot water. Thumb Spica • Indications – Scaphoid fx . Stirrup Splint • Indications – Similiar to posterior splint. • Allows slight flexion and extension . phalangeal and metacarpal.remove splint to . • Dorsal/Volar finger splints phalangeal fx. 2nd -5th metacarpal fx. • Adding a coaptation splint (stirrup) to the posterior splint eliminates inversion / eversion . • Prevents pronation / supination and immobilizes elbow. extra fast-drying. 48. 42. Finger Splints • Sprains . – Better for most distal forearm and elbow fx because limits flex/extension and pronation / supination. poor padding . • This type of splint is not generally used for longterm support of a fracture as it is less secure and provides less structural support than plaster splints or fiberglass splints. CARE OF A PATIENT IN A SPLINT • Splint should be properly applied. • Simultaneous tractions possible. well padded at bony prominences and at the fracture sites • Bandage of the splint shouldn’t be too tight nor too loose. BOHLER BRAUN FRAME 55. • Patient should be encouraged to actively exercise the muscles and the joints inside the splint as much as permitted. • Used for temporary splintage of fractures during transportation. 53. up to 20 if big person (increased risk of burn!) 63. Outline • Mechanism • Functions • Rules of application • Application technique • Complications • POP care 59. • Pulley b-distal femoral/proximal tibial traction • Pulley c-change angle of traction 54. cut it off and look – Remember .             cool • Ischemia – Reduced risk compared to casting but still a possibility – Do not apply Webril and ace wraps tightly – Instruct to ice and elevate extremity – Close follow up if high risk for swelling. Mechanism • Anhydrous calcium sulfate • When mixed with H20 • Exothermic rehydration to the cystalline form (gypsum) 2(CaSO4 . POP application technique • Orthoban is rolled on it evenly • POP is soaked in H2O until all the air bubbles escape then hold on one end and gently remove excess water from the plaster • Apply POP evenly and smoothly • Immediately mould the cast away from bony points . CRAMER-WIRE SPLINT • Ladder splint. debride and dress all wounds before splint application – Recheck if significant wound or increasing pain 51. • Made of 2 thick parallel wires with interlacing wires. • Any compression of nerve or vessel should be detected early and managed accordingly. DISADVANTAGES • Not suitable for transportation 56.calcaneal/distal tibeal traction.12-15 layers. Rules of applications -one joint above and one joint below -moulded with palm -joints should be immobilised in functional position -not too tight or too loose -Upper extremities use 8-10 layers -Lower extremities .1/2 H2O) + 3H2O-> 2 (CaSO4. – When in doubt. Owen Thomas. THOMAS SPLINT Uses: • Immobilization for the injuries of the hip and thigh • Transportation of patient with lower limb injuries(eg: Femur fracture) • Devised by Hugh. Functions • Reduce pain • Reduce further damage to vessels and nerves • Facilitates patient transportation • Immobilization of fracture site 61.pulses lost late. 52. 57. • Pressure sores – Smooth Webril and plaster well • Infection – Clean. Advantage • Easier to mold • Less expensive Disadvantage • More difficult to apply • Gets soggy when getting wet 62. Uses • With traction: -for lower limb injury with displacement/fragment overlap • Without traction: -soft tissue injury over the lower limb ADVANTAGES • Angle of traction can be changed without changing traction arrangements. • Daily checking and adjustments should be made. ischemia. • Initially used for immobilisation for tuberculosis of the knee.2H2O) + Δ • Average time taken to change from powder form to crystalline form :3-9min • Time taken to change from crystalline form to anhydrous form: 24-72hrs 60. • Can be bent into different shapes. Plaster of Paris splint (POP) 58. • Pulley a.   64. POP care • Not to expose POP cast to extreme heat /moisture • Do not insert anything underneath cast • Cover when taking bath • Come back STAT if there is excessive swelling . excessive pain.crack .elevate the limb • Pressure sores Prevention .numb.replace cast • Joint stiffness Solution – physiotherapy • Allergic dermatitis Solution . Complications • Tight cast – compartment syndrome Prevention .padding all bony prominence before applying cast • Skin abrasions/lacerations (complication of removing POP) • loose cast (not able to hold fracture securely) Solution .fiberglass 65. bluish or white discoloration of fingers /toes.