Overview of Traction Techniques in Orthopedics

Traction

An act of pulling or drawing which is associated with a countertraction.

Countertraction

A pulling force applied in the opposite direction to the traction.

Purposes of Traction

Prevent and correct deformity, relieve pain, relieve muscle spasm, reduce or immobilize fracture.

Principles of Traction

Used if traction is done by a healthcare personnel/operator to provide a very specific and controlled distraction force to extremity or joint.

Specific types of skeletal traction

1) Position should be supine 2) Avoid friction 3) Allow the weights to hang freely 4) Apply traction continuously 5) There should be an adequate countertraction 6) The line of pull should be in line with the deformity.

Skeletal Traction

A type of traction that involves the application of a pulling force directly to the bone.

Cervical Skeletal Traction

Uses Gardner-Wells tongs, which are less likely to pull out of place than Crutchfield tongs, to stabilize the cervical spinal cord.

Gardner-Wells tongs

Tongs inserted into holes drilled into the sides of the skull for cervical traction.

Femoral Traction

A type of skeletal traction that can be upper or distal femoral traction.

Upper femoral traction

Several traction options for acetabular fractures, using lateral traction for fractures with medial or anterior force.

Distal femoral traction

Performed when more pulling force is needed, using weights of 25-40 pounds and requires placement of tongs, pins, or screws into the bone.

Skin traction

Alignment of traction along the axis of femur, used for superior force acetabular fractures and femoral shaft fractures.

Perkin's traction

Treatment of tibia and femur fractures from the subtrochanter region and distally, particularly for trochanteric fractures in patients under 45-50 years of age.

Denham pin

Inserted through the upper end of the tibia for femur fractures and the mid tibia for condyles of tibia fractures.

Invasive procedure

A procedure that requires surgical intervention, such as placing tongs, pins, or screws into the bone.

Continuous traction

Traction that is applied without interruption to maintain the desired force.

Weight application in distal femoral traction

Uses weights of 25-40 pounds to provide the necessary pulling force.

Acetabular fractures

Fractures of the acetabulum that may require specific traction techniques.

Knee pathology

Conditions affecting the knee that may necessitate the use of skin traction.

Traction for muscle spasm

Used to relieve muscle spasms by applying a pulling force.

Traction for deformity correction

Used to prevent and correct deformities in the body.

Weights in Traction

Weights are attached either through adhesive or nonadhesive tape, or with straps, boots, or cuffs.

Non-invasive Traction

Is not invasive

it is usually performed in a hospital bed/bedside.

Duration of Traction

Can only be used a few hours at a time.

Distal Tibial Traction

Useful in certain tibial plateau fractures

pin inserted 5 cm above the level of the ankle joint, midway between the anterior and posterior borders of the tibia.

Saphenous Vein Avoidance

Avoid saphenous vein when inserting the pin for distal tibial traction.

Fibula Placement

Place through fibula to avoid peroneal nerve.

Hip and Knee Flexion

Maintain partial hip and knee flexion during distal tibial traction.

Buck's Traction

Used in temporary management of fractures of femoral neck, femoral shaft in older children, displaced shaft in older children, after reduction of a hip dislocation, to correct minor flexed deformities of the hip or knee, and in place of pelvic traction in management of low back pain.

Buck's Traction Weight Limit

Not more than 4.5 kgs.

Equipment for BST

Includes Balkan frame, Steinmann's pin, Thomas splint, Pearson attachment, rest splint, sash cord (ropes), slings, suspension bag = 5% of traction weight, traction bag with weights = 10% TBW.

Hamilton Russel Traction

Buck's with sling

may be used in more distal femur fracture in children and can be modified to hip and knee exerciser.

Bryant's Traction

Useful for treatment of femoral shaft fracture in infant or small child

combines gallows traction and buck's traction.

Counter Traction in Bryant's Traction

Raise mattress for counter traction.

Forearm Skin Traction

Adhesive strip with ace wrap

useful for elevation in any injury and can treat difficult clavicle fracture with excellent cosmetic result.

Risk of Forearm Skin Traction

Risk is skin loss.

Dunlop's Traction

Used for supracondylar and transcondylar fractures in children

used when closed reduction is difficult or traumatic.

Elbow Position in Dunlop's Traction

Elbow flexed at 45 degrees.

Head Halter Traction

Simple type cervical traction

management of neck pain.

Weight Limit for Head Halter Traction

Weight should not exceed 2.3 kg.