SPLINTS AND TRACTIONS
IN ORTHOPAEDICS
ANY MATERIAL USED TO SUPPORT A FRACTURE
UNCONVENTIONAL-CRUDE,TEMPORARY & USED
AS A FIRST AID [Link]:WOOD,BOARD
CONVENTIONAL-REFINED &
SOPHISTICATED,SERVE BOTH AS FIRST AID &
DEFINITIVE [Link]:POP SPLINT,THOMAS
SPLINT.
PLASTER OF PARIS
SEMI HYDRATED CALCIUM SULPHATE.
COMMERCIAL POP ROLLS-ROLLS OF
MUSLIN STIFFENED BY STARCH,POP
POWDER & AN ACCLERATOR SUBSTANCE
LIKE ALUM
Cheap,easily available,comfortable
Easy to mould,quick setting
Strong & light
Easy to remove
Permeable to radiography
Permeable to air,hence underlying skin can
breath
Non-inflammable
4 forms-
Slab
Cast
Spica
Functional cast brace
Temporary splint
USES
Initial stages of fracture treatment & during
first aid
Immobilise the limb postoperatively & in
infections
It is made up of half by pop & half by bandage
roll,hence can accommodate the
Swelling in the initial stages of fracture
Slab is prepared acc to the required length
3 methods of applying a slab
Dry method-slab prepared first & dipped in
water
Wet method-slab is prepared after diping the
pop roll in water
Pattern method-slabs are fashioned in
desired way before dipping it in water
Pop roll completely encircles the limb
Definitive form of fracture treatment &
corrects deformities
3 methods
Skin tight cast-cast is directly applied over
the [Link] cause pressure [Link] to
remove as hair may be incorporated into the
cast.
Bologna cast-cotton padding is applied to the
limb before putting the cast
Three tier cast-stockinette is used first over
which cotton padding is done before applying
the pop cast.
It encircles a part of the body
Eg:hip spica,thumb spica
Its based on the principle that If function is
allowed during closed method of fracture
treatment,it stimulates
osteogenesis,promotes soft tissue healing &
prevents development of joint stiffness &
rehabilitation
Mode of action-hydraulic action of muscle is
brought to [Link] brace allows
movements of the joints & permits the load
To be transmitted to the muscle. The muscles
which are surrounded by inelastic deep fascia
if encased in a hard plaster cannot be
stretched beyond the confines of cast. On
movements & bearing weight,muscle forces
are hence driven inward towards the fracture.
This helps the fracture to be held firmly.
Technique consists of applying an external
splint to fractured limb.
Correct size-8in for thigh,6in for leg,4in for
forearm
Joint above & joint below should be included
Should be moulded with palm & not with
fingers for fear of indentation.
Joint should be immobilised in functional
position.
Plaster should be just fit & should not be too
tight or too loose.
Uniform thickness of plaster is preferred.
STAGES OF PLASTERING
Application of pop slab
Cast setting stage-change of pop to
[Link] takento form a rigid dressing
after contact with water
Set wet cast
Cast drying by evaporation of excess water
Due to tight fit
Pain
Pressure sore
Compartment syndrome
Peripheral nerve injuries
Cast syndrome
Due to improper application
Joint stiffness
Plaster blisters & sores
Breakage
Due to plaster allergy
Allergic dermatitis
Cast disease manifested as muscle
atrophy,osteoporosis,joint stiffness,muscle
weakness,skin breakdown,compartment
syndrome,blister formation.
Parts
A padded metal oval ring with soft leather set
at an angle 120 to the inner bar
2 side bars-one inner & other outer bar of
unequal length. They bisect the oval ring. The
outer bar longer than inner bar
Distal end-2 side bar joined in the form of W.
Outer side bar is angled 2in below the padded
ring to clear the prominent greater
trochanter
Immobilise fracture femur
First aid
Transportation of injured patient
In the treatment of joint diseases like TB knee
length of splint-measurement from the highest
point on the medial side of the groin toheel plus
6in.
Bohler’s modification of braun splint
Consists of heavy metallic frame with 3
pulleys
Proximal pulley prevents foot drop
Second pulley to apply traction in the line of
femur
Third pulley to apply traction in the line of
supracondylar area
Communited trochantric fracture of femur
Fracture shaft of femur & supracondylar
fracture of femur
Fracture shaft of tibia & fibula
Makes nursing care difficult
Heavy frame
Associated with recumbant problems like bed
sores,pneumonia,renal calculi
Temporary splintage of fracture during
transportation
It is made up of thick parallel wires made up
of interlacing wires
It can be bent into different shapes in ordr to
immobilise different parts of body
Padding-well padded at the bony
prominences & at the injury sites
Bandage-should be tied with optimum
pressure
Exercises-active exercises of the joints &
muscles should be permitted within the
splints
Daily checking & adjustments of splints are
recommended
Neurovascular status-distal neurovascular
status should be assessed daily
Cervical spine
SOMI BRACE
4 post collar
Upper limb
Aeroplane splint-brachial plexus injury
Cock up splint-radial n palsy
Knuckle bender splint-ulnar n palsy
Spine
Milwaukee brace-scoliosis
Boston brace
Lumbar belts & corsets-backache
Lower limb
Thomas splint,BB splint
Footdrop splint
Tractions play an important role in the
management of fractures in orthopaedics.
USES
To reduce fracture or dislocation
To retain fracture after reduction
To overcome muscle spasm
To control movement of injured part of body
& to aid in healing
TRACTION BY GRAVITY
Applies only to upper limb.
With a wrist sling weight of arm provides
continuous traction to humerus
Traction is applied over large area of skin.
Maximum weight that can be applied through
skin traction is 5kg.
If weight is applied more than this,traction
will slide down peeling off the skin.
Skin traction is applied to the limb distal to
the fracture site
Adhesive skin traction
Adhesive material is used for strapping which
is applied anteromedial & posterolateral on
either side of lowerlimbs.
Nonadhesive skin traction
Useful in thin & atrophic skin & in pts
sensitive to adhesive strap.
BUCK’S EXTENSION
Commonest type of skin tractions applied to
the lower limb
USES
• Temporary trtmt of fracture neck of femur
• Undisplaced fracture of acetabulam
• After redn of hip dislocation
In upper limbs
Indicated for supracondylar
fractures,intercondylar fractures of humerus
where elbow flexion causes circulatory
embarrassement
Fracture shaft of femur in children less than
2yrs
Legs of the child are tied to overhead beam.
Hips are kept a little raised from bed so that
weight of the body provides counter traction
& fracture is reduced.
Traction is given through a metal or pin
driven through bone.
Reserved for cases where skin traction is
contraindicated & where applied weight
needed is more than 5kg.
STEINMANN’S PIN
Stainless steel rod 3-6mm dia
Upper end of tibia,supracondylar region of
femur & calcaneum.
DENHAM’S PIN
Threaded in the centre & engeges the bony
cortex
Useful in cancellous bone like calcaneum
K-WIRE
Smith traction given by passing k-wire
through olecranon in supracondylar fracture
FIXED TRACTION
Pull is exerted against the fixed point.
Counter traction is applied by part of the
body
Eg:thomas splint-ring of the splint lies against
the ischial tuberosity & povides counter
traction
SLIDING TRACTION
Weight of the body acts as counter traction
Eg:traction given for pelvic fracture,where
weight o body acts as counter [Link]
effective by elevating the foot end of bed.
Applied under anaesthesia
Aseptic precautions
Drive the pin from lateral to medial side in
case of upper tibial traction, to avoid injurig
lateral popliteal nerve.
Pin shold be at right angles to the limb &
parallel to ground
For femural shaft fracture, initial weight
required is 10% of patient’s body weight.
For every 1lb of weight,end of bed should be
raised by 1in.
Proper functioning of traction unit to be
[Link] weights should not be
touching the ground.
Check the terminal part of the limb-its
colour,warmth,sensations.
Any swelling of the fingers showstight
bandage or slipped skin traction.
Proper positioning of the fracture should be
ensured by check xrays
Circulatory embarrassment
Nerve & vessel injury
Pin site- infection,migration,breakage,
bending.
Injury to epiphysis in children
c/c osteomyelitis
Head or cervical traction
Head –halter
Halopelvic
Upper limb
Dunlop’s
Metacarpal
Lower limb
Gallow’s
Russel’s
Buck’s
pelvic
