Traction
Then and Now
Fran Pearce
Education Coordinator
Austin Health
Traction
• Application of a pulling force to an injured or diseased part of the body
or an extremity while a countertraction pulls in the opposite direction
• Requires the use of ropes, weights and pulleys as a means of
counteracting the natural tension in the tissues
• Countertraction is usually the patient’s body
Once the preeminent treatment option, but has been
replaced by ORIF as the treatment of choice
BUT not always and not in developing countries
Our Orthopaedic History
Orthopaedics
derived from Greek words for "correct" or "straight"
("orthos") and "child" ("paidion)
Nicholas Andry 1741
Orthopaedia: or the Art of Correcting and Preventing
Deformities in Children
Jean-Andre Venel 1780 “father of orthopaedics”
He established
the first orthopaedic institute in the first hospital
dedicated to the treatment of children's skeletal
deformities
My Hero – Agnes Hunt
Founded with Robert Jones first UK orthopaedic hospital
‘…, we decided that as the doctors all advocated fresh air, we would
build a shed in the garden and I should sleep there with the bad
cripples and only children who could walk should go upstairs…..’.
The instruments of the “Bonesetter……”
Changing ideas have shaped the discovery and evolution of
orthopaedic technology
Advances -use of computers as instruments in the navigational
guidance the use of robotics
Cordless drills and improvements in the design of saws
Yet some of the old instruments remain:
• Plaster of Paris bandages
• Liston’s bonecutter
• Gigli’s saw, Macewan’s osteotomes
The Thomas Splint
But all evolve………….
The Thomas Splint 1865
Hugh Owen Thomas (1834–1891)
• A calliper splint for TB
Sir Robert Jones (1857 –1933)
• Introduces military orthopaedic hospitals during WW1
• Adapts Thomas splint for femoral shaft fractures
• Mortality rates dropped
from 80% to nearly 12%
The Thomas Splint Today
Temporary or as definitive management
Adapted into Emergency management
initial reduction of femur fractures prior to OR skeletal traction
Evolution
http://www.bbc.co.uk/guides/zs3wpv4
A Tour of Traction
Evolution
Place in orthopaedics
Methods.
Indications / Complications
TRACTION
TYPE OF TRACTION :
1. Manual traction
2. Skin traction
3. Skeletal traction
4. Traction by gravity
SKIN TRACTION
Advantages
• Easy to apply
• No hazard of bone infection or
epiphyseal plate injury
Disadvantages
Limited force not to exceed 3kilos
More common for paediatric patients
Can cause soft tissue problems especially
in elderly or rheumatoid patients
http://www.narang.com/
Foam TRACTION
/
SKELETAL TRACTION
May pull up to 20% of body weight for the lower extremity
Requires local anaesthesia for pin insertion if patient is awake
Preferred method of temporary management till ORIF
SKELETAL TRACTION
• Infection
• Over distraction of the bone fragments
• Nerve damage: excessive traction forces
• Breaking of the pins or wire
Upper Extremity Traction
• Can treat most fractures
• Requires bed rest
• Usually reserved for comatose or multiply
injured patient or settings where surgery
can not be done
Forearm Skin Traction
• Adhesive strip
• Useful for elevation in any
injury
• Can treat difficult clavicle
fractures with excellent
cosmetic result
• Risk is skin loss
Dunlop’s Traction
• Supracondylar and trans condylar fractures in children
• Used when closed reduction difficult or traumatic
• Forearm skin traction with weight on upper arm
• Elbow flexed 45 degrees
Halo Traction
• Unstable C spine # Preoperative Halo-Gravity Traction
severe scoliosis
• Pre Op
Halo Brace
• Adult and children
• C1-3 fractures – dens
• Application –Sedation-Orthotics/ surgeon
Complications
• Pin loosening
• Pin Infection
• Falls risk
• Functional decline
LOWER EXTREMITY TRACTION
• Can be used to treat most lower extremity
fractures of the long bones
• Requires bed rest
• Used when surgery can not be done for one
reason or another
• Uses skin and skeletal traction
Buck’s Traction
• Used preoperatively
for femoral fractures
• Not used to obtain or
hold reduction
Split Russell’s Traction
• Buck’s with sling
• May be used in more
distal femur fx in
children
• Can be modified to hip
and knee exerciser
The Thomas Splint Today
Temporary or as definitive fracture management
Adapted into Emergency management
initial reduction of femur fractures prior to OR skeletal traction
Distal Femoral Traction
Method of choice for acetabular and proximal femur fractures
SLIDING TRACTION WITH BOHLER
BROWN SPLINT:
Used for the fracture of tibia or femur.
Skeletal traction is usually applied, but skin
traction can be given b/k.
Balanced Suspension with Pearson
Attachment (on Thomas splint)
• Enables elevation of limb
to correct angular
malalignment
• Counterweighted support
system
• Four suspension points
allow angular and
rotational control
Slings and Springs
Not true traction
Holds the leg in suspension with no true counter traction.
Restoring rom gradually to an irritable hip, by abducting the affected leg
Rests the hip joint in a flexed position whilst allowing active movement - perthes
Mobilisation while a patient is non-weight bearing following femoral and tibial
osteotomy.
Birth to Six Months DDH
Pavilk harness (1944)
Experienced staff*
Very successful
Allows free movement within
confines of restraints
Gallows TRACTION
Children <12 months (and not walking) or weighing 10 to 16kgs.
Indications
fractured shaft of femur
to stretch the soft tissues pre-operatively for DDH
http://www.complete-healthcare.co.uk/
Ultrasound-guided gradual reduction using FACT
flexion and abduction continuous traction- DDH
• ).
Traction Splint
Sager Traction Splint
Hare traction splint
http://www.eo.com.sg/image/Consumable/Sager-splint.jpg
Quick Action Traction
http://www.splints.com/pages_products/pivot_trac_splint.html
Quick Action Traction Splint
I
Dynamic External Fixation
Value of traction today…
• Safe and dependable way of treating
fractures for more than 100 years
• Bone reduced and held by soft tissue
• Less risk infection at fracture site
• No devascularization
• Allows more joint mobility than plaster
Disadvantages
Costly in terms of hospital stay
Hazards of prolonged bed rest
– VTE
– Decubiti
– Pneumonia
– Delirium
– Functional decline
• Requires meticulous nursing care
Orthopaedic Care in
Developing Countries
Most injured patients worldwide have no access to an
orthopaedic surgeon
Trauma and Infections common
Minimal resources
Simple Techniques- Great Benefit
Casts / Splints / Traction
Orthopaedic Ward 1970s UK
Orthopaedic Ward Manilla 2015
Questions?
Useful Links
• RCN Taction guidelines
http://www.rcn.org.uk/__data/assets/pdf_file/0004/608971/RCNguidance_traction_WEB_2.pdf
• RCN competence framework for orthopaedic and trauma Practitioners
https://www.rcn.org.uk/__data/assets/pdf_file/0010/476047/004316.pdf
• Paediatrics
NSW Traction
http://www.schn.health.nsw.gov.au/_policies/pdf/2014-9099.pdf
Vic NV assessment
http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neurovascular_observations/
DDH
VIC RCH http://www.rch.org.au/kidsinfo/fact_sheets/Pavlik_Harness_for_DDH/
International Hip dysplasia institute http://hipdysplasia.org/
Traction handbook Zimmer
http://www.zimmer.com/content/dam/zimmer-web/documents/en-US/pdf/medical-professionals/surgical-and-operating-
room-solutions/zimmer-traction-handbook.pdf
U Tube have extensive lists of traction videos
