SPLINTS

AND

TRACTION
 INTRODUCTION
• Traction produces a reduction through the surrounding soft parts, which align the fragments by their tension
• When the shaft of a long bone is fractured the elastic retraction of muscles surrounding the bone tends to
produce over-riding of the fragments
• This tendency is greater when
– The muscles are powerful and long bellied as in the thigh
– When the fracture is imperfectly immobilised, so that there is pain and therefore muscle spam 
– When the fracture is mechanically unstable, because the fragments are not in apposition or because the
fracture line is oblique
• Continuous traction generated by weights and pulleys, in addition to causing reduction of a deformity, will also
produce a relative fixation of the fragments by the rigidity conferred by the surrounding soft tissue structures
when under tension
• It also enables maintenance of alignment, while at the same time it is possible to devise apparatus, which permit
joint movement
• Traction may be applied through traction tapes attached to skin by adhesives or by direct pull by transfixing pins
through or onto the skeleton
• Traction must always be apposed by counter traction or the pull exerted against a fixed object, otherwise it
merely pulls the patient down or off the bed
• Traction requires constant care and vigilance and is costly in terms of the length of hospital stay and all the
hazards of prolonged bed rest must be considered when traction is used :
– Thromboembolism
– Decubiti
– Pneumonia
– Atelectasis
• Excessive traction which leads to distraction of the fracture is undesirable
• Once the fracture is reduced a decreasing amount of weight is required to maintain a reduction once the muscle
stretch reflex has been overcome and the fracture immobilised
• For a femoral fracture no more than 10 lbs should be used and for fractures of the tibia and upper limb less
weight is required
 Traction 
Skin Traction
• Traction is applied to the skeleton through its
attached soft tissue and in the adult should be
used only as a temporary measure
• Skin is designed to bear compression forces and
not shear
• If much more than 8 lbs is applied for any length
of time, it results in superficial layers of skin
pulled off
• Other difficulties such as migration of the
bandage may occur with lower weights
Skeletal Traction
• First achieved by the use of tongs
• The application of traction applied by a pin
transfixing bone was introduced by Fritz
Steinmann
• Now a threaded Denham pin is preferred to
prevent early loosening of the device
• The threaded portion of the Denham pin is
offset, closer to the end of the pin held in the drill
chuck and should engage only the proximal
cortex of the recipient long bone
Traction by Gravity
• Only applies to fractures of the upper limb
(hanging cast) 
 Traction categories
Fixed Traction
• The length of the limb remains constant 
• There is continuous diminution of traction force,
as the tone in the muscles diminishes and no
further stimuli results in activation of the muscle
stretch reflex
• Pull is exerted against a fixed point, e.g. tapes
are tied to the cross piece of a Thomas splint
and the leg pulled down until the root of the limb
abuts against the ring of the splint
• Pins in plaster is a form of fixed traction
Balanced Traction
• In weight traction, it is the tension in the
apparatus which remains constant and the
length depends on the amount of tearing
of the intermuscular septum and fibrous
tissue of the limb
• The pull is exerted against an opposing
force, provided by the weight of the body
when the foot of the bed is raised
Combined Traction
• May be used in conjunction with fixed
traction, where the weight takes up any
slack in the tapes or cords, while the splint
maintains a reduction
• This combination facilitates less frequent
checks and adjustment of the apparatus
Sliding Traction
• First introduced by Pugh by applying traction tapes to the limb and
fastening them to the raised foot of the bed which was then inclined
head down
• He utilised this traction in the treatment of conditions such as
Perthes, where only one limb was fastened to the end of the bed
enabling the pelvis on the opposite side to slide down the bed more;
thus creating traction and abduction
• The extent to which the patient slides down on the bed is limited by
the friction of the body against the mattress
• The traction was subsequently modified by Hendry using a mattress
on a sliding frame, which resulted in the same amount of traction
with an inclination of 10o, as on a normal mattress at 30 -
40o inclination
• This is also really a form of balance traction, where the amount of
weight is determined by the inclination of the bed
 TYPES
OF
TRACTION
Thomas Splint Traction
 Thomas Splint Traction
• Hugh Owen Thomas introduced his splint which he called "The Knee Appliance" in 1875
• The method of Hugh Owen Thomas uses fixed traction with the counter traction being
applied against the perineum by the ring of the splint
• This is in contrast to other methods using weight traction which is countered by the
weight of the body
• Backward angulation of the distal fragment can never be corrected by traction in the axis
of the femur which only results in elongation with persistence of the deformity
• A Thomas splint and fixed traction is only capable of maintaining a reduction previously
achieved by manipulation
• The use of supports enables correction of angulation caused by muscle tension
• Placement of a large pad behind the lower fragment acts as a fulcrum over which
backward angulation is then corrected by the traction force
• The pad should be 6" in width, 9" long and 2" thick, applied transversely across the splint
under the distal fragment and popliteal fossa
• It is the splint which controls alignment and not the traction
• The tension in the apparatus should only be that sufficient to balance resting muscle tone
• Suspension of the splint using an overhead beam enables the splint to move easily with
the patient when they move in bed
• Its use in combination with a Pearson Knee-flexion piece enables mobilisation of the knee,
while maintaining traction, alignment and splinting of the fracture
Hamilton Russell Traction
 Hamilton Russell Traction
• Robert Hamilton Russell wrote "Fracture of the femur: A
clinical study" in which he described his traction in 1924
• Sling under the distal 1/3 of the thigh provides upward
lift, as well as longitudinal traction in the line of the tibia
• The sling under the distal fragment controls posterior
angulation and the lifting force is related to the main
traction force through the medium of pullies
• No rigid splinting is used in this method
• Combines a means of suspending the lower extremity
and a means of applying traction in the axis of the femur
• Many other varieties of both skeletal and skin traction
result in a similar effect
Buck Traction
 Buck Traction
• Buck introduced simple horizontal traction
in 1861
• Traction is analogous to Pugh's traction
only the inclination of the bed is replaced
by the application of weights over a pulley.
Bryant's traction
 Bryant's traction
• Vertical extension traction was described by
Bryant in 1873 and applied to the management
of femoral fractures
• The development of ischemia of the lower leg
through reduced perfusion resulted in limitation
of its application to the short term management
of a fractured femur
• A modification of his traction has been shown to
reduce the risk of limb ischemia and may be
applicable where prolonged traction is required
in an infant.
Braun Frame
 Braun Frame
• This is merely a cradle for the limb
• Disadvantage is that the position of the pulleys
cannot be altered and the size of the splint often
does not fit the limb as might be wished
• Lateral bowing is common as the splint and the
distal fragment are fixed to the frame, while the
patient and the proximal fragment can move
sideways leaving the frame behind
Perkins Traction
 Perkins Traction
• Here no splinting is used at all
• The posterior angulation of the thigh is
controlled by a pillow 
• The alignment and fixation depend entirely
on the action of continuous traction
 Fisk Traction
• Hinged version of a Thomas splint is
arranged to allow 90 degrees of knee
movement
• It is particularly attractive as it allows
active extension of the knee joint
• Fixation and alignment is dependent
entirely on the weight traction and the
splint merely applies the motive power for
assisted knee movement
90 - 90 Traction
 90 - 90 Traction
• The thigh is suspended in the vertical
plane by weight traction pulling vertically
upwards
• The ill effect of gravity as the cause of
backward angulation of the fragments is
thus eliminated
 NURSING MANAGEMENT
• encourage the patient to do as much for himself as
is possible within the constraints of his 
immobilization.
• Assist or perform those tasks that the patient cannot 
perform
• Assess the patient or the traction setup to deter the best method for
changing the linen.
• When assisting with the bedpan or urinal, provide privacy to the patient.
• Encourage the patient to eat all prescribed diet.
• Encourage the patient for deep breathing exercise to reduce the risk of
respiratory complications.
• Encourage the patient of do exercises actively specially on the unaffected
part.
• Eliminate any factors that reduce the traction pull or that alter it’s direction
ropes and puley should be straight lined and unobstructed.
CAST
 What is a cast?
• A cast holds a broken bone in place as it heals.
Casts also help to prevent or decrease muscle
contractions, and are effective at providing
immobilization, especially after surgery.
 
Casts immobilize the joint above and the joint
below the area that is to be kept straight and
without motion. For example, a child with a
forearm fracture will have a long arm cast to
immobilize the wrist and elbow joints.
 What are casts made of?
• The outside, or hard part of the cast, is made from two
different kinds of casting materials.

• plaster - white in color.

• fiberglass - comes in a variety of colors, patterns, and
designs.
Cotton and other synthetic materials are used to line the
inside of the cast to make it soft and to provide padding
around bony areas, such as the wrist or elbow.
Special waterproof cast liners may be used under a
fiberglass cast, allowing the child to get the cast wet.
Consult your child's physician for special cast care
instructions for this type of cast.
TYPES OF CAST
Short arm cast:
• Location: Applied below the elbow to the
hand.
• Uses: Forearm or wrist fractures. Also
used to hold the forearm or wrist muscles
and tendons in place after surgery.
Long arm cast:
• Location: Applied from the upper arm to
the hand.
• Uses: Upper arm, elbow, or forearm
fractures. Also used to hold the arm or
elbow muscles and tendons in place after
surgery.
Arm cylinder cast:
• Location: Applied from the upper arm to
the wrist.
• Uses: To hold the elbow muscles and
tendons in place after a dislocation or
surgery.
Shoulder spica cast:
• Location: Applied around the trunk of the
body to the shoulder, arm, and hand.
• Uses: Shoulder dislocations or after
surgery on the shoulder area.
Minerva cast
Minerva cast:
Location: Applied around the neck and
trunk of the body.
Uses: After surgery on the neck or upper
back area.
Short leg cast:
• Location: Applied to the area below the
knee to the foot.
• Uses: Lower leg fractures, severe ankle
sprains/strains, or fractures. Also used to
hold the leg or foot muscles and tendons
in place after surgery to allow healing.
Leg cylinder cast:
• Location: Applied from the upper thigh to
the ankle.
• Uses: Knee, or lower leg fractures, knee
dislocations, or after surgery on the leg or
knee area.
Long leg cast:
• Location: Applied to the area above the
knee to the foot.
• Uses: Upper and lower leg fractures,
severe ankle sprains/strains, or fractures.
Also used to hold the leg or foot muscles
and tendons in place after surgery to allow
healing.
Unilateral hip spica cast:
• Location: Applied from the chest to the
foot on one leg
• Uses: Thigh fractures. Also used to hold
the hip or thigh muscles and tendons in
place after surgery to allow healing.
One and one-half hip spica cast:
• Location: Applied from the chest to the
foot on one leg to the knee of the other
leg. A bar is placed between both legs to
keep the hips and legs immobilized.
• Uses: Thigh fracture. Also used to hold
the hip or thigh muscles and tendons in
place after surgery to allow healing.
Bilateral long leg hip spica cast:
• Location: Applied from the chest to the
feet. A bar is placed between both legs to
keep the hips and legs immobilized.
• Uses: Pelvis, hip, or thigh fractures. Also
used to hold the hip or thigh muscles and
tendons in place after surgery to allow
healing.
Short leg hip spica cast:
• Location: Applied from the chest to the
thighs or knees.
• Uses: To hold the hip muscles and
tendons in place after surgery to allow
healing.
Abduction boot cast:
• Location: Applied from the upper thighs to
the feet. A bar is placed between both legs
to keep the hips and legs immobilized.
• Uses: To hold the hip muscles and
tendons in place after surgery to allow
healing.
 NURSING MANAGEMENT
• Keep the cast clean and dry.

• Check for cracks or breaks in the cast.

• Rough edges can be padded to protect the skin from scratches.

• Do not scratch the skin under the cast by inserting objects inside the cast.

• Can use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin.
Never blow warm or hot air into the cast.

• Do not put powders or lotion inside the cast.

• Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.

• Prevent small toys or objects from being put inside the cast. (child)

• Elevate the cast above the level of the heart to decrease swelling.

• Encourage the patient move his/her fingers or toes to promote circulation.

• Do not use the abduction bar on the cast to lift or carry the child.