The sites of skeletal traction performed in the lower limb are mentioned below:
- Distal End of Femur.
Technique: The point of entrance of the pin is about one inch proximal to the adductor tubercle and slightly anteriorly over the distal end of femur.
Indication: The traction is applied for fracture of the pelvis, fracture and dislocation around the hip joint, fracture of the upper, lower and mid- shaft of femur.
- Traction Through the Greater Trochanter of Femur.
Technique: The pin is inserted through the mid-part of the greater trochanter in a transverse direction to the longitudinal axis of the femur. The orthopedic pin can be accessible from the orthopedic implant exporter and manufacturers.
Indication: This is done in central fracture dislocation of the hip joint. Traction is directed laterally to enable the central dislocation to come out.
- Traction Through Proximal tibia
The point is selected a little distal and posterior to the tibial tubercle. It is wiser to insert the pin from the lateral side of the tibia to avoid injury to the peroneal nerve.
Indication: Traction through the distal end of femur and proximal end of tibia serves the same purpose. Tibial traction is more commonly used as it is a much easier technique.
This technique can be used in supracondylar fracture of the femur with involvement of the knee joint.
- Lower Tibial Traction
Technique: The pin is inserted in a horizontal direction from medial to lateral side. The point of insertion is about 3 to 4 fingers above the medial malleolus and one finger behind the anterior border of the tibia. The pin may be inserted through both the tibia and fibula. With practice this can be passed anterior to the fibula without entering through it.
Indication: Some comminuted and unstable fractures of tibia which are difficult to manage by simple plaster immobilization can be managed by this technique. This is an ideal procedure in cases where soft tissue loss is associated with the fracture of the tibia, as plaster application cannot be performed. The traction is maintained after application of a Thomas splint. This procedure enables the surgeon to supervise the soft tissue lesion with ease.
- Traction Through the Calcaneum
Technique: The point of insertion of the pin is about 2.5 cm. (1”) proximal and about 1.88 cm. (¾”) anterior to the heel. Care must be taken not to injure the posterior tibial vessels.
Indication: This is done for the same conditions as the lower tibial traction.
SKELETAL TRACTION IN UPPER LIMB
In the case of an upper limb, this can be done through the olecranon process and through the finger bones.
- Olecranon Process
Technique: A point about 1.25 cm (½”) to 2.5 cm. (1”) distal to the tip of the olecranon process and about 1.25 cm (½”) anteriorly is selected. The ulnar nerve must be safeguarded while introducing the pin.
Indication: Fracture at any position of the humerus, unstable supracondylar fractures and fracture dislocation around the shoulder joint can be treated by this technique.
- Traction Through the Fingers
Traction can be applied for fracture-dislocations involving the phalanges and interphalangeal joints. A small pin is passed through the terminal phalanx and “U” bar is mounted on the ends of the pin through which traction is applied. This method can also be used in cases of fracture of the toes of the lower limbs.
Skull traction is made by making holes on both sides of the scalp. The openings in the skull bone are made by guarded trephine, which pierces only through the outer table of the skull but does not make an opening in the inner table. The points may vary but usually, they are about 5 cm (2”) to 7.5 cm. (3”) above the level of the external auditory meatus.
Indication: Fracture and fracture dislocations of the cervical spine are managed by this procedure.
Advantages of skeletal traction:
- Prolonged traction is ideally maintained by the skeletal traction.
- Joint movements distal to the site of skeletal traction can be encouraged. Traction suspension apparatus must be designed in such a way that this can be adjusted with ease. Performance of physical exercise minimizes the chances of joint stiffness, which is a common feature after plaster immobilization.
Disadvantages of skeletal traction:
Prolonged immobilization of the patient in bed while the traction is maintained and infection at the site of insertion of the pin are the main drawbacks of skeletal traction. The pin (an orthopedic implant) may glide further from one side to the other and may enhance the chances of infection.
TYPES OF TRACTION
Two types of traction are commonly used.
- Dunlop Traction by applying skin traction for supracondylar fracture.
- Olecranon Skeletal Traction: Olecranon traction can be applied in two ways especially in case of supracondylar fracture. These procedures are done when the lesion is unstable variety. The traction can be adjusted in a horizontal direction parallel to the surface or the bed or can be applied by overhead traction.
- Fixed Skin Traction:The foot end of the traction tape is tied to the cross piece of the Thomas splint and made taut. The end of the splint is fixed to the foot- end of the bed.
The circular ring of the upper end of the splint presses against the ischial tuberosity of the patient.
- Balanced Traction:The technique is done on the same principle as the fixed skin traction. The foot- end of the bed is raised. By doing so the body weight of the patient exerts a counter- traction.
OTHER TECHNIQUES OF TRACTION
- Hamilton Russel Traction:In this technique no Thomas or any rigid splint is required.
- Thomas Splint with Pearson’s Knee Flexion Piece:Knee flexion piece is attached to the Thomas splint which allows movement of the knee- joint.
- Traction on Braun Frame:Skeletal traction is applied either through upper or lower end of tibia. The limb is placed on the Braun frame.
- Fisk traction:In this method the knee movement can be performed upto 90⁰ along with the flexion piece.
- Vertebral Traction of Femur:The traction can be applied by inserting the pin through the condyles of the femur or through the proximal end of tibia. No splint is required in this procedure. This technique can be used in cases of fracture of the shaft and supracondylar fracture of the femur.