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Specific Types of 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

  • 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 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

  • 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

  • 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

  • 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 90o 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

  • 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

Charnley

  • Strongly recommends the use of a BK POP incorporating the Steinmann or Denham pin in the upper end, in order to reduce pressure on the soft structures around the knee
  • Benefits of POP/Traction unit (Charnley) :
    • Foot supported at right angles to the tibia
    • Common peroneal nerve and calf muscles protected from pressure against the slings of the splint and the splint itself
    • The tibia is suspended from the skeletal pin inside the POP, so that an air space develops under the tibia as the calf muscles loose their bulk
    • External rotation of the foot and distal fragments is controlled
    • The tendo achilles is protected from pressure sores
    • Comfort; The patient is unaware of the traction when applied through the medium of a nail

Upper Limb

  • A number of skin traction methods have been described and a number more utilised without documentation in the literature
  • Ingerbrightsen's overhead skin traction (A); Dunlop's side arm skin traction (B); and Graham's extension skin traction (C) are but a few
  • Skeletal pin traction can also be utilised :
    • Overhead (A)
    • Overhead with secondary distal forearm traction directed cephalad (B)
    • Side arm pin traction (C)
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