TRACTION METHODS SUMMARIZED

ARM TRACTION METHODS

FOREARM TRACTION Adhesive strapping is applied to a child’s forearm when his elbow is so swollen from a supracondylar fracture that it cannot be reduced immediately (72.6, Fig. 72-11). Uncommon.

CAUTION! Don’t let the strapping interfere with the circulation in his hand.

SKIN TRACTION FOR A FRACTURED HUMERUS is only necessary when a patient is confined to bed (Fig. 71-16). Rare.

OLECRANON TRACTION A Kirschner wire or a small Steinmann pin is passed through the olecranon for some lower humerus fractures (Fig. 72-14). This is the preferred method of treating comminuted supracondylar fractures in adults. Uncommon.

METACARPAL TRACTION A Kirschner wire through the first two metacarpals is used for for some forearm fractures, especially if the circulation of the forearm is impaired so that you cannot apply skin traction (Fig. 70-13). Rare.

LEG TRACTION METHODS

’90 – 90 TRACTION’ is useful when the proximal fragment of a fractured femur is sharply flexed. A Steinmann pin is put through the supracondylar region of a patient’s femur, or his upper tibia, and his hip and knee are flexed to 90 (77.12). Uncommon.

GALLOWS TRACTION The legs of a small child with a fractured femur are suspended from a bar with adhesive strapping (78.2). Very common.

EXTENSION TRACTION Adhesive strapping is used to treat fractures of the femur in an older child or teenager with his knee extended. Also useful for some fractures of the neck of the femur (78.3). Very common.

Figure 70.11: A SCALE OF TRACTION WEIGHTS showing the range of weights needed for various fractures. Adjust them: (1) to the patients’s build, and (2) during the course of treatment.

PERKINS TRACTION An upper tibial pin is used to treat most fractures of the femur in an adult. The patient’s knee is flexed and he exercises it (78.4). Very common.

BOHLER–BRAUN TRACTION using a special Boehler–Braun frame is useful for some supracondylar fractures of the femur (79.13). It can also be used for other fractures, especially those of the tibia (79.3), but we describe better methods. Uncommon.

DISTAL TIBIAL TRACTION A pin through the distal tibia is used to treat some fractures of the proximal tibia (80.5). Fairly common.

CALCANEAL TRACTION A pin through the calcaneus is used to treat some tibial fractures (81.12, Fig. 81-10). Fairly common.

The purpose of traction is to reduce overlap and bring the displaced bone ends together—not to pull them so far apart (distract them) that they cannot unite! So: (1) Check the length of a patient’s injured limb by measuring it, or with X–rays, and adjust the traction accordingly. (2) Vary the traction you apply to the needs of the patient—small patients need less weight than large ones. Don’t apply too much traction, and be prepared to adjust it. To begin with you need to apply more traction than is necessary later, when the soft tissues have stretched. For example, for femoral fractures you may need to apply 15 kg to start with, and then reduce it kilo by kilo on the following days.

Ideally, traction should be checked with X–rays, but unfortunately the BRS X–ray machine (1.13) is not portable, and you will probably not have a machine which you can take to the wards. The solution is to have a few beds with large castors which you can wheel to the X–ray department without taking down the traction.

Applying traction to a cast is dangerous because the skin through which pressure is applied is likely to necrose. The only safe way to apply traction to a cast is to pass a pin through the patient’s bone and to incorporate this in the cast. Never apply traction to a plaster boot without a proximal tibial pin in place, because it too easily causes pressure sores on the dorsum of the foot.

Figure 70.12: EQUIPMENT FOR BONE TRACTION. Both the handle and the hand drill are cannulated so that a Kirschner wire can pass right through them and be held close to the skin. If you don’t have any other kind of drill, use an ordinary carpenter’s drill.