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THE USES OF SPLINTS AND TRACTION IN SURGERY DR. RABIU Taopheek Bamidele
..Not only should the technical use (of splints) be appreciated by the men, but it should also be appreciated that all necessary handling of the injured part without splinting should be avoided. It cannot be too strongly emphasized that a wound which may be of moderate seriousness may become greatly increased in importance by careless or incompetent handling in the transport to or from the hospital. Joel E. Goldthwait, Lt. Col. 1921.

Introduction
Maxim in emergency care splint them where they lie Traction necessary for holding reduction SPLINTS Why are splints useful? Prevention of further soft tissue injury Relieve of Pain Lowering of incidence of fat embolism and shock Facilitation of patient transportation and radiographic studies. Types 1. Improvised splints No excuse for not splinting Use any rigid material (walking sticks, umbrellas, pieces of wood) padded with any soft material Bandage legs together; fractured finger to adjacent undamaged finger(Buddy strapping) Strapping arm to the trunk. 2. Conventional Splints 1. Basswood splints 2. Universal splints aluminum Prefabricated to fit legs and upper limbs designed to fit everyone and so fit no one. 3. Cramer wire splints Resemble miniature ladders Can be bent into appropriate shapes No appreciable interference with radiographs Most useful Recommended in Emergency war Surgery, NATOs hand book for armed forces. 4. Thomas Splints Originally described by Hugh Owen Thomas (1876) Introduced in World War 1 by Sir Robert Jones Reduced mortality in # Femur from 80% to 20% Incorporated with POP in World War II as Tobruk Splint Many modification available e.g. Fisk splint (1944) with knee flexion piece. 5. Inflatable splints Made of double walled polyvinyl jacket with a zip fastener and a valve for inflation. Control swelling & bleeding. Reduce blood flow in limbs May increase compartment pressure Examples include PASG or MAST.

6. Structural Aluminum Malleable (SAM) splints Invented by scheinberg, 1974 Best fulfilled properties of an ideal first-aid splint (efficient, light, inexpensive, easily applied to various parts of body, easy storage/transportation & radioluscent Thin aluminum strip coated with polyvinyl (initially, but later by polyethylene foam) Strips that can be rolled like bandage Now used by US Army and Several Emergency services Climate, water and blood resistant (carried by members of an expedition to Mt. Everest). 7. Cast Splintage Pop widely used Useful especially for distal limbs & childrens #s Beware of dangers of cast TRACTIONS Muscle spasm develop in response to joint inflammation or bone fracture Traction overcomes muscle spasm, relieves pain and rests limb in best functional position. Aids healing by reducing movement Methods of apllication 1. Gravity: Useful in humeral fractures with or without casts (U-Casts) 2. Skin tractions Applied over large area of skin Apply to the limb distal to failure site Maximum traction wt I5Lb (6.7kg) (ideally should be between 4 5 kg) sometimes used temporarily for upper limb fractures too (Dunlop's traction) Uses 2 methods (i) Adhesive strapping e.g. Elastoplast, seton (ii) Non- adhensive strapping e.g. ventfoam Contraindications: Skin abrasions Skin laceration Impaired circulation varicose ulcers, impending gangrene, stasis dermatitis. Marked shortening of bony fragments Complications Allergic reactions Skin Excoriation Pressure sores Common peroneal nerve palsy

3. Skeletal tractions Uses metallic pin or wire (steinmmann 1916, Denham 1972; Kirschner 1909) Mostly for lower limbs May be used to effect reduction or hold reduction Reserved for cases in which skin traction is contraindicated. Common sites Lower end of femur Upper end of tibia Lower end of tibia Calcaneus Olecranum Counter tractions These are needed for effective tractions. There are basically three ways of effecting this: 1. Fixed tractions Pull exerted against a fixed point 2. Sliding / Balanced Tractions Gravity used for counter traction by bed tilt. 3. Combined tractions fix cords to end of Thomas splint and suspend the entire splint.

Fixed Tractions Thomas splint Traction unit developed by Charnley (1970) Tibial steinmman pin incorporated in B/K cast For femoral shaft #s Advantages: Prevent tissue compression esp common peroneal nerve Prevent equinus at ankle Protects tendo Achilles Control rotation of foot & distal segment Conservatively treats ipsilateral tibial fractures at same time. Roger Anderson well-leg traction developed by Anderson, 1932 for fractures of the pelvis, femur and tibia Skeletal traction to injured leg, counter traction through well leg. Now valuable in correction of hip abduction or adductione.g. before extra-articular arthrodesis. Sliding Tractions Initial weight for reduction usually greater than maintenance Great care to avoid distraction of fracture Types of Sliding tractions 1. Bucks traction or Extension (BUCK, 1961) uses skin traction popularized during American Civil war. 2. Using Thomas splint Fixed splint Knee flexion piece. 3. Using Fisk Splint 4. Hamilton Russell Traction (Russell, 1924) For femoral Shaft #s and post hip arthroplasty Uses skin traction + knee sling traction Theory of parallelogram of vectors / resultant force 5. Tulloch Brown Traction (Nangle, 1951) with nissen foot plate (Nissen, 1971) femoral shaft #s, hip arthroplasty or pseudoarthrosis Not used in children. 6. Bryants (Gallows) Traction (Bryant 1880) Femoral shaft #s in children < 2yrs Above 2 yrs vascular complication common Skin traction to both lower limbs fixed to an overhead beam 7. Modified Bryants traction For congenital hip dislocation Alternate day abduction by 100 commenced on 5th Day 8. Traction with Bohler Braun Frame For #s tibia or femur Difficult nursing care Predisposition to deformity at traction site. Other types of tractions Pelvic tractions for prolapsed dics Spinal traction: For cervical spine conditions Applied around the head (non-skeletal or halter traction) To skull (skull/skeletal traction) In ambulant patient halo traction Halo-pelvic traction for deformities of thoraco-lumbar spines Management of Patients in Traction The Patient Pain Paraesthesia Skin irritation Presence of swelling Muscle power Active and passive movts of ankles and toes Presence or absence of peripheral pulses

Traction Suspension system Check daily or after each physiotherapy or radiography Position of splint The bandages Adhesive strapping Steinmann pin Positioning of slings Traction weights Elevation of bed. Radiological examination Regular 2ce in 1st week Weekly for next 3 weeks Monthly until union occurs After each manipulation After each change in traction weight

Physiotherapy Hugh Owen Thomas (1976): combination of forced, uninterrupted and prolonged rest. Lucas championniere (1895): full limb function is early if muscle and joint contractures prevented. Correct management balance between the two. Early rehabilitation.

Conclusion Splints and Traction very important Judicious use Reduced morbidity and mortality Modified by Dr Oluwadiya KS

De signe d by Dr O luwadiya KS base d on the Northpole conce pt Hom e R e side nt's Hom e Page Go to the top