骨科牵引.ppt

1,Orthopaedic Traction,Company Logo,2,Traction is the application of a pulling force to a part of the body,Definition,Company Logo,3,Purpose:,to minimize muscle spasm;to reduce,align,and immobilize fractures;to reduce deformity;to increase space between opposing surfaces,Company Logo,4,General Considerations,Safe and dependable way of treating fractures for more than 100 yearsBone reduced and held by soft tissueLess risk infection at fracture siteAllows more joint mobility than plaster,Company Logo,5,Disadvantages,Costly in terms of hospital stayHazards of prolonged bed restThromboembolismDecubitiPneumoniaRequires meticulous nursing careCan develop contractures(挛缩),Company Logo,6,History,Skin traction used extensively in Civil War for fractured femursKnown as the“American Method”Skeletal traction by a pin through bone introduced by Steinmann and Kirschner,Company Logo,7,Beds And Frames,Standard bed has 4-post traction frameIdeal bed for traction with multiple injuries is adjustable height with Bradford frameMattress moves separate from frame,Company Logo,8,Beds and Frames,Bradford frame enables bedpan and linen changes without moving ptAlternatively bed can be flexible to allow bending at hip or knee,中的 解释:【医】布莱德福氏架(大腿骨折和脊柱结核患者的床架),Company Logo,9,Knots,Ideal knots can be tied with one hand while holding weightEasy to tie and untieOverhand loop knot will not slip,Company Logo,10,Knots,A slip knot tightens under tensionUp and over,down and over,up and through,Company Logo,11,Traction may be applied to,the skin(skin traction)directly to the bony skeleton(skeletal traction).,Company Logo,12,Skin Traction:indication,Child fracture of shaft of femurAdult epiphysis Fracturepelvic fracture no evident displaceChild joint contracture or adult light joint contracture,Company Logo,13,Forearm Skin Traction,Adhesive strip with Ace wrapUseful for elevation in any injuryCan treat difficult clavicle fractures with excellent cosmetic resultRisk is skin loss,Company Logo,14,Double Skin Traction,Used for greater tuberosity or prox humeral shaft fxArm abducted 30 degreesElbow flexed 90 degrees7-10 lbs on forearm5-7 lbs on armRisk of ischemia at antecubital fossa,Company Logo,15,Dunlops Traction,Used for supracondylar and transcondylar fractures in childrenUsed when closed reduction difficult or traumaticForearm skin traction with weight on upper armElbow flexed 45 degrees,Company Logo,16,Bucks Traction,Often used preoperatively for femoral fracturesCan use tape or pre-made bootNo more than 10 lbsNot used to obtain or hold reduction,Company Logo,17,Split Russells Traction,Bucks with slingMay be used in more distal femur fx in childrenCan be modified to hip and knee exerciser,Company Logo,18,Bryants Traction,Useful for treatment femoral shaft fx in infant or small childCombines gallows traction and Bucks tractionRaise mattress for countertractionRarely,if ever used currently,Company Logo,19,announcements,No damage,ulcer,inflammation,phlebeurysma,embolism on skin;2-3weeks;No more than 2 to 3 kg(4.5 to 8 lb)of traction can be used on an extremity,otherwise bubble will can be seen.Monitoring angle of traction,weigh,line of traction every day.Get out of the way of fibular head to protect the common peroneal nerve;Guide the patient to do functional exercise.,Company Logo,20,Skeletal Traction:,to treat fractures of the femur,the tibia,and the cervical spine.The traction is applied directly to the bone by use of a metal pin or wire,Company Logo,21,Cervical skeletal traction,Used to treat the unstable spine(fx,dislocation,especialy SCI with dislocation)Pull along axis of spine Preserves alignment and volume of canalGardner-Wells and Crutchfield tongs commonly used,SCI;spinal cord injury 颈脊髓损伤,Company Logo,22,Gardner Tongs,Easy to applyPlace directly cephalad to external auditory meatusIn line with mastoid processJust clear top of earsScrews applied with 30 lbs pressure,Company Logo,23,Gardner Tongs,Pin site care importantWeight ranges from 5 lbs for c-spine to about 20 lbs for lumbar spineExcessive manipulation with placement must be avoidedPoor placement can cause flex/ext forcesCan get occipital decubitus（褥疮）,Company Logo,24,Crutchfield Tongs,Must incise skin and drill cortex to placeRotate metal traction loop so touches skull in midsagittal planePlace directly above ext auditory meatusRisks similar to Gardner tongs,Company Logo,25,Olecranon Pin Traction,Difficult supracondylar/distal humerus fxGreater traction forces allowedCan make angular and rotational correctionsPlace pin 1.25 inches distal to tipAvoid ulnar nerve,3 cm,2 cm,Company Logo,26,Lateral Olecranon Traction,Used for humeral fracturesArm held in moderate abductionForearm in skin tractionExcessive weight will distract fracture,Company Logo,27,Metacarpal Pin Traction,Used for obtaining difficult reduction forearm/distal radius fxOnce reduction obtained,pins can be incorporated in castPin placed radial to ulnar through base 2nd/3rd MCStiffness intrinsics common,Company Logo,28,90-90 Traction,Useful for subtroch and proximal 3rd femur fxEspecially in young childrenMatches flexion of proximal fragmentCan cause flexion contracture in adult,Company Logo,29,Femoral Traction Pin,Must avoid suprapatellar pouch,NV structures,and growth plate in childrenPlace just proximal to adductor tubercle along midcoronal planeAt level proximal pole patella in extended position,Company Logo,30,Distal Femoral Traction,Alignment of traction along axis of femurUsed for superior force acetabular fx and femoral shaft fxUsed when strong force needed or knee pathology present,Company Logo,31,Proximal Tibial Traction,Used for distal 2/3rd femoral shaft fxFemoral pin allows rotational momentsEasy to avoid joint and growth plate1 inch distal and posterior to tibial tubercle,1cm,3cm,Company Logo,32,Distal Tibial Traction,Useful in certain tibial plateau fxPin inserted 1.25 inches proximal to tip medial malleolusAvoid saphenous veinPlace through fibula to avoid peroneal nerveMaintain partial hip and knee flexion,Company Logo,33,Calcaneal Traction,Temporary traction for tibial shaft fx or calcaneal fxInsert about 1.5 inches inferior and posterior to medial malleolusDo not skewer subtalar joint or NV bundleMaintain slight elevation leg,34,Special traction,Company Logo,35,Head Halter traction,Simple type cervical tractionManagement of neck painWeight should not exceed 5 lbs initiallyCan only be used a few hours at a time,头颈部系带牵引,1lbs=0.45kg,Company Logo,36,Outpatient head halter traction,Used to train neck pain and radicular symptoms from cervical disc diseaseDevice hooks over doorFace door to add flexionUse about 30 min per dayWeight 10-20 lbs,神经根症状,1lbs=0.45kg,Company Logo,37,Halo Ring Traction,Direction of traction force can be controlledNo movement between skull and fixation pinsAllows the pt out of bed while traction maintainedUsed for c-spine or t-spine fx,Company Logo,38,Halo Ring Traction,Ring with threaded holesAllow 1-1.5 cm clearance around headPlace below equatorSpacer discs used to position ringCentral anterior and 2 most posterior,Company Logo,39,Halo Ring Traction,Two anterior pins Placed in frontal bone grooveSup and lat to supraorbital ridgeTwo posterior pinsPlaced posterior and superior to external earTighten pins to 5-6 inch-pounds with screwdriver,Company Logo,40,Halo Traction,Traction pull more anterior for extensionMore posterior for flexion,Company Logo,41,Halo Vest,Major use of halo traction is combine with body jacketAllows pt out of bedCan use plaster jacket or plastic,sheepskin lined jacket,Company Logo,42,Halo Vest,Pin site infection a riskCan remove pins and place in different holePin penetration can produce CSF leakScars over eyebrowsCan get sores beneath vest,