A traction jig for reduction of distal radialfractures

David Wisea,*, Tim Coatsa, Ram Persadb

aAccident and Emergency Department, Royal London Hospital, London E1 1BB, UKbRoyal London Hospital, London E1 1BB, UK

Accepted 16 January 2003

Introduction

Adult patients with Colles’ and other extra-articulardistal forearm fractures are commonly managed ‘inhouse’ by Accident and Emergency departments byclosed reduction of the fracture, followed by immo-bilization in a simple cast (typically a plaster of Parisback-slab).1 Two main problems are commonlyencountered. Firstly, incomplete reduction of thefracture; secondly, loss of (satisfactory) reductionduring application of the cast. Both of these sce-narios may be related to difficulty in maintainingconstant traction throughout the procedure.‘Finger-traps’ can be used as part of a system toprovide constant traction on upper limb fractures inthe operating theatre2 or in the emergency depart-ment;3 in the UK there use has been restrictedmainly to the operating theatre due to technicaldifficulties applying the technique. We present a

finger-trap traction jig for reduction of distal radialfractures that overcomes these difficulties andwhich can be used in the Accident and EmergencyDepartment.

The technique

Anaesthesia is provided according to local protocol(we use axillary block, haematoma block or nitrousoxide/oxygen [Entonox]). The equipment picturedwas constructed by the Engineering Department ofour hospital and consists of two brackets whichscrew on to our standard hospital trolley; minordesign modifications may be necessary to fit otheraccident and emergency department trolleys. Onebracket has a padded upper arm brace attached,the other a pulley (see Figs. 1 and 2). The patientis positioned supine with shoulder abducted to 908and with elbow flexed to 908. The upper arm isfirmly supported by the brace such that the tractionforce is applied to the upper arm rather than theshoulder (Fig. 1). Tape is applied to the thumb,index and ring fingers to protect the skin. ‘Finger-traps’ are placed over the taped digits (these are

Injury, Int. J. Care Injured (2004) 35, 65—67

Summary A traction jig is described which facilitates the closed reduction of extra-articular distal radial fractures and which maintains the reduction whilst a plaster castis applied. The jig is suitable for use by a single operator in an Accident and Emergencydepartment setting.� 2003 Published by Elsevier Ltd.

*Corresponding author. Present address: 128 Englefield Road,Islington, London N1 3LQ, UK. Tel.: þ44-20-7226-0593; fax:þ44-20-7226-0593; mobile: 07876-385-765.

E-mail address: davidwise2@hotmail.com (D. Wise).

0020–1383/$ — see front matter � 2003 Published by Elsevier Ltd.doi:10.1016/S0020-1383(03)00024-X

wire or nylon tubular mesh sheaths which have thefibres aligned such that the diameter of the sheath isreduced as the axial pull is increased–—thus ‘trap-ping’ the digit). The three finger-traps are attachedvia a bar to a traction weight of 8 kg (Fig. 2). Theset-up provides some ulnar deviation and palmarflexion. The firm axial distracting force is main-tained for 5 min or until the fracture has disim-pacted. A ‘fine-tuning’ manipulation can be madeif required. Whilst still on traction a cast is appliedand X-rays taken. When the cast has hardened thetraction is released.

Discussion

This equipment is commercially available (Prome-dics Ltd., Moorgate Street, Blackburn, LancashireBB2 4PB, UK) but can be easily constructed by anyreasonably equipped hospital engineering depart-ment. It enables a single operator to achieve excel-lent reduction of displaced distal radial fractures,and it holds the reduction until the cast has set. Dueto the relatively constant nature of the traction,anaesthetic requirements are often reduced. Thejig is easy to use in the Accident and EmergencyDepartment and has become our standard methodfor reduction of distal radial fractures.

Figure 1 Upper arm brace counteracts the tractionforce.

Figure 2 Traction is applied via ‘finger-traps’, pulley and an 8 kg weight.

66 D. Wise et al.

Contributors

David Wise, Tim Coats and Ram Persad co-wrote thepaper. Ram Persad designed the jig.

Acknowledgements

The authors would like to thank the EngineeringDepartment of The Royal London Hospital for con-structing the jig.

References

1. Cochrane Database of Systematic Reviews. Conservativeinterventions for treating distal radius fractures in adults[Review]. The Cochrane Library. Copyright 2001.

2. Derkash RS, Weaver JK, Freeman JR, et al. Treatment ofcomminuted distal radial fractures with preliminary horizon-tal finger trap traction and a Roger—Anderson externalfixation device. Orthop Rev 1990;19(9):790—6.

3. Simon RS, Koenigsknecht SJ. Emergency orthopaedics. Theextremities. 4th ed. New York: McGraw-Hill; 2001. p. 222—30. ISBN 0-8385-2210—2216.

A traction jig for reduction of distal radial fractures 67