Mechanical Immobilisation DevicesSPLINTS and TRACTIONS

Surgeon Rear Admiral Pavan Sarin, NM (Retd)

Professor Orthopaedics

North DMC Medical College

WHAT ARE SPLINTS?

•Devices that immobilize and protect an injured limb or spine

• Can be of any rigid material-POP, plastic or metal

•Usually along with some padding to make it comfortable

• They are used before or instead of casts or traction.

INDICATIONS OF SPLINTS

•Fractures, sprains and dislocations

• Joint infections

•Acute arthritis/ gout

•Acute tenosynovitis

CONTRAINDICATIONS OF SPLINTS

•Compartment syndrome

•Need for open reduction

• Infected skin condition or when there is a high risk of infection

SPLINTING MATERIALS

•Plaster

•Crammer wire splints

•Fibreglass

•Pre-fabricated splints

•Air splints

•Vacuum splints

POP

•Calcium sulphate dehydrate

•When wet it crystallises

•Exothermic reaction

•Average setting time- 3 to 9 minutes

•Average drying time: 24-72 hrs

POP

Advantages

•Easier to mold

•Less expensive

Disadvantages

•More difficult to apply

•Gets soggy and soft when it gets wet

CRAMMER WIRE SPLINT

•Used for temporary quick splintage of a limb for transport

• Two thick parallel wires with ladder like thin wires

•Malleable, can easily be bent to the contour of limb

THOMAS SPLINT

• Hugh Owen Thomas- Father of Orthopedics

• Father not a trained physician (bone setter), was taken to court to defend his practice 3 times

• Sent to train all the five sons

• An eccentric and temperamental man-injured people to treat them?

• Would treat patients free on Sundays

THOMAS SPLINT

• Ring at an angle of 120 degrees

• Two side bars

• Outer bar bent to accommodate the greater trochanter

• Leg supported on slings tied to the side bars

THOMAS SPLINT WITH TRACTION

BOHLER BRAUN SPLINT- 3 Pulleys

•Proximal pulley to prevent foot drop

•2nd pulley- traction in line with the femur

•3rd Pulley- traction in line for traction in line with the leg

BOHLER BRAUN SPLINT- Advantages

• Traction unit is self contained-easy tption

• Limb in comfortable position

• Angle of traction changeable

• Wound care possible

• Multipurpose application

• Simultaneous traction through Calcaneal/distal tibia and proximal tibia/distal femur possible

DENNIS BROWN SPLINT

•Used in the treatment of club foot.

• Father of paediatric surgery in the UK.

COCK-UP SPLINT

AEROPLANE SPLINT

Sternal-Occipital-Mandibular Immobilizer (SOMI) BRACE

LUMBAR CORSET

Air Splints- Inflatable

• Also called “pneumatic splints”

• Become rigid when filled with air

• Limit motion, control bleeding/swelling

• Injured part inserted into deflated splint

• Air infused and splint molds to injured body part

• Fill to point which allows indentation with fingertips

• Injury should be checked and treated within 30-45 minutes after application

Vacuum Splints

• Operate by extracting air from the splint

• Thousands of polystyrene balls inside the splint mold around the injured body part similar to a cast.

• Advantages-• Ability to provide support whilst

relieving pressure at the injury site

• Ability to conform to any shape

• Limb may also be X-rayed with the splint in situ

CARE OF PATIENT ON SPLINT

• Padding on the fracture site

• Padding on bone prominences

• Active mobilisation of muscles and joints

• Watch out for effects of compression on nerves/ vessels

• Daily check and adjustments of weights

• Check pressure points and perineum for pressure points

• Care of back

Pre- Post Checks with Splints- FACTS

• Function

•Arterial pulsations

•Capillary refill

• Temperature

• Sensations

MECHANICAL IMMOBILISATION DEVICES

SPLITS

• The use of various devices can achieve therapeutic benefits

TRACTIOINS

• Devices that immobilize by pulling on contracted muscles

• Not as easy to apply as splints

• May require special training for application to prevent further injury

TRACTIONS

• Traction is pulling effect exerted on a part of skeletal system.

• Involves use of weights connected to patient with ropes, pulleys, slings, etc.

OBJECTIVE of TRACTION

• Reduction of fracture/ dislocation

• Maintenance of “

• Reduce/ relieve pain

• Immobilisation of painful joint

• Prevention of deformity, counteracting muscle spasm

• Correction of small defects

PRINCIPLES OF EFFECTIVE TRACTION

• Traction must produce a pulling effect on the body

• Counter traction must be maintained

• The traction and counter pull must be in the opposite directions

• Splints and slings must be suspended without interference

• Ropes must move freely through each pulley

• Precise amount of weight must be applied

• The weights must hang free

TYPES OF TRACTIONS

– Manual-Pulling on body using hands and strength

– Used frequently to replace dislocation

– Skin-Devices applied to skin such as pelvic belt, Buck’s/Russell’s traction

– Skeletal-Pulls directly on bone with wires, pins, tongs into bone

BUCKS TRACTION

ADVANTAGES OF TRACTION

• Regain normal length and alignment of involved bone.

• Relieves pain and muscle spasm

• Restricts movements while the injury heals

• Maintains functional position until the healing is complete

• Allows other activities

• Prevents further structural damage and deformity

• Relieves pressure on nerves (esp spine)

• Prevent or reduce skeletal deformities or muscle contractures

• Provides a fusiform tamponade around a bleeding vessel

DISADVANTAGES OF TRACTION

•Costly in terms of hospital stay

•Hazards of prolonged bed rest• Thromboembolism• Decubitus ulcer• Pnuemonia

•Require extensive nursing care

SKIN TRACTION

• Limited force can be applied -generally not to exceed 5 lbs

• More commonly used in pediatric patients

• Can cause soft tissue problems especially in elderly or rheumatoid patients

• Not as powerful when used during operative procedure for both length or rotational control

Contraindications for Skin Traction

• Patients with loose skin

• Wounds on the limb

• Circulation problem- gangrene/ varicose veins

• Skin infection

Complications of Skin Traction

• Allergy

• Muscular atrophy

• Paralysis

• Oedema

SKELETAL TRACTION

• More powerful than skin traction

• May pull up to 20% of body weight for the lower extremity

• Requires local anesthesia for pin insertion if patient is awake

• Preferred method of temporizing long bone, pelvic, and acetabular fractures until operative treatment can be performed

SKIN vs SKELETAL TRACTION

Skin Traction Skeletal Traction

Required for force Mild Moderate/ severe

Age used Children Adults

Applied with Adhesive tape Steinmann, K-wire

Commonly Below knee Upper tibia

Weight permitted 2-3 kg Up to 20 kgm

Duration Short Long

TYPES of SKELATAL FIXATION

• Choice of thin wire vs. Steinman pin

• Thin wire is more difficult to insert with hand drill and requires a tension traction bow

SITES OF SKELETAL TRACTION

MODE OF SKELETAL TRACTIONS

FIXED TRACTION

Counter traction applied by the splint

SLIDING TRACTION

Wt of body acts counter traction

90- 90 Traction

COMPLICATIONS OF SKELETAL TRACTION

• Pin/ wire tract infection

• Effects of prolonged pull on ligaments

• Pressure sores

• Difficulty in application of splints

SUMMARY

• SPLINTS

• Indications

• Contraindications

• Cramer wire

• Thomas splint

• BB splint

• Air/vacuum splints

• Care of patient with splint

• TRACTIONS

• Objective

• Principle

• Types of hold

• Sites of skeletal fixation

• Advantages

• Disadvantages

• Complications

• Fixed/ sliding