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

SPLINTS

Why are splints useful?

Types

1. Improvised splints 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, NATO’s 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 & children’s #s
    • Beware of dangers of cast

TRACTIONS

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. Buck’s 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. Bryant’s (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 Bryant’s 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

 

 

 

 

Conclusion

 

Modified by Dr Oluwadiya KS

NB: Dr Rabiu is now a consultant neurosurgeon with LAUTECH Teaching Hospital, Osogbo