Non-surgical techniques: Traction

Question 1

In the hip which muscles are flexors and which are extensors?

Answer 1

Flexors = psoas and quads
Extensors = hamstrings

Question 2

What is the principle behind traction as a holding method?

Answer 2

Increases muscle tone which surround the fracture and maintain alignment of the broken fragments - allows movement as fracture heals - helps t induce callus formation and bone healing

Question 3

In general what load is required for traction of the lower limb?

Answer 3

10N per 100N of body weight

Question 4

How is a counter force achieved to stop the patient being pulled out of bed?

Answer 4

Tilting the bed backwards (using the weight of the body and the frictional resistance between the patient and the bed)

Question 5

What are the 2 ways in which a load can be applied to the limb in traction?

Answer 5

Skin traction

Skeleta traction

Question 6

What is skin traction and when should it be used?

Answer 6

Load applied via a foam or sticky bandage applied to the skin (attachment dependent on adhesiveness of bandage or frictional resistance of the foam)

Can only be used up to 50N

Question 7

What is skeletal traction?

Answer 7

Load applied via pin inserted through the bone

Question 8

What are the advantages of skeletal traction?

Answer 8

Can be used to apply large loads
Load can be precisely relative to the long axis of the bone (important when traction is being used in dynamic situations)

Question 9

What is the principle disadvantage o skeletal traction?

Answer 9

Risk of causing bone infection at the pin bone interface

Question 10

What are the 3 ways of using traction?

Answer 10

Static (fixed) traction
Dynamic traction
Balanced traction

Question 11

What is static (fixed) traction?

Answer 11

Load is applied to the limb and attached to a splint so the splint itself provides the counter force

Question 12

Example of static traction

Answer 12

Thomas Splint

Question 13

Why is static (fixed) traction only acceptable for a week or two?

Answer 13

Prevents joint movement
Does not induce axial movement at the fracture site
Leads to muscle disuse

Question 14

What is static (fixed) traction mainly used for? Why?

Answer 14

Treating childrens fraction - because they do not cope well with complicated traction and their fractures heal quickly

Question 15

What is dynamic traction?

Answer 15

Same principles as in static traction but patient is encouraged to use their joints
Load is arranged so that irrespective of limb position the net pull is maintained along the axis of bone

Question 16

What are the 2 functions of the pulleys in dynamic traction?

Answer 16

Alter the direction of the fore (by being statically mounted on a surrounding bed frame)
Alter the magnitude of the traction force (by being mounted on the limb or ‘free floating’ within the traction cord system)

Question 17

What is the commonest form of traction?

Answer 17

A simple system with static pullets

Question 18

When are free floating pulley systems useful?

Answer 18

When the physio wants to counter the weight of a limb segment so that very weak muscles can be exercised without the full weight of the limb early in treatment

Question 19

What are the uses of balanced traction?

Answer 19

Used principally to offset pressure effects caused by splints
May be used as a supplement to static or dynamic traction

Question 20

Example of when balanced traction is needed and why?

Answer 20

Thomas splint - counter force is applied to the groin (pressure effect can be offset by applying a small load to the splint as a whole which tends to draw pressure off the groin area)

Question 21

What are the clinical complications of traction?

Answer 21

Bed sores
Chest infections
UTI
Disuse atrophy of muscles and bone

Question 22

Why has traction fallen into some disuse as a technique?

Answer 22

Requires prolonged hospitalisation (up to 3 months at least) - inconvienient for patients and expensive for hospitals

Question 23

Why is traction the safest method for treating fractures?

Answer 23

Easy access to the fracture

Difficulties with alignment can be easily observed and corrected