SKELETAL TRACTION Flashcards
WHAT IS PERKINS TRACTION AND WHAT DO YOU EXPECT TO SEE?
Perkins traction
Is a type of skeletal traction with pt. on Perkins bed and doing Perkins exercises?
What can you see?
a) A pt. lying supine in bed with leg abducted/adducted
b) He/ She has # femur
c) He/ She is on skeletal traction with wts.
d) Bed is raised with hard board
IN WHAT STATE SHOULD THE LEG BE DURING PERKINS TRACTION?
State of the leg during Perkins traction
a) Abducted = # of proximal 1
/3 of femur – to avoid angulation after healing
b) Adducted/Straight = all other femur #
HOW DO YOU PREVENT OVER TRACTION AND NON-UNIONS IN PERKINS TRACTION?
Apply 1/7 of body wt. (adults) and for each kg of wt. raise foot end of bed by 4cm
WHAT ARE THE ADVANTAGES OF PERKINS TRACTION?
Perkins exercise helps to
1) Increases blood supply
2) Promote healing
3) Controlled movement and compression of the bone ends encourages union
4) Prevents muscle atrophy – exercise maintain the tone of quadriceps
5) Prevents knees joint stiffness/ contractures
6) Prevents DVT, Decubitus ulcers and hypostatic pneumonia
7) Encourages positive psychological effect on pt
IN WHICH CASES IS PERKINS TRACTION INDICATED?
Indications
1) Undisplaced incomplete # of the neck of the femur.
2) All intertrochanteric #
3) Those subtrochanteric # in which the contraction of the iliopsoas has not flexed the upper fragment so much as to bring it seriously out of line.
4) All # of the shaft of the femur in pts. over 18, including overlapped, double, spiral, comminuted and open #s, and # with severe STI.
5) Those supracondylar # in which the lower fragment has not been too severely flexed by the contraction of gastrocnemius
6) All condylar # of the femur, except those in which a condyle has rotated completely
IN WHICH CASES IS PERKINS TRACTION CONTRAINDICATED?
Contraindications
1) All complete # of the neck of the femur
2) Displacement of the proximal femoral epiphysis
3) Subtrochanteric # with severe flexion of the proximal fragment
4) Supracondylar # with marked flexion of the distal fragment
5) Displacement of the distal femoral epiphysis
6) # of the condyles in which a fragment has rotated completely
7) All pts. under 18. Their epiphyses will not have united and the pin may damage the epiphyseal plate.
8) Arthritis of the knee, or a stiff knee from any cause, which will make exercise impossible without moving the fragments too much.
9) Non-union in # treated by other methods
WHAT ARE THE EARLY COMPLICATIONS OF PERKINS TRACTION?
Early (during insertion) complication
1) Damage to common peroneal nerve causing foot drop
2) Fat embolism
3) # of Tibia at the site of insertion of the pin
4) Soft tissue injury
5) Hemorrhage
WHAT ARE THE LATE COMPLICATIONS OF PERKINS TRACTION?
Late (during Traction) complication
1) Pin site infection- osteomyelitis
2) Pin may become loose
3) Osteoporosis- bone desorption to bed bound
4) Over traction – causing non- union
5) Malunion
6) Delayed union
7) Joint stiffness (ankylosis)
8) Muscle disuse atrophy
9) DVT
10) Hypostatic pneumonia
11) Decubitus ulcers (Bed sores)
12) Contractures
HOW CAN COMPLICATIONS IN PERKINS TRACTION BE PREVENTED DURING PIN INSERTION?
Careful pin insertion
a) Trans-tibial pin should be inserted 2 cm distal and 2cm lateral to the tibial tuberosity - this avoids injury to the common peroneal nerve
b) The Pin should be inserted from lateral to medial so as to avoid injury to common peroneal nerve
c) Can also be pushed into calcaneum or distal femur
WHICH PINS ARE USED FOR PERKINS TRACTIONS?
Denham pin
Steinmann pin
HOW IS A PERKINS TRACTION MAMNAGED?
Start periods of 10-30 min of active exercise several times a day from the 3rd day
Callus in the first 10 days is what determines the outcome
OUTLINE THE STEPS IN APPLYING A PERKINS TRACTION
Initially
-Correct the shock if the pt. is in shock by giving blood
-Palpate the peripheral pulses
-Initial X-ray, take A-P and lateral view and the hip.
Inset pin 2 cm distal to the tibial tuberosity
Apply wt. about 1/7 of the pts.’ wt.
Raise the bed by about 4cm for each kg.
Measure both the pts. legs from the anterior superior iliac spine to the tip of medial malleoli to make sure they are the same length.
If necessary adjust the traction wt. and elevation of the foot end of the bed, so as to let the bony fragments overlap by about 1cm
Check the leg length every day for the next 2 wks. and adjust the wts appropriately.
Then you can check length every 2 wks.
HOW DO YOU TEST THE FEMUR FOR CLINICAL NON-UNION?
No tenderness at the # site
Bone cannot be angulated at the # site
No tenderness on trying to angulate
Callus can be felt
WHAT ROLE DOES X-RAY PLAY IN PERKINS TRACTION?
X-RAY should be done on the 4th wk., 6th wk. and 12th wk.
If no callus on the x-ray by the 4th wk. suspect that there will be a delay in the union
When there are definite signs of clinical union usually in the 6th to 10th wk. remove the wts and continue exercise - range of movement improves progressively.
Transverse and oblique # take longer than spiral #
WHAT SHOULD YOU LOOK FOR WHEN SUSPECTING A FAT EMBOLISM IN A PT WITH PERKINS TRACTION AND HOW DO YOU TREAT IT?
If during the first 2-3 days after a pt. has fractured his femur he becomes disoriented, drowsy or comatose or he has a cough, shortness of breath and haemoptysis suspect that he is suffering from fat embolism.
This is as a result of globules of fat escaping from the injured marrow of his femur and entering the capillaries of his lungs or brain.
Look for petechial over his chest, mouth or in the conjunctiva
Fat in urine is usually confirmatory
Restrict fluids, give oxygen, and give him diuretics
