Outline about Splints and Traction appliances

1. SPLINTS AND
TRACTIONS
Moderators
Dr Farid Malik Dr Amarjeet Singh
Dr Hilal Ahmed 1st Year Post Graduate

2. History
• 3000BC:Imhotep Egypt(wood splints and bandages)
• 400BC: Hippocrates Greece(Described aids to reduce #)
Treated fracture shaft of femur and of leg with the leg straight in extension
• 160 AD: Galen Rome(described variety of bandages/spica)
• 1000AD:Albucasis Arabia( egg white, flour)

3. • 1363: de Chaulic France(Isometric traction to a limb with pulleys)
• 1852: Mathysen Holland
• 1852: Pirogov Russia(Splint before moving the injured)
• 1861: Buck USA(Skin traction)
• 1875: HO Thomas England(Absolute rest)
• 1876: Championniere France
• 1907: Steinmann  Germany
• Lorenz Bohler - "the father of traumatology" popularized skeletal traction
worldwide by means of Steinmann pin after he devised Bohler's stirrup. He
modified Braun's splint and developed the multipurpose Bohler Braun splint.

4. Closed Reduction
• All displaced fractures should be reduced to minimize soft
tissue complications, including those that require ORIF
• Adequate analgesia and muscle relaxation are critical for
success
• Correct/restore length, rotation, and angulation
• Immobilize joint above and below

5. SPLINT
Is a device used for support or immobilisation of a limb or spine.
Any Material Used to support a fracture is a splint
• Conventional
• Non Conventional
.

7. Outlines
• Functions
• Indications
• Prepartion
• Types
• Care of a patient on splinting

8. FUNCTIONS
• Temporary immobilization of sprains, fractures, and reduced
dislocations
• Control of pain
• Facilitates patient transportation
• Prevention of further soft tissue or neurovascular injuries
• Decreases risk of converting a minor injury to a major injury

9. INDICATIONS
• Fractures
• Sprains
• Joint Infections
• Tenosynovitis
• Acute Arthritis/Gout
• Lacerated wounds over Joints
• Puncture wound or animal bite over the hand and feet
• To Stabilize or rest the Joint in Ligamentous injury
• To correct deformity
• To Support and immobilize joints post op.

10. PREPARATION
• Define injury and what splint is required
• Splint in position of function
• Clean and repair skin lesions prior to splint application
• Document neurovascular examination before splint application
• Anticipate ability for the patient to remove clothes after splint is
applied

11. Cramer Wire Splint
• Ladder splint.
• Used for temporary splintage of fractures during transportation.
• Made of 2 thick parallel wires with interlacing wires.
• Can be bent into different shapes.

12. THOMAS SPLINT
• Devised by H.O Thomas initially for T.B Knee

13. Parts
• Padded oval metal ring
• To which are attached inner and outer side bars
• Ring set at an angle of 120* to inner bar
• The two side bars joined at the distal end in the form
of `W`
• Outer bar angled out 5cm below the ring

14. Choosing the Thomas Splint
• Measure the oblique circumference of thigh
immediately below the gluteal fold –equals the internal
circumference of padded ring
• Measure the distance from crotch to heel and add 6-9
inches-equals the length of inner bar

15. Preparing a Thomas Splint
• Fashion slings between side bars-cut an adequate length of 6`
wide domette bandage.
• PASS THE BANDAGE OVER
THE INNER BAR AND THEN
PASS BOTH ENDS ABOVE THE
OUTER BAR
• Fasten the two ends under outer bar
with 2 large safety pins
• Distal sling must end 6cm above heel

16. • Proximal sling leaves a
triangular area of thigh
unsupported –avoided by
passing bandage around
the ring as well as the
side bars
• Line the sling with gamgee tissue(cotton wool between 2 layers
of gauze)
• Place a large pad 9/6/2 inches ,transversely under thigh
• After splint has been fitted bandage the limb in to the splint

17. Bohler Braun Splint

18. MATERIALS USED
• Plaster of Paris(POP)
• Fiberglass(Orthoglass)
Rapid action (20mins)
stronger
lighter
Water resistant

19. Prefabricated splints
• Plastic shells lined with air cells, foam or gel components.
• Pros and cons same as fiberglass splints

20. Air Splints
• An air splint is used to immobilize a fracture using an
inflatable support.
• This type of splint is not generally used for long-term support
of a fracture as it is less secure and provides less structural
support than plaster splints or fiberglass splints.

21. Vacuum splints
• Moulds to shape of injury using a handheld pump to draw out
the air from within the sleeve.

22. PRE/POST SPLINT CHECKS
• F- Function
• A- Arterial pulses
• C- Capillary refill
• T- Temperature
• S-Skin

23. Figure of 8 Splint
• Clavicle #
• Most are prefabricated and simple to apply
• Apply with patient standing and hands on the iliac crest
• Shoulders should be abducted

24. Shoulder Immobiliser/Sling and Swathe
• # Clavicle in Adults
• # Scapula

25. Aeroplane Splint
• Brachial plexus injuries
• Pre/Post-operative shoulder management
• Contracture prevention
• Post-muscle
release/tendon transfer
of shoulder
• Burn management in the
axillary region.

26. Long Arm Posterior Splint
• Indications
- Distal humerus #
- Both-bone forearm #
-Unstable proximal radius or ulna # (sugar-tong better)

27. Forearm Sugar Tong
• Indications
- Unstable Proximal radius
and Ulnar #
- Distal radius and ulnar #
Extends around distal
humerus to give rotational
control
Padding should be atleast 3-4
layers thick with extra
layers at the elbow

28. Double Sugar Tong
• Indications
- Elbow and forearm #
- Prox/mid/distal radius and ulnar #
Better for most distal forearm and elbow #
because limits flex/extension
and pronation / supination.

29. Coaptation Splint
• Shaft of humerus #
• Consist of a U slab applied
to the medial and lateral
aspects of the arm, encircling
the elbow and overlapping the
shoulder(over the deltoid)
• Medially it ends in the axilla
and must be well padded to
avoid skin breakdown

30. Forearm Volar Splint aka ‘Cockup’ Splint
• Indications
Soft tissue hand / wrist injuries - sprain, carpal tunnel night splints,
etc
• Most wrist #, 2nd -5th metacarpal #
• Most add a dorsal splint for
increased stability - ‘sandwich splint’ (B).
• Radial Nerve Palsy
• Not used for distal radius
or ulnar # - can still supinate and pronate.

31. Radial and Ulnar Gutter
Fractures, phalangeal and metacarpal,
and soft tissue injuries of the little and ring fingers.
Fractures, phalangeal and metacarpal,
and soft tissue injuries of index and long fingers

32. Thumb Spica
• Scaphoid # seen or suspected (check snuffbox tenderness)
• Thumb Phalanx # or Dislocations
• De Quervain tenosynovitis.
• Gamekeeper’s/Skiers Thumb
• Notching the plaster (shown) prevents buckling when wrapping
around thumb.
• Wine glass position.

33. Finger Splints
• Sprains- Dynamic Splinting(Buddy Strapping)
• Volar/Dorsal finger splints- Phalangeal #
(Although gutter splints better for proximal #)

34. Stack Splint
• Management of mallet finger

35. Aluminium Splint
• Phalangeal #
• Mallet Finger

36. Oval 8 Finger Splint
• Mallet/Baseball Finger
• Trigger finger
• Swan neck
• Boutonniere
• Fractures
• Arthritis
• Lateral/Medial Deviations

38. Tri point Splint
• Swan Neck Deformity
• Boutoneirre Deformity

39. Lower Extremity
Von Rosen Splint
Congenital Dislocation of Hip
• H Shaped Malleable splint
• Hip should be properly reduced before its splinted
• Hip held in flexion and Abduction
• Extreme positions avoided and joint allowed some movement in the
splint

40. Hip Spica Cast
• # Shaft of Femur in Children and in young adults once the
fracture becomes sticky
• Encircles one or both the legs and the chest or trunk
• Generally strengthened with a reinforcement bar
• Cast trimmed at the anal and genital regions to allow the
passage of urine and stool

41. Knee Splints
• Knee Injuries
• Proximal Tibia/Fibula Fractures
• Place knee in full extension
• Plaster is placed from
posterior buttocks to
3 inches above the
malleoli

42. Ankle
Posterior Ankle Splint
• Distal tibia/fibula #.
• Reduced dislocations
• Severe sprains
• Tarsal / metatarsal fx
• Use at least 12-15 layers of plaster
placed from metatarsal heads on
plantar surface foot, extends up back
of leg to level of fibular neck
NOTE - Adding a coaptation splint (stirrup) to the posterior splint
eliminates inversion / eversion - especially useful for unstable fx and
sprains.

44. Foot
Dennis Brown Splint
• Congenital Talipes Equino Varus (C.T.E.V.)
• Used after successful correction of deformity to prevent relapse.
• Used throughout the day before child starts walking.
• Once child starts walking ,a DB splints is used at night and CTEV shoes during the
day.

45. Buddy Strapping
• Phalangeal fractures of the toes
• Fractured toe secured to adjacent toe with tape
• Use a small piece of wadding and place between the injured toe and
an adjacent toe to prevent maceration

46. SPINE
Cervical Collar
• Flexible foam/Rigid/Adjustable collar
• Encircles the neck to support the skull against the thorax
inferiorly
• Motion control and keeping warm at cervical level
• Soft tissue injury, minor sprains for first few days after injury
• Post operative immobilisation
• Note :- They are not useful for very unstable injury pattern

47. Soft Cervical Collar/ Thomas Collar
• Commonly used for mild soft tissue strains and sprains

48. Semi Rigid/Philadelphia Collar
• Can provide access to the trachea
• Moderate Control of ROM( b/w occiput and C3)

49. SOMI (Sternal Occipital Mandibular
Immobilizer)
• Cervical spine injury
• Rigid Frame Design
• Commonly used in stable fractures and Moderate to Severe
soft tissue damage
• Limits Flexion and Extension
• Extends Inferior into the
Thoracic Region for greater
control of all cervical levels
• Effectiev in controlling forward
flexion b/w C1-C4 esp at the
C1-C2 joint.
• Doesn’t control extension and
Lateral flexion

50. Four Post Collar
• Neck immobilisation in cervical spine injury
• More stable than cervical collar
• Applying pressure to mandible , occiput , sternum and up per
thoracic spine
• They can be uncomfortable

51. Milwaukee Brace
• Scoliosis
• Named after the city of Milwaukee where it was designed.
• It fits snugly over the pelvis below; chin and head pads
promote active postural correction and thoracic pad presses on
the ribs at the apex of the curves
• Occasionaly in the management
Of AS and TB( No pressure pad)

52. Boston Brace
• Scoliosis
• Pre fabricated
• Used for low curves( Apex of the curve below T8)
• Worn 23 Hours / Day
• Made of semi-rigid plastic and foam

53. Lyon Brace
• Scoliosis
• Pelvic section, an axillary
plate, thoracic plate and
lumbar plate, which are
fabricated in plastic

54. Taylor’s Brace
• Dorso-lumbar Immobilisation
• Anterior Compression Fractures of the vertebral body
• Semi rigid design
• Commonly used for TB, osteoporosis, trauma, Degenerative
spine disease
• Limits
forward
Flexion,
Extension
and Lateral
flexion of
T.L spine

55. Ash Brace
• Hyperextension Brace
• Compression #
• Prevents Forward Flexion

56. Care
• Do not get the splint wet.
• Use plastic bags to cover the splint while bathing.
• Do not walk on the splint.
• Do not stick anything down the splint Such as a coat
hanger to scratch or itch. This may lead to injury and
infection.
• Look for Numbness, tingling, increased pain, change
in coloration of fingers or toes, or swelling in fingers
or toes.

57. COMPLICATIONS
• Rare- If applied correctly
• Most Common
Sores, abrasions and secondary infections from lose or ill
fitting splints
• Less common
Neurovascular compromise from tight fitting splints
Contact Dermatitis
Thermal burns from the heat of the plaster.

58. TRACTION
• Traction is a method of restoring alignment to a fracture
through gradual neutralisation of muscular forces
• Applied to the limb distal to the fracture, so as to exert a
continuous pull in the long axis of the bone
• Ligamentotaxis

59. Functions
• Reduction of fractures and dislocations
• Reduce / relieve pain
• Preventing deformities.
• Correction of soft tissue contractures
• Ensure immobilisation
• Minimize muscle spasms

60. Types
Manual
• Pulling on the body using a person's hands and muscular
strength.
• Most often used briefly to realign a broken bone
• Also used to replace a dislocated bone into its original position
within a joint.

61. Skin Traction
• Traction force is applied over a large area of skin.
• Spreads the load and is Comfortable
• Generally weight used is 5lbs
• Maximum Traction weight that can be applied by skin traction
is 15lb(6.7kg)
• Two Methods of Applying
1) Adhesive Skin Traction.
2) Non Adhesive Skin Traction.
(Weight not exceeding 10lb or 4.5kg)

62. Method
• Shave the limb(Not for non adhesive)
• Protect the malleoli(felt, foam rubber or few turns of crepe)
• Starting at the ankle/wrist,leaving a loop
projecting 5cm beyond the distal end
of the limb and apply strapping
• Antero medially and postero laterally
-To encourage medial rotation
• Apply crepe bandage
• Check that spreader and
traction cords present
• Attach reqd wt

64. Contraindications
• Abrasions of the Skin
• Lacerations of the skin in the area to which traction is applied
• Impairment of circulation-Varicose ulcers ,Impending gangrene
• Dermatitis
• Marked shortening of bony fragments (Traction required to
reduce is much more than what can be given via skin)

65. Complications
• Allergic reaction to the adhesive
• Excoriations of the skin
• Pressure sores(Over the malleoli,tendo calcaneus)
• Common Peroneal nerve Palsy

66. SKELETAL TRACTION
• Metal Pin or a wire is driven through a bone
• Traction force applied directly to the skeleton
• Frequently used in the management of Lower limb fractures
• Should be reserved in cases in which Skin traction is
Contraindicated
• Serious complication is
‘Osteomyelitis’

67. Steinmann Pin
• Rigid Stainless Steel Pins of varying lengths,4-6 mm in dia
• After insertion Bohler Stirrup is attached to the pin
• Bohler stirrup allows the direction of the traction to be varied
without turning the pin in the bone

68. Denham Pin
• Has a short raised threaded portion
• It engages the bony cortex and reduces the risk of pin sliding
• Useful for use in Cancellous bone such as Calcaneum or in
osteoporotic bones

69. Kirschner(K) Wire
• Small in diameter.
• Insufficiently rigid until pulled taut in a special stirrup
• Rotation of the stirrup is imparted to the wire
• Wire easily cuts out of bone if a heavy weight is applied
• Mostly used in the upper limb

71. Olecranon
• #Supracondylar Humerus
• Comminuted # of lower end
of Humerus
• Unstable # of the Shaft
of Humerus
Method:
• Deep to the s/c border of the upper
end of the ulna,1.25 inches(3cm)
distal to the tip of olecranon
• This avoids the elbow joint
• Medial to Lateral
• Rare now

73. 2nd and 3rd Metacarpals
• Comminuted # of the bones of the forearm
(particularly comminuted
# of the Lower end of radius)
Method:
• K wire inserted 0.75 – 1 inch(2-2.5cm)
proximal to the distal end of 2nd MC
• Wire traverses 2nd and 3rd MC
transversely to lie at right angles
to the longitudinal axis of the radius.
Complication:
Fibrosis of the Interosseus muscles
and can lead to stiffness of fingers.

74. Upper end of femur-Greater trochanter
• Central # Dislocations of the hip
• To restore the relationship of the weight bearing part of the femoral
head to the dome of the acetabulum
Method:
• Lateral surface of the femur,
1 inch(2.5 cm) below the most
prominent part of the greater
trochanter, mid way between
the anterior and posterior
surfaces of femur.
• 10-20 lbs
• Active hip and knee movements started
• Continued for 4-6 weeks

76. Lower end of femur
• Method of choice for Acetabular and Proximal femur
fractures
• If there is a knee ligament injury usually use distal femur
instead of proximal tibial traction
• 3 cm proximal
to the articluation
b/w lateral femoral
Condyle and lateral
Tibial plateau

77. • Place pin from medial to lateral at the adductor
tubercle - slightly proximal to epicondyle

78. Upper end of Tibia
• 0.75 inch(2.0cm) behind the crest, just below the level of the
tubercle of the tibia
• Pin driven from Lateral to Medial side of the limb to avoid
damage to the CPN

79. Lower end of Tibia
• 2 inches(5 cm) above the level of the ankle joint, mid
way between the anterior and posterior borders of
the tibia

80. Calcaneus
• 0.75 inch(2 cm) below and behind the lateral mallelous or 1.25
inch(3cm) below and behind the medial malleolus
• Care must be taken to avoid
entering the sub talar joint
• Most commonly used with a
spanning ex fix for
“travelling traction”
or a Bohler Braun frame
• Stiffness of the subtalar joint

81. Complications of Skeletal Traction
• Introduction of Infection
• Incorrect placement
Cut out of the bone causing pain and failure
Control of rotation difficult
Uneven pull being applied.
• Distraction
• Ligamentous Damage
• Damage to episphyseal growth plates(Genu
recurvatum in the treatment of # SOF by UTST
• Depressed scars

82. Counter Traction
• A Traction force applied to the affected part of the body will
overcome muscle spasm only if another force acting in the
opposite direction --- counter traction--- is applied at the same
time as the traction force.
• If it is not given the whole body tends to move in the direction
of the traction force, and muscle spasm will not be overcome

83. Fixed Traction
• Counter traction by applying a force against a fixed point on the
body, proximal to the attachments of the muscles in spasm
• To apply a force on the fixed point on the body an appliance
such as the Thomas splint is used
• Traction force balances the pull of the muscles and as the
muscular pull and hematoma decrease, the traction force
decreases
• Distraction at the # site and accompanying danger of delayed
union or non union is less likely to occur

84. Fixed Traction in a Thomas Splint
• Maintains reduction of a fracture
• Reduced transverse # most suitable but reduction of a spiral or
oblique # can be maintained also
• Counter Traction not
dependent upon gravity
the apparatus is self
contained and the
patient may be lifted
and moved without
risk of displacement
of the #
• Useful in transportation

85. Traction Unit
• Charnley 1970
• Upper Tibial Steinmann pin incorporated in a light B/K Plaster cast
Advantages:
• Compression of Tissues in the upper calf doesn’t occur between the
calf sling and the steinmann pin
• Equinus deformity at the ankle doesn’t occur because the foor is
supported by plaster cast
• Tendo calcaneus is protected from pressure by the padded cast
• Rotation of the foot and the distal fragment is controlled
A fracture of the ipsilateral tibia can be treated at the same time

86. RogerAnderson Well leg Traction
• Anderson 1932
• Nowadays used in correcting an abduction or adduction
deformity at the hip.

87. Sliding Traction
• Gravity utilized to provide Counter traction by tilting the bed so
that the patient tends to slide in the opposite direction to that of
the traction force.
• Traction force continues to act as long as the weight remains
clear of the floor
• When used to reduce a # the initial wt used is greater than the
wt required to maintain (Great care taken to avoid distraction)
• Femoral shaft # an initial wt of 10% of the weight of the patient
is usually sufficient
• Counter traction 1 inch(2.5cm) for each lb(0.46kg) of traction
wt.

88. Buck’s Traction
• Popularised during the American civil war
Uses:
• Temporary management of # NOF
• # SOF in older and larger Children
• Undisplaced # of the Acetabulum
• After reduction of hip dislocation
• Correct minor FFD of the hip
or knee
• In place of pelvic traction in the
Management of low back pain

89. Method:
• Adhesive strapping or Ventfoam skin traction Bandage
• Support the leg on a soft pillow to keep the heel clear of the bed
• Pass the cord from the spreader over a pulley attached to the end of the bed
• 5-7lb(2.3-3.2kg)
• Elevate the foot end of the bed
• Lateral rotation of the limb is not controlled by this method

90. Perkins Traction
• Fracture tibia
• # femur from subtrochanteric region distally in all ages
• fracture Trochanter in <50 yrs
Principle is use of Skeletal traction without any
externalsplintage coupled with active movements of injured limb
• Perkins showed that by encouraging early muscular activity
stiffness of joint was prevented by extensibility of muscles by
reciprocal innervation.

91. Method
• Under GA and aseptic precautions
• Insert Denham pin through upper Tibia
• Attach Simonis swivel to each end of pin
• Connect 2 traction cords to each swivel
• Pass each cord over separate pulleys
• Attach wt (4.6kgs) to each traction cord making total traction
wt of 9.2kgs.
• Elevate foot of bed by 1 inch for every 0.46 kg.
• Place pillows under thigh to maintain normal bowing of thigh.
• CHECK LIMB LENGTH WITH TAPE & INCREASE OR
DECREASE THE TRACTION WEIGHT
• Start active quadriceps exercises immediately.

92. Hamilton Russel Traction
• # Shaft of Femur
• After Arthroplasty operations of the hip
Method:
Weight
Adults- 8lb(3.6kg)
Infants and older children- 0.5 – 4lb(0.28 – 1.8 kg)

93. Tulloch Brown Traction
• Tulloch Brown or U loop tibial pin traction and suspension with
a Nissen foot plate and Stirrup
Uses:
• After Arthroplasty of the Hip
• Pseudoarthrosis operation on the hip
• # Shaft of Femur
Not used in children

94. Ninety/Ninety Traction
• Obletz(1946) as an aid to the operative and early post op
management of compound fractures of the femur with wounds
on the post aspect of thigh
• Subtrochanteric #
• Proximal 1/3rd of Femur
• Children as well as adults
Three ways of applying it
1.Using a Tulloch Brown U loop

95. • 2. Using a second Steinmann Pin
• 3.Using a B/K Plaster cast

96. Complications of Ninety/Ninety Traction
• Those of Skeletal Traction
• Stiffness and loss of extension of the Knee
• Flexion contracture of the Hip
• Injury to the Lower femoral or upper tibial epiphyseal growth
plates
• Neurovascular damage

97. Sliding Traction with a Thomas Splint and
Knee Flexion piece(Pearson Modification)
• Used to Obtain the reduction of an oblique or spiral # of the
shaft of the femur and then to retain it until union occurs
• Suspend the knee flexion piece to maintain 20-30 degrees of
flexion at knee joint( extended position is zero)
Knee flexion piece
• Helps in easier mobilization of the knee
• Controls Rotation,
• Prevents stretching
of the post capsule
and post cruciate
ligaments of the
knee

98. Sliding Traction with a Fixed Thomas
Splint
• Tendency for the splint to splint to slip down the limb.
• Prevented by careful arrangement of suspension cords or by
fixing the traction cords from the patient to the splint and then
pulling on the splint
• Weight of 18lbs enough
For most adults
• Suspend the Thomas
splint such that the
heel is just off the bed
And the cord in line with
The splint

99. Bryant’s (Gallows Traction)
• # SOF in children
• Less than 2 years
• Weigh less than 35-40lb(15.9-18.2 kg)
Fractures in children unite rapidly
Seldom applied for more than 4 weeks

100. Complications
• Vascular complication of Bryants traction may occur in either
the injured or normal limb.
• A careful check must be done in both limbs during first 24-72
hrs. -By checking color and temp of limbs. -Dorsiflexion of
both ankle passively.
• Bryants traction in children under 2yrs - safe
• 2-4yrs - vascular complications more(can be prevented by using
posterior splint).
• Over 4yrs - absolutely contraindicated.

101. Modified Bryant’s Traction
• Sometimes used in the initial management of CDH when
diagnosed over the age of 1 year
• Abduction begun after 5 days
• 10degrees on alternate days
• By 3 weeks fully abducted

102. Bohler Braun Frame
• Can be used in the Management of fractures of Tibia or femur
• European countries
• Skin traction can be used but skeletal preferred
Method:
Wt 7-10 lbs(3.2 – 4.5 kgs)

103. Disadvantages
• Cannot move with the patient
• Nursing care is difficult
• Patients body and the proximal fragment of the # can move
relative to the distal fragment which is cradled in the splint
and is therefore relatively immobile, which predisposes to a
deformity

104. Agnes Hunt Traction
• Mild Flexion deformity of the hip as a result of poliomyelitis.
• For traction to have any effect upon the flexion deformity at
the hip joint the compensatory lumbar lordosis must be
eliminated

105. Pelvic Traction
Conservative management of prolapsed Intervertebral disc
• Special Canvas harness is buckled around the patient’s pelvis
• Long cords or straps attach the harness to the foot of the bed
• Foot of the bed raised amount of which depends upon the
patients weight
• Function is to ensure that the patient lies quickly in bed rather
than to attempt to distract the vertebral bodies.
Alternative:
Buck’s traction
Pelvic traction is superior but however because it leaves the
patient’s legs free and therefore able to move freely

107. Spinal Traction
• Skin or Skeletal
• Cervical
• Thoracic and Lumbar(Halo pelvic method)

108. Halter or Non Skeletal Traction
• Uncomfortable if applied for long
• Reserved usually in the treatment of cervical spondylosis on
out patient basis
• Types
Canvas or Chamois leather
Crile Head Halter
• A canvas or chamois
leather head halter traction
used-max wt 3-5 lb
• Crile head halter traction
–chin is free
• Head of the bed must be raised to provide counter traction

110. Skull or Skeletal Traction
• Traction achieved by gaining purchase on the outer table of
the skull with metal pins
• Pins inserted under local anesthesia
• General Anesthesia not used
• Crutchfield or Cone(Barton) or a Halo splint may be used
• 20-40lb(9.1 – 18.2kg)

111. Uses
• To reduce a fracture dislocation
• To maintain position of cervical spine before and
after operative fusion
• In cervical spondylosis with severe nerve root
compression

112. Aims of Skull Traction
• To avoid damage to the Cervical cord
• The restore the AP diameter of the Spinal Canal
• To obtain complete reduction of the dislocation or fracture dislocation
A decrease in the AP diameter of the spinal canal of less than 3 mm may be
accepted
• When sufficient reduction has been obtained
Do not increase the weight further
Extend the C spine by placing a small rolled towel or sand bag under the neck
( Not under the head as it will flex the c spine)

114. Crutchfield Tongs
• Fit into the Parietal bones
• Special drill point with a shoulder is used to enable an accurate depth of hole
to be drilled
• When fully opened the distance between the
tips should not be less than 10cm

115. Failure of the Procedure
• Crutchfield stated that failure may be due to several factors
Faulty instrument( when opened fully the distance b/w the points should be
11cm and certainly not less than 10cm)
Placing the drill holes too close together in the skull.
Insufficient penetration of the skull
Failure to keeps the Tongs tight

116. Cone(Barton) Tongs
• Designed by Barton
• Drill not required
• Threaded steel points are
screwed into the
parietal bones behind
the ears

117. Halo Splint(Ace Cervical Traction
Equipment)
• Oval Metal band available in different sizes which arches posteriorly to clear
the occiput and patient is able to rest his head comfortably
• Threaded holes at 2,4,6 and 8 O clock through which fixing pins are threaded
into the outer table of the skull
• Pins have sharp points and broad shoulders

118. Complications of Skull Traction
• May pull out
• Penetrate the Inner Table
• Fatal complications
Osteomyelitis of the skull
Extradural Hematoma
Extradural abscess
Subdural Abscess
Cerebral Abscess
If any of the above is suspected discontinue the traction and another method of
controlling the C spine substituted

119. Halo Body Orthosis
• Introduced in 1959 for the Mx of Paralytic deformities of the cervical and
thoracic spine
• Halo splint suspended from a jointed adjustable overhead frame incorporated
in a POP jacket
• Jacket extends from Shoulders to the iliac crests
• Purchase obtained by close Moulding of the Jacket around the Iliac crests
• Cumbersome

120. Halo Vest
• Padded polyethylene vest
• Two halves anterior and posterior strapped together over the shoulders and
around the lower chest
• Two metal uprights attached
to each half
• These are attached to
the Halo Splint after
optimum head position
has been obtained

121. Halo Pelvic Traction
• Halo Splint connected by 4 vertical spring loaded distraction rods to a steel
pelvic hoop
• Pelvic hoop is attached to two long threaded steel rods each of which passes
through one wing of the ilium
• Immobilize the Spine or to slowly correct or reduce the deformities of the
spine(Scoliosis and Tuberculosis) before spinal fusion is done
• Remains in place during the operation and for a variable time afterwards
• Patient ambulant
• Halo splint in this is similar one but doesn’t arch up posteriorly to clear the
occiput and instead it is drilled and tapped around it perimeter to accept
screws for the attachment of the distraction rods
• Under Endotracheal Anesthesia or Ketamine Hydrochloride

123. References
• Traction and Orthopaedic Appliances, 2nd Edition, John D.M
Stewart Jefferey P Hallet
• Rockwood and Green: Fractures in Adults,
6th edition, Lippincott, 2006
• Prosthetics, Orthosis and Traction, John Ebnezar