医药卫生骨科牵引

LOGOPrepared By:shuye yang Orthopaedic TractionOrthopaedic Traction1vTraction is the application of a pulling force to a part of the body 2Purpose:vto minimize muscle spasm;vto reduce,align,and immobilize fractures;vto reduce deformity;vto increase space between opposing surfaces3General ConsiderationsvSafe and dependable way of treating fractures for more than 100 yearsvBone reduced and held by soft tissuevLess risk infection at fracture sitevAllows more joint mobility than plaster4DisadvantagesvCostly in terms of hospital stayvHazards of prolonged bed restThromboembolismDecubitiPneumoniavRequires meticulous nursing carevCan develop contractures(挛缩挛缩)5HistoryvSkin traction used extensively in Civil War for fractured femursvKnown as the“American MethodvSkeletal traction by a pin through bone introduced by Steinmann and Kirschner6Beds And FramesvStandard bed has 4post traction framevIdeal bed for traction with multiple injuries is adjustable height with Bradford framevMattress moves separate from frame7Beds and FramesvBradford frame enables bedpan and linen changes without moving ptvAlternatively bed can be flexible to allow bending at hip or knee 中的中的 解释解释:【医】布莱德福氏架(大腿骨折和脊柱结核患者的床架)8KnotsvIdeal knots can be tied with one hand while holding weightvEasy to tie and untievOverhand loop knot will not slip9KnotsvA slip knot tightens under tensionvUp and over,down and over,up and through10Traction may be applied to vthe skin(skin traction)v directly to the bony skeleton(skeletal traction).11Skin Traction:indicationChild fracture of shaft of femurAdult epiphysis Fracturepelvic fracture no evident displaceChild joint contracture or adult light joint contracture 12Forearm Skin TractionAdhesive strip with Ace wrapUseful for elevation in any injuryCan treat difficult clavicle fractures with excellent cosmetic resultRisk is skin loss13Double Skin TractionUsed for greater tuberosity or prox humeral shaft fxArm abducted 30 degreesElbow flexed 90 degrees710 lbs on forearm57 lbs on armRisk of ischemia at antecubital fossa 14Dunlops TractionUsed for supracondylar and transcondylar fractures in childrenUsed when closed reduction difficult or traumaticForearm skin traction with weight on upper armElbow flexed 45 degrees 15Bucks TractionvOften used preoperatively for femoral fracturesvCan use tape or premade bootvNo more than 10 lbsvNot used to obtain or hold reduction16Split Russells TractionvBucks with slingvMay be used in more distal femur fx in childrenvCan be modified to hip and knee exerciser17Bryants TractionUseful for treatment femoral shaft fx in infant or small childCombines gallows traction and Bucks tractionRaise mattress for countertractionRarely,if ever used currently18announcementsNo damage,ulcer,inflammation,phlebeurysma,embolism on skin;23weeks;No more than 2 to 3 kg(4.5 to 8 lb)of traction can be used on an extremity,otherwise bubble will can be seen.Monitoring angle of traction,weigh,line of traction every day.Get out of the way of fibular head to protect the common peroneal nerve;Guide the patient to do functional exercise.19Skeletal Traction:vto treat fractures of the femur,the tibia,and the cervical spine.vThe traction is applied directly to the bone by use of a metal pin or wire 20Cervical skeletal tractionvUsed to treat the unstable spine(fx,dislocation,especialy SCI with dislocation)vPull along axis of spine vPreserves alignment and volume of canalvGardnerWells and Crutchfield tongs commonly usedSCI;spinal cord injury 颈脊髓损伤颈脊髓损伤21Gardner TongsvEasy to applyvPlace directly cephalad to external auditory meatusvIn line with mastoid processvJust clear top of earsvScrews applied with 30 lbs pressure22Gardner TongsPin site care importantWeight ranges from 5 lbs for cspine to about 20 lbs for lumbar spineExcessive manipulation with placement must be avoidedPoor placement can cause flex/ext forcesCan get occipital decubitus褥疮褥疮23Crutchfield TongsMust incise skin and drill cortex to placeRotate metal traction loop so touches skull in midsagittal planePlace directly above ext auditory meatusRisks similar to Gardner tongs24Olecranon Pin TractionDifficult supracondylar/distal humerus fxGreater traction forces allowedCan make angular and rotational correctionsPlace pin 1.25 inches distal to tipAvoid ulnar nerve3 cm2 cm25Lateral Olecranon TractionUsed for humeral fracturesArm held in moderate abductionForearm in skin tractionExcessive weight will distract fracture26Metacarpal Pin TractionvUsed for obtaining difficult reduction forearm/distal radius fxvOnce reduction obtained,pins can be incorporated in castvPin placed radial to ulnar through base 2nd/3rd MCvStiffness intrinsics common279090 TractionUseful for subtroch and proximal 3rd femur fxEspecially in young childrenMatches flexion of proximal fragmentCan cause flexion contracture in adult28Femoral Traction PinMust avoid suprapatellar pouch,NV structures,and growth plate in childrenPlace just proximal to adductor tubercle along midcoronal planeAt level proximal pole patella in extended position29Distal Femoral TractionAlignment of traction along axis of femurUsed for superior force acetabular fx and femoral shaft fxUsed when strong force needed or knee pathology present30Proximal Tibial TractionUsed for distal 2/3rd femoral shaft fxFemoral pin allows rotational momentsEasy to avoid joint and growth plate1 inch distal and posterior to tibial tubercle1cm3cm31Distal Tibial TractionUseful in certain tibial plateau fxPin inserted 1.25 inches proximal to tip medial malleolusAvoid saphenous veinPlace through fibula to avoid peroneal nerveMaintain partial hip and knee flexion32Calcaneal TractionTemporary traction for tibial shaft fx or calcaneal fxInsert about 1.5 inches inferior and posterior to medial malleolusDo not skewer subtalar joint or NV bundleMaintain slight elevation leg33LOGOSpecial tractionSpecial traction34Head Halter tractionvSimple type cervical tractionvManagement of neck painvWeight should not exceed 5 lbs initiallyvCan only be used a few hours at a time头颈部系带牵引1lbs=0.45kg35Outpatient head halter tractionvUsed to train neck pain and radicular symptoms from cervical disc diseasevDevice hooks over doorvFace door to add flexionvUse about 30 min per dayvWeight 1020 lbs神经根病症1lbs=0.45kg36Halo Ring TractionvDirection of traction force can be controlledvNo movement between skull and fixation pinsvAllows the pt out of bed while traction maintainedvUsed for cspine or tspine fx37Halo Ring TractionRing with threaded holesAllow 11.5 cm clearance around headPlace below equatorSpacer discs used to position ringCentral anterior and 2 most posterior38Halo Ring TractionvTwo anterior pins Placed in frontal bone grooveSup and lat to supraorbital ridgevTwo posterior pinsPlaced posterior and superior to external earvTighten pins to 56 inchpounds with screwdriver39Halo TractionvTraction pull more anterior for extensionvMore posterior for flexion40Halo VestMajor use of halo traction is combine with body jacketAllows pt out of bedCan use plaster jacket or plastic,sheepskin lined jacket41Halo VestPin site infection a riskCan remove pins and place in different holePin penetration can produce CSF leakScars over eyebrowsCan get sores beneath vest4243。