Application of plaster can provide a satisfactory method of external fixation. Plaster cast must be well fitted. Immobilization of the injured part is achieved by including the joints above cussions have been made in detail about plaster immobilization in the corresponding chapter.
IMMOBILIZATION BY TRACTION
Advantages: Traction is applied to prevent the recurrence of deformity at the fractured site. The pull on the distal fragment maintains the alignment. This is especially useful in long bone fractures, e.g., femur. In these cases, plaster casts do not provide satisfactory immobilization and alignment. There are Surgical or orthopedic implants importer across the world. Implants are used in surgery by surgeons.
Disadvantages: Prolonged immobilization in bed is required during the period of traction. Improper nursing care may produce bed sores and chest complications. Children are more difficult to manage while in traction.
Types of Traction
Traction can be applied by skin or through the bone. The latter is called skeletal traction.
Following precautions are undertaken while performing the skin traction.
- Shaving: Shave the skin of the affected limb. In children this is not necessary.
- Application of adhesive tape: While traction is maintained on the fractured part during the process of reduction, the adhesive tapes are applied to both sides of the limb in longitudinal directions. The U-shaped turn beyond the end of the limb should have some space for applying traction. Crepe bandage is then gently wrapped round the limb over the adhesive tape.
- Bony prominence: The bony prominences over the malleoli and head of the fibula must be protected by cotton pads.
Complications of Skin Traction
Following complications may arise due to application of skin traction.
- Skin lesions: Blister formation and necrosis of the skin under the adhesive tape can develop. Regular checkup is essential.
- Venous and arterial insufficiency: This may develop due to tightening of the bandage. In extreme cases gangrene can also develop. This is more likely to happen amongst the children being treated by Gallow’s traction for fracture of the femur.
- Nervous lesion: Lateral popliteal nerve palsy is likely to develop due to pressure near the head of the fibula.
Skeletal traction is an effective means of immobilization. This technique is used to overcome the muscular spasm in fracture of the long bones, unstable fractures and in fracture dislocations. This technique is commonly used when simple plaster immobilization fails to achieve the purpose, e.g., in fracture of the cervical spine.
GENERAL TECHNIQUE OF SKELETAL TRACTION
Tibial Traction: This is commonest type of traction used in general practice and is therefore described in detail.
- Local cleansing: The area is shaved and cleaned with antiseptic solution.
- Local anesthesia: A point behind the tibial tubercle is selected. The future site of pin entrance and emergence is infiltrated with local anesthesia solution.
- Stab incision: A small stab incision is made over the anaesthetized area with the point of the blade.
- Insertion of pin: Steinmann pin mounted on the “T” handle is hammered through the bone. This can also be introduced by screwing motion of the handle. It emerges under the skin on the opposite side. A small stab wound is made over the skin where the emerging pin makes an elevation under the skin. The pin is pushed to the opposite side to the desired length.
- Fixation of bone: Small gauze pieces are wrapped round the skin on both sides of the pin to protect the wounds. The stirrup is fixed with screws over the pin. Implants and instrument are provided orthopaedic instrument exporter.
- Application of cork: The projected ends of the pin are covered by insertion of ordinary corks. This is a protective device from the sharp pi ends.
- Precautions: The pin must not enter the joint space or damage the epiphyseal plates in growing age. Adjoining nerves and vessels must be away from the site of the pin tract. Lateral popliteal nerve is likely to be injured if the proper site is not selected.