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PrinciplesofTractionmethods

Department of Orthopaedic Surgery - University Stellenbosch, South Africa


General Principles Page Next Page >>

1. Femur traction
2. Cervical spine
Skin versus Skeletal Traction
traction The skin can only take about 5kg traction in an adult. If more than this
3. Dunlop Traction force is required to obtain on maintain a reduction Skeletal traction
4. Femur fractures must be used. Avoid skeletal traction in children - growth plates can
5. Site map easily be damaged by skeletal pins.
Indications for Skin Traction
• Children
• Temporary traction - only a few days e.g. Preoperative
• Small force required to maintain reduction <5 kg

Fragile or delicate skin


In the elderly or patients with allergy to Elastoplast (Zinc)
hypoallergenic skin traction bandages are available.
Contraindications to Skin Traction
• Force required > 5kg
• Skin damage or sepsis in area

Indications Skeletal Traction


• Adults requiring > 5kg traction
• Skin damage requiring dressings
• Long term

Counter Traction
Any force needs an opposing force. If traction pulls a limb distally the
patient will slide downwards towards the pulley, and the traction will
not be effective. Provide an opposing force by raising the foot of the
bed on blocks. By sloping the bed in the other direction the tendency to
slide will be opposed. In Cervical traction thefront end of the bed needs
raising, and with Dunlop traction the side of the bed near the injury
needs elevation.

Multiple Pulley Systems


In many situations multiple pulleys are used, so that less weights are
necessary. Multiple pulleys are commonly used in pelvic traction where
high forces (commonly up to 40 kg) may be needed.
If a triple and double block were used as
in the picture only 40/5 or 8 kg. would
be required to generate the 40 kg. lift
Multiple pulleys
decrease the force needed.
needed at the end rope
FemoralTraction
Department of Orthopaedic Surgery - University Stellenbosch, South Africa

Femoral Traction page Next Page >>


1. Principles of
traction
2. Cervical spine
Skin Traction - Lower Extremity
traction Buck's skin traction is widely used in the lower limb
3. Dunlop Traction for femoral fractures, lower backache, acetabular
4. Femur fractures and hip fractures. Skin traction rarely reduces a
5. Site map fracture, but reduces pain and maintains length in
fractures.
Method
The skin is prepared and shaved -it must be
dry. Friar's balsam may be used to improve
adhesion. The commercially available strapping is
applied to the skin and wound on with an
overlapping layer of bandage. The bandage should
not extend above the level of the fracture.
Dangers of Skin Traction
• Distal Oedema
• Vascular obstruction
• Peroneal nerve palsy
• Skin Necrosis over bony
prominence's
Avoid complications resist the
temptation of trying to
improve adhesion by
wrapping the bandages more
tightly. If the tapes slip rather
use skeletal traction if
possible (not a child)

Gallows Traction
This is used in infants and children with femoral
fractures.
Indications Gallows Traction
• Child must weigh less than 12 kg
• Femoral fractures
• Skin must be intact
Both the fractured and the well femur
are placed in skin traction and the
infant is suspended by these from a
special frame. Vascular compromise is
the biggest danger. Check the
circulation twice daily. The buttocks
should be just off the bed.

Slings of flannel 150mm wide are


positioned
Skin down the length of the
Thomas
tractionsplint. The Master sling "Inner Under
shouldin be
a just distal to the fracture, Outer Over"
allowing
Site
Thomas the proximal
for prox. fragment
tibial Denham pinto2.5 cm Thomas Traction -Adult
for counter-
reduce
inferior underdistal
Splint.
and gravity.
to tibial tubercle Click to see annotated
torque
larger image
CervicalTraction
Department of Orthopaedic Surgery - University Stellenbosch, South Africa
Cervical Traction Next Page >>

1. Traction principles
2. Femur traction
3. Dunlop Traction
Halter Traction
4. Femur fractures Halter traction is used for short term cervical traction. Uses include
5. Site map minor neck injuries without obvious fractures e.g. Whiplash injury,
neck muscle spasm, conservative treatment of cervical disk lesions.
Children with cervical fractures can also be treated without skeletal pins
as their skull is too fragile to withstand pins.

Problems with
Halter Traction
• Uncomfortable
• Tempero-
mandibular pain
• Contraindicated in mandible fractures
• Difficult to control flexion - extension
Flexion Extension cervical X-rays
If a patient has normal cervical X-rays, but has neck muscle
spasm Flexion Extension views may be needed to exclude serious
instability of the cervical spine. Halter traction is a good way to relieve
the spasm before these X Rays can be done. The patient is admitted and
placed in Halter traction until the neck is free of muscular spasm. Under
direct supervision of the attending doctor the flexion extension views
are taken in the X ray department. The patient must have no pain when
the neck is flexed and extended. If neurological symptoms such as
parasthesia develop the X rays are abandoned.

Skull Traction
In more serious cervical injuries skull tongs such as Cones calipers are
indicated. Indications include the conservative treatment of cervical
fractures and dislocations.
Application of Cones Calipers
• Shave the hair above the ear region
• Local anaesthetic
• Avoid masseter
• Avoid Temporal artery
• Small incision above ear in line with auditory meatus
• Screw in pin until it just perforates outer table skull
• Tie on rope
• Attach weights
Direction and Weights
• Force - 2.5 kg for head and
1/2 kg for each vertebra* Crutchfield tongs:
Allow the patient to be
• Direction Neutral In line with easily turned, as the
caliper sits high on the
Auditory meatus skull. Consider these in
• Position to apply the Cone's Caliper Flexion needed - raise pulley a paralized patient.
pins - in line with auditory meatus
• Extension needed - use double mattress
ending @ shoulders
*(Each uninvolved vertebra cephalad)
Complications of Cervical Traction
• Bleeding - temporal artery
• Pressure sore on skull - avoid downwards vector to rope
• Sepsis - from skin to subdural abscess
• Worsening neurological status
• Squint from 6th cranial nerve fallout

Contraindications Skull Tongs


• Children
• Local sepsis
• Skull fracture
The double mattress method is an effective way to extend the neck.
Never place the head pulley too low as a pressure sore can result on the
occiput, especially in the unconscious or neurologically compromised
patient.
At Tygerberg Hospital the Cone's calipers are commonly used. The
Crutchfield tongs are another caliper that fit higher on the skull vault
and allow easier turning of the paralised patient.

Reduction of Facet dislocations


Skeletal traction to the skull can be used to reduce cervical facet
dislocationsWeights are serially added while the neck is positioned in
flexion After each 2.5kg weight is added a
lateral X ray is taken to determine
reduction. The attending doctor checks for
neurological signs. If neurology deteriorates
the weights are removed. Up to 20 kg.
traction may be used in this way for a few
hours only. After reduction the neck is placed in extension and the
lighter maintenance weights are used.
OtherTractionMethods
Department of Orthopaedic Surgery - University Stellenbosch, South Africa

Other Traction Methods <<To Index

1. Traction principles
2. Femur traction
3. Cervical Traction
Dunlop Traction
4. Femur fractures The main use of Dunlop's traction is in the maintenance of reduction in
5. Site map supracondyar fractures of the humerus in children.
Dunlop Traction
• Supracondyar fractures in children
• Allows swollen elbow to settle
• Contraindicated in open fractures and skin defects

Skin traction is placed on the forearm and A special frame used on the side
of the bed.
Traction is placed along the axis of the forearm as well as at right angles to
the humerus by means of a broad sling placed around the upper arm. Bed
blocks are required on the lateral side (fracture side up) of the bed.

If a supracondyar
fracture cannot be
reduced to over 90
degrees elbow flexion,
this method of traction
is an alternative to
invasive methods such
as a percutaneous K-
wires. It allows swelling to subside. Do
not rely on this method to reduce a supra
condylar fracture, a manipulation will still be required!
Pelvic traction for Backache
In sciatica and other backaches relief from pain can be obtained by means
of pelvic traction. Traction is applied to a pelvic harness with weights over
the end of the bed.

An alternative in Sciatica is the 90-90


position. By means of cushions under
the knees, the hips are flexed near 90 degrees, as well as the knees. This
shortens the sciatic nerve and relieves pain.

Acetabular Traction
In conservative treatment of acetabular fractures longitudinal traction in
the long axis of the limb is often used. In addition the head of the femur
can be disimpacted from the acetetabulum ( central fracture dislocations)
by means of manipulation under anesthesia. The reduction is maintained
by means of lateral traction from pins paced in intertrochanteric

region.
Lateral Traction for an acetabular fracture

<< Go Home
Cranial nerves are nerves that emerge directly from the brain, in contrast to spinal nerves which
emerge from segments of the spinal cord. In humans, there are 12 pairs of cranial nerves. Only
the first and the second pair emerge from the cerebrum, the remaining 10 pairs emerge from
the brainstem.


[edit]Cranial nerves in non-human vertebrates
Human cranial nerves are nerves evolutionarily homologous to those found in many
other vertebrates. Cranial nerves XI and XII evolved in the common ancestor to amniotes (non-
amphibian tetrapods) thus totaling twelve pairs. These characters are synapomorphies for their
respective clades. In some primitive cartilaginous fishes, such as the spiny dogfish or mud shark
(Squalus acanthias), there is a terminal nerve numbered zero (as it exits the brain before the
traditionally designated first cranial nerve).

[edit]List of cranial nerves


Sensory,
Origi
# Name Motor Nuclei Function
n
or Both
olfactory
trigone,
Cranial nerve
medial
zero(CN0 is
olfactory New research indicates CN0 may play a role in the detection of
not
0 Sensory gyrus, pheromones [2][3] Linked to olfactory system in human embryo
traditionally
and lami
recognized.)
na
[1]
terminali
s
Anterior
Olfactory Purely Transmits the sense of smell; Located in olfactory foramina in
I olfactory
nerve Sensory theCribriform plate of ethmoid
nucleus
Ganglio
Purely
II Optic nerve n cells of Transmits visual information to the brain; Located in optic canal
Sensory
retina[5]
Oculom
otor Innervates levator palpebrae superioris, superior rectus, medial
Oculomotor Mainly Midb nucleus, rectus, inferior rectus, and inferior oblique, which collectively
III
nerve Motor rain Edinger- perform most eye movements; Also innervates m. sphincter pupi
Westphal Located in superior orbital fissure
nucleus
Innervates the superior oblique muscle, which depresses, rotates
Trochlear Mainly Midb Trochlea
IV laterally (around the optic axis), and intorts the eyeball; Located
nerve Motor rain r nucleus
insuperior orbital fissure
Principal
sensory
trigemin
al
nucleus,
Spinal
trigemin
Both Receives sensation from the face and innervates the muscles of
al
Trigeminal Sensory mastication; Located in superior orbital fissure (ophthalmic nerv
V Pons nucleus,
nerve and V1), foramen rotundum (maxillary nerve - V2), and foramen
Mesence
Motor ovale(mandibular nerve - V3)
phalic
trigemin
al
nucleus,
Trigemin
al motor
nucleus
Poste
rior
Abducens Mainly margi Abducen Innervates the lateral rectus, which abducts the eye; Located
VI
nerve Motor n s nucleus insuperior orbital fissure
of Po
ns
Pons(
cereb Facial
Provides motor innervation to the muscles of facial expression,
ellop nucleus,
Both posterior belly of the digastric muscle, and stapedius muscle, rec
ontin Solitary
Sensory the special sense of taste from the anterior 2/3 of the tongue, and
VII Facial nerve e nucleus,
and provides secretomotor innervation to the salivary glands (except
angle Superior
Motor parotid) and the lacrimal gland; Located and runs through intern
) salivary
acoustic canal to facial canal and exits atstylomastoid foramen
above nucleus
olive
Later
al to
Vestibulococh
CN
lear Vestibul
VII Senses sound, rotation and gravity (essential for balance &
nerve (or audi ar
Mostly (cere movement). More specifically. the vestibular branch carries imp
VIII tory- nuclei,C
sensory bello for equilibrium and the cochlear branch carries impulses for hea
vestibular ochlear
ponti Located in internal acoustic canal
nerveor statoa nuclei
ne
coustic nerve)
angle
)
Nucleus
ambiguu Receives taste from the posterior 1/3 of the tongue, provides
Both
s,Inferior secretomotor innervation to the parotid gland, and provides moto
Glossopharyn Sensory Medu
IX salivary innervation to the stylopharyngeus. Some sensation is also relay
geal nerve and lla
nucleus, the brain from the palatine tonsils. Sensation is relayed to oppos
Motor
Solitary thalamus and some hypothalamic nuclei. Located injugular foram
nucleus
X Vagus nerve Both Poste Nucleus Supplies branchiomotor innervation to most laryngeal and all
Sensory rolate ambiguu pharyngeal muscles (except the stylopharyngeus, which is innerv
s,Dorsal by the glossopharyngeal); provides parasympatheticfibers to nea
ral
motor all thoracic and abdominal viscera down to thesplenic flexure; an
sulcu
and vagal receives the special sense of taste from the epiglottis. A major
s
Motor nucleus, function: controls muscles for voice and resonance and the soft
ofMe
Solitary palate. Symptoms of damage: dysphagia(swallowing
dulla
nucleus problems), velopharyngeal insufficiency. Located injugular fora
Accessory Crani Nucleus
nerve(or crani al ambiguu
Controls sternocleidomastoid and trapezius muscles, overlaps w
al accessory Mainly and s,Spinal
XI functions of the vagus. Examples of symptoms of damage: inabi
nerveor spinal Motor Spina accessor
to shrug, weak head movement; Located in jugular foramen
accessory l y
nerve) Roots nucleus
Provides motor innervation to the muscles of the tongue (except
Hypoglo
Hypoglossal Mainly Medu the palatoglossus, which is innervated by the vagus) and other gl
XII ssal
nerve Motor lla muscles. Important for swallowing (bolus formation) and speech
nucleus
articulation. Located in hypoglossal canal

Some of the major cranial nerves and their ganglia and fiber connections

[edit]Mnemonic devices
Main article: List of mnemonics for the cranial nerves

As the list is important to keep in mind during the examination of the nervous system, there are
many mnemonic devices in circulation to help remember the names and order of the cranial
nerves. Because the mind recalls rhymes well, the best mnemonics often use rhyming schemes.
Two of the best known examples are, "Oh, Oh, Oh To Take A Family Vacation! Go Vegas After
Hours!", or "On Old Olympus' Towering Top, A Finn And German Viewed A Hop". Others are more
explicit, for example: "On the Occasion Of Party The Attractive Faces Are Girl Visitors, Say Hello".
Its also "OOOPTAFAGV SH" A very useful way of remembering which nerve is motor and which is
sensory use, "Some Say Marry Money But My Brother Says Big Boobs Matter More". Although
many exist from many sources, for
example OLd OPi.e. OCcasionally TRies TRIGonometry AndFeels VEry GLOomy, VAGUe, And H
YPOactive.[6]

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