4.Lower Limb

8/22/2019 4.Lower Limb

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Lower-limbtraction


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Limb traction is useful for reducing and

immobilizing femoral shaft fractures supracondylar and intercondylar

fractures of the femur

condylar fractures of the upper end

of the tibia grossly infected or contaminated

fractures of the tibia

and severe fractures of the anklemortise with subluxation ordislocation or both


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Neglected dislocations of the hip and

kneegross deformities and displacements

due to traumatic, infectious

or rheumatoid conditions of the hipand knee

and deformities after poliomyelitis

can all be corrected by continuous

traction.


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Skin traction Technique

Sedate the patient (anaesthesia isunnecessary).

Clean the limb with soap and water, anddry it

Prepare the skin with an antisepticsolution, preferably methylated spirit,and let it dry

. If a commercial traction set (complete

with adhesive tapes, traction cords,spreader bar, and foam protection forthe malleoli) is not available, improvisethe apparatus as described below.


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Open a roll of adhesive strapping on a cleandry table and spread it with the adhesivesurface up. (Use a size appropriate to the size

of the patient; for an adult, a 7.5-cm wide, non-elastic tape is usually suitable.) For above-knee traction, measure a length of strappingthat is twice the length of the limb from thegreater trochanter to the sole of the foot . Addan extra 35 - 40 cm to accommodate thespreader and to leave enough space (10 - 15cm) between the sole and the spreader topermit movement at the ankle. For below-knee

traction, the length of strapping should bemeasured from the tibial condyles. For thetreatment of compound fractures, tractionshould be applied just distal to the site offracture and the strapping should be cut

accordingly.


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Place a square, wooden spreader of

approximately 7.5 cm (with a central

hole) in the middle of the length ofstrapping that you have spread on the

table.

Cut another length of strapping about 35-40 cm long and centre it on the spreader

with the adhesive surface down. The

spreader is now sandwiched between

the two strappings


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Holding the patients ankle and foot, pull the

limb steadily, elevating it from the bed.

Instruct an assistant to hold the spreaderwith a loop of strapping projecting 10 - 15

cm beyond the sole of the foot

Apply the strapping to the medial and lateralsides of the limb, still elevated and held in

moderate traction

Protect the malleoli, Achilles tendon

insertion, and the head and neck of the

fibula by placing strips of felt or cotton-wool

padding under the strapping at these sites


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For above-knee traction, the adhesive

strapping should extend proximally to

the groin on the medial side and to thegreater trochanter on the lateral side

To avoid causing deformity due to

external rotation, place the lateralstrapping slightly posterior, and the

medial strapping slightly anterior to the

mid-lateral and mid-medial lines,

respectively


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Ensure that the strapping lies flat on thesurface of the limb. Do nor cover the

anterior border of the tibia or encircle thelimb with strapping

Now apply a crepe or ordinary gauzebandage firmly over the strapping

beginning 2 - 5 cm proximal to the malleoli.Continue bandaging up the limb, over thestrappings, up to the groin (or asappropriate to the level of traction). Elevate

the end of the patients bed and attach atraction cord through the spreader with therequired weight . this should normally notexceed 5 kg


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Contraindications

Do not apply skin traction to a limb with

abrasions, lacerations, ulcers of the

skin, loss of sensation, impending

gangrene, atrophic skin, or peripheralvascular disease. Skin traction is also

contraindicated in the treatment of

marked overriding of fracture fragmentsor of gross, long-standing deformities


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Complications

Possible complications include allergic reaction

to the adhesive material (usually zinc oxide);blister formation or excoriation of the skin fromthe strapping slipping; pressure sores over themalleoli; and common peroneal nerve palsy.

Most of these complications can be avoided bycorrect application of the adhesive strapping.The most important cause of common peronealnerve palsy is lateral rotation of the limb,

resulting in compression of the nerve at theupper end of the fibula. Avoid this by keepingthe patients knee joint moderately flexed (up to10).


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Different kinds of skin traction

Bucks ExtensionAffection of the hip and femor


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Bryant traction

Affection of hip and femor below 3yrs

old


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Boot cast traction

For post poliomyelitis with residualparalyis of hip and knee


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Modified bucks extension traction

Affection of the hip and femor


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Pelvic girdle

For lumbo-sacral affection andherniated nucleus pulposus


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Hammock suspension traction

Affection of the pelvis and malgainedfracture


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Skeletal traction

Balanced skeletal tractionAffection of the hip and/or femur


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Ninety-ninety degrees traction

Subtrochanteric and proximal 3rd

fractue of femor


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Balance Skeletal Traction (BST)
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4.Lower Limb