骨科牵引.ppt
LOGO1Orthopaedic TractionCompany Logo2vTraction is the application of a pulling force to a part of the body Company Logo3Purpose:v to minimize muscle spasm;v to reduce,align,and immobilize fractures;v to reduce deformity;v to increase space between opposing surfacesCompany Logo4General 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 plasterCompany Logo5DisadvantagesvCostly in terms of hospital stayvHazards of prolonged bed rest Thromboembolism Decubiti PneumoniavRequires meticulous nursing carevCan develop contractures(挛缩挛缩)Company Logo6HistoryvSkin traction used extensively in Civil War for fractured femursvKnown as the“American Method”vSkeletal traction by a pin through bone introduced by Steinmann and KirschnerCompany Logo7Beds And Framesv Standard bed has 4-post traction framev Ideal bed for traction with multiple injuries is adjustable height with Bradford framev Mattress moves separate from frameCompany Logo8Beds and Framesv Bradford frame enables bedpan and linen changes without moving ptv Alternatively 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)Company Logo9Knotsv Ideal knots can be tied with one hand while holding weightv Easy to tie and untiev Overhand loop knot will not slipCompany Logo10Knotsv A slip knot tightens under tensionv Up and over,down and over,up and throughCompany Logo11Traction may be applied to vthe skin(skin traction)v directly to the bony skeleton(skeletal traction).Company Logo12Skin Traction:indicationChild fracture of shaft of femurAdult epiphysis Fracturepelvic fracture no evident displaceChild joint contracture or adult light joint contracture Company Logo13Forearm Skin TractionAdhesive strip with Ace wrapUseful for elevation in any injuryCan treat difficult clavicle fractures with excellent cosmetic resultRisk is skin lossCompany Logo14Double Skin TractionUsed for greater tuberosity or prox humeral shaft fxArm abducted 30 degreesElbow flexed 90 degrees7-10 lbs on forearm5-7 lbs on armRisk of ischemia at antecubital fossa Company Logo15Dunlops TractionUsed for supracondylar and transcondylar fractures in childrenUsed when closed reduction difficult or traumaticForearm skin traction with weight on upper armElbow flexed 45 degrees Company Logo16Bucks Tractionv Often used preoperatively for femoral fracturesv Can use tape or pre-made bootv No more than 10 lbsv Not used to obtain or hold reductionCompany Logo17Split Russells Tractionv Bucks with slingv May be used in more distal femur fx in childrenv Can be modified to hip and knee exerciserCompany Logo18Bryants TractionUseful for treatment femoral shaft fx in infant or small childCombines gallows traction and Bucks tractionRaise mattress for countertractionRarely,if ever used currentlyCompany Logo19announcementsNo damage,ulcer,inflammation,phlebeurysma,embolism on skin;2-3weeks;No more than 2 to 3 kg(4.5 to 8 lb)of tra-ction 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.Company Logo20Skeletal 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 Company Logo21Cervical skeletal tractionv Used to treat the unstable spine(fx,dislocation,especialy SCI with dislocation)v Pull along axis of spine v Preserves alignment and volume of canalv Gardner-Wells and Crutchfield tongs commonly usedSCI;spinal cord injury 颈脊髓损伤颈脊髓损伤Company Logo22Gardner Tongsv Easy to applyv Place directly cephalad to external auditory meatusv In line with mastoid processv Just clear top of earsv Screws applied with 30 lbs pressureCompany Logo23Gardner TongsPin site care importantWeight ranges from 5 lbs for c-spine 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）Company Logo24Crutchfield 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 tongsCompany Logo25Olecranon Pin TractionDifficult supracondylar/distal humerus fxGreater traction forces allowedCan make angular and rotational correctionsPlace pin 1.25 inches distal to tipAvoid ulnar nerve3 cm2 cmCompany Logo26Lateral Olecranon TractionUsed for humeral fracturesArm held in moderate abductionForearm in skin tractionExcessive weight will distract fractureCompany Logo27Metacarpal Pin Tractionv Used for obtaining difficult reduction forearm/distal radius fxv Once reduction obtained,pins can be incorporated in castv Pin placed radial to ulnar through base 2nd/3rd MCv Stiffness intrinsics commonCompany Logo2890-90
