Define Traction & Immobilisation. Describe its types and complications.

Definition & Purposes

Traction is the application of a sustained pulling force to a limb or the spine to reduce and hold a fracture or dislocation, overcome muscle spasm, relieve pain, and prevent or correct deformity. Immobilisation (by plaster casts, splints or braces) holds a part still to allow healing. Both are fundamental conservative tools in orthopaedics.

Types of Traction

Skin traction applies the force through adhesive strapping over the skin and is limited to light loads for short periods (e.g. Buck’s traction for a hip fracture pre-op; Bryant’s (gallows) traction for a young child’s femoral fracture). Skeletal traction applies the force directly to bone through a metal pin (e.g. A Steinmann pin through the proximal tibia or calcaneus), allowing heavier, longer-term traction. Traction may be fixed (against a fixed point, e.g. A Thomas splint) or balanced/sliding (using weights and pulleys).

Casts, Splints & Their Principles

Plaster (or synthetic) casts immobilise a fracture, usually spanning the joint above and below. Principles: apply well-moulded but not too tight; elevate the limb; and watch for complications. A fresh injury may be put in a backslab / split cast to allow for swelling. Splints (e.g. Thomas splint for a femoral fracture) provide support and traction, particularly for transport.

Complications

Traction: skin damage/pressure sores and neurovascular compromise (skin traction), pin-site infection and loosening (skeletal traction), joint stiffness, and the general complications of prolonged bed rest (chest infection, DVT, pressure sores). Casts: tightness (compartment syndrome), pressure sores, joint stiffness, and ‘cast disease’ (stiffness, wasting and osteoporosis from prolonged immobilisation).

Principles of Effective Traction

For traction to work safely it must obey a few principles: there must be an adequate counter-traction (often the patient’s own body weight, achieved by elevating the foot of the bed) to oppose the pull, the line and magnitude of pull must be appropriate to reduce and hold the fracture without over-distraction, and the apparatus (ropes, pulleys and weights) must run freely and hang clear of the floor. The limb’s neurovascular status and the pin or skin sites are checked regularly, and traction is increasingly a temporary or transport measure in modern practice, with most fractures that once needed weeks of traction now treated by early internal or external fixation to allow mobilisation.

Skin traction is limited to about 5 kg to avoid skin damage.

• Traction = sustained pull to reduce/hold fractures, overcome spasm, relieve pain, correct deformity.
• Skin traction (through skin; light, short; Buck’s/Bryant’s) vs skeletal (pin in bone; heavier, longer).
• Fixed (Thomas splint) vs balanced/sliding traction; Bryant’s only for young children.
• Casts immobilise (span joint above & below); use a backslab for fresh swelling.
• Watch for tight-cast compartment syndrome/pressure sores & pin-site infection; split a tight cast at once.