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Conservative Treatment of Fractures BY DR. TARIF AL-AKHRAS Objectives • Traction: – Methods. Types – Indications / contraindications – Complications • Casting: – Types – Indications / contraindications – Complications TRACTION IN ORTHOPEDICs TRACTION • Traction treatment involves the use of puling force to a part of the body to overcome muscle spasm, shortening and some time the effect of gravity TRACTION • As well as acting on limbs, traction can be applied to the pelvis and spine. TRACTION • By controlling movement of the injured part, traction enables bone and soft tissue to heal and can be used as a method of treatment. TRACTION It is used for : • Restoring and maintaining of bone alignment following fracture. • Resting inflamed joint and maintaining them in functional position. • Gradually correcting deformity due to contracted soft tissue. • Relieving pain due to muscle spasm. TRACTION TYPE OF TRACTION : 1. Manual traction 2. Skin traction 3. Skeletal traction 4. Traction by gravity TRACTION • Manual traction Exerted directly when the physician pulls on the part during manipulation to obtain closed reduction of a fracture or dislocation. TRACTION SKIN TRACTION UTTILIZED • In children • In temporary management in adult ( femoral fracture or dislocation ) TRACTION Contraindication to skin traction • Diseases predisposing skin to damage and poor healing (DM, varicose ulcers and use steroid drug). • Any wounds, sores or rash in the area where traction to be applied. • Marked swelling in the area. • A history of hypersensitive skin. • Any suspicion of circulation problem. TRACTION Advantages of skin traction • • Easy to apply No hazard of bone infection or epiphyseal plate injury http://www.narang.com/ TRACTION Different type of skin traction Foam traction/ TRACTION Different type of skin traction http://www.complete-healthcare.co.uk/ TRACTION Different type of skin traction www.harzomedequip.com fixed traction Cervical skin traction http://www.complete-healthcare.co.uk/ TRACTION Skeletal traction Achieved by inserting Kirschner wire or Steinman pin directly into the bone TRACTION TRACTION The most commonly used sites for pin insertion are : • • • • • Upper tibia Femoral condyle Calcaneum Olecranon Skull TRACTION Complication of skletal traction • Infection: TRACTION predisposing factor • Poor insertion technique • Loosening of the pin • Tension of the skin and subcutaneous tissues leading to ncrosis traction • Over distraction of the bone fragments • Nerve damage: can result from the use of heavy traction forces • Breaking of the pins or wire •Plaster of Paris Plaster of Paris • POP was first used in orthopedics by Mathysen, a Dutch surgeon in 1852 • It commercially available since 1931 Plaster of Paris its chemical formula (CaSO4)2H2O+3H2O Hemihydrated calcium sulfate 2(CaSO4×H2O)+heat Hydrated calcium Sulfate ( plaster of Paris) (gypsum) Plaster of Paris It used in four form • • • • Slab Cast Spica Functional cast brace Plaster of Paris Slab • It is a temporary splint made up of half by POP and half by bandage roll. • Used in the initial stages of fracture treatment, during first aid and to immobilize the limbs postoperatively Plaster of Paris Cast • The POP roll completely encircles the limb. • It is used as definitive form of fracture treatment and also to correct deformity. Plaster of Paris Spica This is encircles apart of the body, e.g. thumb spica hip spica http://www.aafp.org/ Plaster of Paris Rules of application of POP Choose the correct size of the roll. A joint above and joint below should be included. The joint should be immobilized in functional postoins. The plaster should not be too tight or too loose Complications off Plaster of Paris Due to tight fit • Pain • Pressure sore • Compartmental syndrome • Peripheral nerve injury Complications off Plaster of Paris Due to improper aplication Joint stifnes Blisters and sores breakage Due to plaster allergy • Allergic dermatitis Plaster of Paris Plaster of Paris http://www.stanfordchildrens.org/ www.stanfordchildrens.or Fiber glass cast • Advantage The materials are strong, light weight, cool , water resistant and radiolucent • Disadvantage expensive, sharp edge Fiber glass cast Fiber glass cast