8kAN1'S 1kAC1ICN

8ryanLs LracLlon ls malnly used ln young chlldren who have fracLures of Lhe femur or congenlLal
abnormallLles of Lhe hlp
1
8oLh Lhe paLlenLs llmbs are suspended ln Lhe alr verLlcally aL a nlneLy degree
angle from Lhe hlps and knees sllghLly flexed Cver a perlod of days Lhe hlps are gradually moved
ouLward from Lhe body uslng a pulley sysLem

88?An1'S 18AC1lCn
MILWAUkLL 8kACL
1he M||waukee brace also known as a cervlcoLhoracolumbosacral orLhosls or C1LSC ls a back brace
used ln Lhe LreaLmenL of splnal curvaLures (such as scollosls or kyphosls) ln chlldren lL ls a fullLorso
brace LhaL exLends from Lhe pelvls Lo Lhe base of Lhe skull lL was orlglnally deslgned by 8lounL and
SchmldL ln 1946 for posLoperaLlve care when surgery requlred long perlods of lmmoblllzaLlon

MILWAUkLL 8kACL
a|o LracLlon ls a way of keeplng your head and neck sLlll whlle you geL beLLer afLer an accldenL or
operaLlon Lo your neck bones 1hls wlll usually always be used ln adulLs wlLh broken necks lf surgery ls
noL performed lmmedlaLely posL ln[ury lf surgery goes ahead and ls successful posL ln[ury Lhen Lheres
usually no furLher need for halo LracLlon lf surgery ls ruled ouL Lhen Lhe halo LracLlon wlll be used for up
Lo Lwo monLhs on bed resL and Lhen a furLher monLh Lo Lhree monLhs aLLached Lo a speclally made vesL
so Lhe head ls kepL perfecLly sLlll whllsL slLLlng


PALC 18AC1lCn

Thomas Splint Traction
O Hugh Owen Thomas introduced his splint which he called "The Knee Appliance" in 1875
O The method oI Hugh Owen Thomas uses Iixed traction with the counter traction being
applied against the perineum by the ring oI the splint
O This is in contrast to other methods using weight traction which is countered by the
weight oI the body
O ackward angulation oI the distal Iragment can never be corrected by traction in the axis
oI the Iemur which only results in elongation with persistence oI the deIormity
O A Thomas splint and Iixed traction is only capable oI maintaining a reduction previously
achieved by manipulation
O The use oI supports enables correction oI angulation caused by muscle tension
O !lacement oI a large pad behind the lower Iragment acts as a Iulcrum over which
backward angulation is then corrected by the traction Iorce
O The pad should be 6" in width, 9" long and 2" thick, applied transversely across the splint
under the distal Iragment and popliteal Iossa
O t is the splint which controls alignment and not the traction
O The tension in the apparatus should only be that suIIicient to balance resting muscle tone
O $uspension oI the splint using an overhead beam enables the splint to move easily with
the patient when they move in bed
O ts use in combination with a !earson Knee-Ilexion piece enables mobilisation oI the
knee, while maintaining traction, alignment and splinting oI the Iracture

THOMA$ $!T TRACTO

amilton Russell Traction
O $ling under the distal 1/3 oI the thigh provides upward liIt, as well as longitudinal
traction in the line oI the tibia
O The sling under the distal Iragment controls posterior angulation and the liIting Iorce is
related to the main traction Iorce through the medium oI pullies
O o rigid splinting is used in this method
O Combines a means oI suspending the lower extremity and a means oI applying traction in
the axis oI the Iemur
O Many other varieties oI both skeletal and skin traction result in a similar eIIect
uck Traction
O uck introduced simple horizontal traction in 1861
O Traction is analogous to !ugh's traction only the inclination oI the bed is replaced by the
application oI weights over a pulley

&CK TRACTO




raun Frame
O This is merely a cradle Ior the limb
O isadvantage is that the position oI the pulleys cannot be altered and the size oI the splint
oIten does not Iit the limb as might be wished
O ateral bowing is common as the splint and the distal Iragment are Iixed to the Irame,
while the patient and the proximal Iragment can move sideways leaving the Irame behind

RA& FRAME


!erkins Traction
O Here no splinting is used at all
O The posterior angulation oI the thigh is controlled by a pillow
O The alignment and Iixation depend entirely on the action oI continuous traction


- Traction
O The thigh is suspended in the vertical plane by weight traction pulling vertically upwards
O The ill eIIect oI gravity as the cause oI backward angulation oI the Iragments is thus
eliminated

- TRACTION
Charnley
O $trongly recommends the use oI a K !O! incorporating the $teinmann or enham pin
in the upper end, in order to reduce pressure on the soIt structures around the knee
O eneIits oI !O!/Traction unit (Charnley) :
4 Foot supported at right angles to the tibia
4 Common peroneal nerve and calI muscles protected Irom pressure against the
slings oI the splint and the splint itselI
4 The tibia is suspended Irom the skeletal pin inside the !O!, so that an air space
develops under the tibia as the calI muscles loose their bulk
4 External rotation oI the Ioot and distal Iragments is controlled
4 The tendo achilles is protected Irom pressure sores
4 ComIort; The patient is unaware oI the traction when applied through the medium
oI a nail

CERVICAL S!INE RACE
A cervlcal splne brace and LracLlon devlce lncorporaLes a forwardly open head and [aw brace whlch ls
ad[usLably supporLed verLlcally above a forwardly collar member 1he brace and Lhe collar member have
cooperaLlng laLeral wall secLlons havlng maLlng arcuaLe surfaces LhaL are [uxLaposed and whlch lnclude
lnLerengaglng means LhaL assure Lhey remaln preclsely angularly allgned wlLh each oLher whlle Lhe
verLlcal spaclng beLween Lhem ls belng changed SupporL of Lhe brace and ad[usLmenL ls by palrs of
laLerally exLendlng brackeLs whlch lnLerconnecL wlLh roLaLable rod mechanlsms LhaL carry coaxlal rlghL
handed and lefLhanded lead screw surfaces A mlLer gear afflxed Lo each rod ln a cenLral locaLlon maLes
wlLh a cooperaLlve mlLer gear afflxed Lo a horlzonLal shafL LhaL carrles a sLarwheel aL one end whlch
permlLs smooLh and accuraLe paLlenL ad[usLmenL

CERVCA $!E RACE

Cast Types
A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease muscle
contractions, and are eIIective at providing immobilization, especially aIter surgery.

Casts immobilize the joint above and the joint below the area that is to be kept straight and
without motion. For example, a child with a Iorearm Iracture will have a long arm cast to
immobilize the wrist and elbow joints.
The outside, or hard part oI the cast, is made Irom two diIIerent kinds oI casting materials.
O plaster - white in color.
O 1iberglass - comes in a variety oI colors, patterns, and designs.
Cotton and other synthetic materials are used to line the inside oI the cast to make it soIt and to
provide padding around bony areas, such as the wrist or elbow.

$pecial waterprooI cast liners may be used under a Iiberglass cast, allowing the child to get the
cast wet. Consult your child's physician Ior special cast care instructions Ior this type oI cast.

DIFFERENT TY!ES OF CASTS

elow is a description oI the various types oI casts, the location oI the body they are applied, and
their general Iunction.

Type o1
Cast
Location Uses
Short arm
cast:
Applied below the
elbow to the hand.
Forearm or wrist Iractures. Also used to hold the Iorearm
or wrist muscles and tendons in place aIter surgery.
Long arm
cast:
Applied Irom the
upper arm to the hand.
&pper arm, elbow, or Iorearm Iractures. Also used to
hold the arm or elbow muscles and tendons in place aIter
surgery.
Arm
cylinder
cast:
Applied Irom the
upper arm to the wrist.
To hold the elbow muscles and tendons in place aIter a
dislocation or surgery.
llustrations oI arm casts, 3 types






Type o1
Cast
Location Uses
Shoulder
spica cast:
Applied around the trunk
oI the body to the
shoulder, arm, and hand.
$houlder dislocations or aIter surgery on the shoulder
area.
Minerva
cast:
Applied around the neck
and trunk oI the body.
AIter surgery on the neck or upper back area.
Short leg
cast:
Applied to the area below
the knee to the Ioot.
ower leg Iractures, severe ankle sprains/strains, or
Iractures. Also used to hold the leg or Ioot muscles
and tendons in place aIter surgery to allow healing.
Leg
cylinder
cast:
Applied Irom the upper
thigh to the ankle.
Knee, or lower leg Iractures, knee dislocations, or
aIter surgery on the leg or knee area.
llustrations oI leg casts, 3 types



MERVA CA$T

Type o1 Cast Location Uses
Unilateral hip
spica cast:
Applied Irom the chest to the Ioot on one
leg.
Thigh Iractures. Also used to hold
the hip or thigh muscles and
tendons in place aIter surgery to
allow healing.
One and one-
hal1 hip spica
cast:
Applied Irom the chest to the Ioot on one
leg to the knee oI the other leg. A bar is
placed between both legs to keep the hips
and legs immobilized.
Thigh Iracture. Also used to hold
the hip or thigh muscles and
tendons in place aIter surgery to
allow healing.
ilateral long
leg hip spica
cast:
Applied Irom the chest to the Ieet. A bar is
placed between both legs to keep the hips
and legs immobilized.
!elvis, hip, or thigh Iractures.
Also used to hold the hip or thigh
muscles and tendons in place aIter
surgery to allow healing.




llustrations oI hip spica casts, 3 types






Type o1 Cast Location Uses
Short leg hip
spica cast:
Applied Irom the chest to the
thighs or knees.
To hold the hip muscles and tendons in place
aIter surgery to allow healing.

llustration oI child wearing a short leg hip spica cast









llustration oI child wearing abduction boots


Type o1 Cast Location Uses
Abduction boot cast: Applied Irom the upper
thighs to the Ieet. A bar
is placed between both
legs to keep the hips and
legs immobilized.
To hold the hip muscles
and tendons in place
aIter surgery to allow
healing.