NGWETE MGENI ORTHO OSCE REVISION
1. SKELETAL TRACTION
a.) Identify instruments
Steinmann pin; rigid stainless steel pins 4-6mm diameter usually attached to Bohler stirrup which
allows direction of traction to be varied without turning pin.
Denham pin; same as
Steinmann except short threaded length
in centre which engages the bony cortex
and reduces the risk of the pin sliding
hence used in cancellous bone like
calcaneum and osteoporotic bones.
Kirschner wire; same as Steinmann but
have smaller diameters. Easy to insert
and minimize the chance of soft tissue
damage & infections. Also easily cuts
bone if heavy traction weight is applied.
Commonly used in upper limb e.g.
olecranon traction
b.) What else is required in insertion of
skeletal traction – traction weights//
hand drill or bone hammer// bandages//
iodine or spirit//cotton wool pads//
stirrups
c.) Purpose of traction
To retain normal length and alignment of involved bone
To reduce and immobilize a fracture bone
To relieve or eliminate muscle spasm
To relieve pressure on nerves
To prevent or reduce skeletal deformities or muscle contractures
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,d.) Describe the process of skeletal traction
Explain procedure, seek consent and prepare equipment » Use GA or LA » Paint the skin with iodine
and spirit » Mount the pin/wire on the hand drill/use a bone hammer
Hold the limb in same degree of lateral rotation as the normal limb and with ankle at right angles
Identify the site of insertion and make a stab wound using a scalpel
Hold the pin horizontally at right angles to the long axis of the limb and push it inwards through the
bone
Apply small cotton woolen pads soaked in tincture around the pins to seal the wound
The pin should pass only through skin, SC tissue and bone avoiding muscles and tendons
Attach the stirrup/cords and hang the weight to a right angle balance
Thank and advise patient on care for site
e.) How do you calculate weight to be put on traction
One tenth of body weight.
f.) Landmarks of skeletal traction
Upper tibia- 2cm distal and posterior to tibia tubercle; used for # of distal 2/3rd femoral shaft
Lower femoral-
Lower tibia- 5cm proximal to tip of medical malleolus, midway between anterior and
posterior border of tibia (to avoid saphenous) also placed through fibula (to avoid peroneal
nerve); used for tibia plateau #s
Calcaneus-2cm below and behind lateral malleoli; used for #s of calcaneal and tibia shaft ✓.
Medial malleolar to calcaneous 2/3
Olecranon-k wire is inserted 2.5/3 cm distal, Perpendicular to longitudinal axis of ulnar from
medial to lateral, to avoid ulnar nerve indication supracondylar and distal humerus fracture
Metarcarpal-
Skull traction-
g.) What are the indications for skeletal traction
• Weight more than 5kgs
• External fixation in place
• Skin traction contraindicated
• To maintain reduction of a fracture until the fragments are stable e.g. # shaft of femur
• To correct deformity due to muscle spasms e.g. skin traction in treatment of early stages of
arthritis of hip
• To immobilized an inflamed joint e.g. septic or tuberculosis knee
• To reduce cervical fracture dislocations in cervical traction through the skull
h.) What are the disadvantages of traction –
Costly in terms of hospital stay
Hazards of prolonged bed rest (DVT/Thromboembolism, Pneumonia)
Requires continuous nursing care
Can lead to development of contractures.
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, i.) Complications of skeletal traction –
Local
1. Pressure sores to skin on bony prominences and soft tissues, i.e, Achilles' tendon, coccyx,
malleoli and over the tendon calcaneus, thomas splint ring
2. Common peroneal nerve palsy
3. Impairment of circulation and skin erythema.
4. Compartment syndrome
5. Tape and bandage slippage causing pressure to achilles and around head of fibula
6. Allergic reactions to the adhesive and tape allergies
7. Excoration of the skin from slipping of the adhesive strapping (abrasion of the epidermis)
8. Introduction of infection into the bone.
9. Incorrect placement of the pin or wire.
10. Distraction at the fracture site as large traction forces can be applied through skeletal
traction.
11. Ligamentous damage if a large traction force is applied through a joint for a
prolonged period of time.
12. Damage to epiphyseal growth plates when used in children
13. Soft tissue injury
Depressed scar
SYSTEMIC
- GI- Constipation, Impaction and difficult to evacuate feces can occur as the result of immobility
and the lack of exercise that is needed to promote normal bowel functioning.
- GUT- Urinary retention, stasis, renal calculi, incontinence, UTIs
- Integumentary system- Skin breakdown, pressure ulcers, poor skin turgor, skin abrasions/ulcer,
skin allergy
- Musculoskeletal- Lack of weight bearing activity can lead to disuse osteoporosis, hypercalcemia,
and fractures.
o The joints are affected with stiffness, pain, impaired range of motion and contractures
including foot drop which is a plantar flexion contracture.
o Muscles are adversely affected with weakness and atrophy as the result of immobility.
- Respiratory- Thickening of respiratory secretions
The pooling of respiratory secretions and an increased inability of the client to mobilize
and expectorate these secretions, all of which can lead to: Atelectasis, Hypostatic
pneumonia, and Respiratory tract infections.
o Immobility can also lead to shallow, ineffective respirations, decreased respiratory
movement, and a decrease in terms of the client's vital capacity.
- Psychological- Apathy, Isolation, Frustration, A lowered mood, depression.
- Circulatory- Venous stasis, venous dilation, decreased BP, edema, embolus formation,
thrombophlebitis, Orthostatic hypotension,
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1. SKELETAL TRACTION
a.) Identify instruments
Steinmann pin; rigid stainless steel pins 4-6mm diameter usually attached to Bohler stirrup which
allows direction of traction to be varied without turning pin.
Denham pin; same as
Steinmann except short threaded length
in centre which engages the bony cortex
and reduces the risk of the pin sliding
hence used in cancellous bone like
calcaneum and osteoporotic bones.
Kirschner wire; same as Steinmann but
have smaller diameters. Easy to insert
and minimize the chance of soft tissue
damage & infections. Also easily cuts
bone if heavy traction weight is applied.
Commonly used in upper limb e.g.
olecranon traction
b.) What else is required in insertion of
skeletal traction – traction weights//
hand drill or bone hammer// bandages//
iodine or spirit//cotton wool pads//
stirrups
c.) Purpose of traction
To retain normal length and alignment of involved bone
To reduce and immobilize a fracture bone
To relieve or eliminate muscle spasm
To relieve pressure on nerves
To prevent or reduce skeletal deformities or muscle contractures
1|Page
,d.) Describe the process of skeletal traction
Explain procedure, seek consent and prepare equipment » Use GA or LA » Paint the skin with iodine
and spirit » Mount the pin/wire on the hand drill/use a bone hammer
Hold the limb in same degree of lateral rotation as the normal limb and with ankle at right angles
Identify the site of insertion and make a stab wound using a scalpel
Hold the pin horizontally at right angles to the long axis of the limb and push it inwards through the
bone
Apply small cotton woolen pads soaked in tincture around the pins to seal the wound
The pin should pass only through skin, SC tissue and bone avoiding muscles and tendons
Attach the stirrup/cords and hang the weight to a right angle balance
Thank and advise patient on care for site
e.) How do you calculate weight to be put on traction
One tenth of body weight.
f.) Landmarks of skeletal traction
Upper tibia- 2cm distal and posterior to tibia tubercle; used for # of distal 2/3rd femoral shaft
Lower femoral-
Lower tibia- 5cm proximal to tip of medical malleolus, midway between anterior and
posterior border of tibia (to avoid saphenous) also placed through fibula (to avoid peroneal
nerve); used for tibia plateau #s
Calcaneus-2cm below and behind lateral malleoli; used for #s of calcaneal and tibia shaft ✓.
Medial malleolar to calcaneous 2/3
Olecranon-k wire is inserted 2.5/3 cm distal, Perpendicular to longitudinal axis of ulnar from
medial to lateral, to avoid ulnar nerve indication supracondylar and distal humerus fracture
Metarcarpal-
Skull traction-
g.) What are the indications for skeletal traction
• Weight more than 5kgs
• External fixation in place
• Skin traction contraindicated
• To maintain reduction of a fracture until the fragments are stable e.g. # shaft of femur
• To correct deformity due to muscle spasms e.g. skin traction in treatment of early stages of
arthritis of hip
• To immobilized an inflamed joint e.g. septic or tuberculosis knee
• To reduce cervical fracture dislocations in cervical traction through the skull
h.) What are the disadvantages of traction –
Costly in terms of hospital stay
Hazards of prolonged bed rest (DVT/Thromboembolism, Pneumonia)
Requires continuous nursing care
Can lead to development of contractures.
2|Page
, i.) Complications of skeletal traction –
Local
1. Pressure sores to skin on bony prominences and soft tissues, i.e, Achilles' tendon, coccyx,
malleoli and over the tendon calcaneus, thomas splint ring
2. Common peroneal nerve palsy
3. Impairment of circulation and skin erythema.
4. Compartment syndrome
5. Tape and bandage slippage causing pressure to achilles and around head of fibula
6. Allergic reactions to the adhesive and tape allergies
7. Excoration of the skin from slipping of the adhesive strapping (abrasion of the epidermis)
8. Introduction of infection into the bone.
9. Incorrect placement of the pin or wire.
10. Distraction at the fracture site as large traction forces can be applied through skeletal
traction.
11. Ligamentous damage if a large traction force is applied through a joint for a
prolonged period of time.
12. Damage to epiphyseal growth plates when used in children
13. Soft tissue injury
Depressed scar
SYSTEMIC
- GI- Constipation, Impaction and difficult to evacuate feces can occur as the result of immobility
and the lack of exercise that is needed to promote normal bowel functioning.
- GUT- Urinary retention, stasis, renal calculi, incontinence, UTIs
- Integumentary system- Skin breakdown, pressure ulcers, poor skin turgor, skin abrasions/ulcer,
skin allergy
- Musculoskeletal- Lack of weight bearing activity can lead to disuse osteoporosis, hypercalcemia,
and fractures.
o The joints are affected with stiffness, pain, impaired range of motion and contractures
including foot drop which is a plantar flexion contracture.
o Muscles are adversely affected with weakness and atrophy as the result of immobility.
- Respiratory- Thickening of respiratory secretions
The pooling of respiratory secretions and an increased inability of the client to mobilize
and expectorate these secretions, all of which can lead to: Atelectasis, Hypostatic
pneumonia, and Respiratory tract infections.
o Immobility can also lead to shallow, ineffective respirations, decreased respiratory
movement, and a decrease in terms of the client's vital capacity.
- Psychological- Apathy, Isolation, Frustration, A lowered mood, depression.
- Circulatory- Venous stasis, venous dilation, decreased BP, edema, embolus formation,
thrombophlebitis, Orthostatic hypotension,
3|Page
