What is the difference between skeletal and skin traction

To be an effective traction the traction should act on the deformity and not the whole body. To counter the effect on the whole body we need another force that acts in opposite direction. Let us understand this with an example. Suppose that there is a fracture of shaft of the femur bone. Shaft femur fracture would produce a deformity because of the pull of the muscles and broken bone. To straighten it one requires to put a pulling force distal to the fracture site.

Let us say on holds the foot and pulls the limb so as to correct the deformity. Some of the deformity would be corrected but the force of the pull would also pull the body towards the person who is pulling. We need to cancel this force to avoid dragging of the body. Let us say that another person is holding the shoulders of the person and is able to resist the drag exerted by pull.

If he exerts a force equal to the pull, there would be two forces that would act on body and body would not move. At the same time, both the forces would also be exerted on the fracture and therefore correction of the deformity results. If there is no resistance when you would result in pulling of a person toward you.

However if a person holds him from the elbow, all your force is transferred to forearm only. This is another example of traction and countertraction forces,. In orthopedic practice,countertraction may be obtained by altering the angle of the body-weight force in relation to the pull of traction, such as by elevating the foot of the bed with blocks to enable body weight to act as a counter force.

Pain management in both groups included paracetamol and if required pethidine. In cases where the proximal fragment was prominent anteriorly under the skin, weights were gradually increased in steps of 0. When the patient could actively lift the arm off the pillow, usually 14 to 18 days after the injury, traction was removed, the elbow was rested in a sling and the patient was discharged.

No supervised physiotherapy was advised, however, active mobilization of the elbow was encouraged. The primary outcome measures were varus deformity and range of movement in the elbow, while secondary one were the length of hospital stay, incidence of myositis ossificans, neurovascular complications and pin infection rate.

All patients were reviewed at follow-up, which ranged between 3 and 6 months average, 3. The flexion and hyperextension were measured with a goniometer placed on the lateral aspect of the elbow and centered over the lateral epicondyle of the humerus. The carrying angle was measured with a goniometer placed on the anterior aspect of the upper limb with the elbow in extension and the forearm in supination.

The axis of the goniometer was placed over the center of the cubital fossa, its proximal arm aligned with the humeral shaft and its distal arm lying on a line from the center of the antecubital fossa to the center of the wrist.

Neurovascular deficit was assessed clinically. All children had followed-up radiographs to assess union, however due to an inadequate radiographic technique, the Bauman angle could not be assessed in a reliable way. Data collected on the designed form included age, sex, side and the final outcome measures enlisted above Table 1. The rate of nerve injury at presentation was 4. All nerves injuries recovered. Three patients had no radial pulse at the beginning which returned within 24 hours; there was no compartment syndrome in our series.

When comparing both treatment groups, cubitus varus was noted in 7. In the skin traction group there were no blisters caused by adhesive tapes, however in 3 children the traction had to be reapplied because of loosening the tapes. Table 3 Graded results of treatment of displaced supracondylar fracture of the humerus by skin or skeletal traction. This is the test for any method of treatment.

In our study cubitus varus deformity was noted in 7. Secondly, compared with traction, percutaneous pinning reduces considerably both the length of hospital stay and cost of treatment9. In a high-technical setting, some authors consider traction as the first choice treatment for children with humeral supracondylar fracture present after a delay of few days with a grossly swollen elbow6,10,15 and for supracondylar comminution3, Although in a high-technical support setting percutaneous pinning is the first treatment choice for most displaced supracondylar fractures, in a low-technical setting this option is not feasible due to the lack of image intensifiers and orthopaedic expertise.

One of feasible options in this setting is skeletal traction that can be applied as an olecranon pin 6,15,16 or a winged screw to the ulna3,4, 5, 7. Interestingly, two studies compared the results of overhead skeletal traction with sidearm traction indicating distinctly better results after overhead skeletal traction than sidearm traction13, Pirone et al.

Young et al. In a recent review of current treatment of humeral supracondylar fractures, it was concluded that unstable fractures can be treated with either traction or percutaneous pinning with satisfactory results, if done well Similar results were obtained by Piggot et al20 while better outcome with only 2. Furthermore in our study, all children in straight-arm skin traction with poor results were older than 10 years, thus suggesting that for children younger than 10 years, this was a good treatment option.

Likewise, other authors achieved good results without varus deformity with straight-arm lateral skin traction 8,21,22, Although percutaneous pinning reduced the prevalence of cubitus varus and vascular complications, it is associated with complications, including nerve injury, deformity, elbow stiffness, and pin infection that range from 1.

Iatrogenic nerve injury following percutaneous pinning was reported in 2. One of the limitations of this study was a relatively high proportion of patients lost in follow-up, Another constraint was the 3-month-short follow-up period, which might have possibly negatively affected the functional results of the treatment, as it has been shown in other studies8,23 that flexion limitation returns to normal in moths for the majority of children, especially in children less than 10 years of age.

Although we did radiological assessment, we did not show results of Bauman angle because we thought like other authors 21 that the angle changes with the rotation of the arm, and with non-perfect technique it is unreliable. In a low-technical setting, elevated, straight-arm skin traction is a good treatment option for displaced humeral supracondylar fractures. It does not only yield results comparable to percutaneous pinning in specialized centers, but also has several advantages, such as relatively easy application, no need for high-technical equipment, specialist orthopaedic surgeon, an operating theatre and general anaesthesia.

Although in our study the overhead skeletal traction group did not differ significantly from skin traction group with regards to the prevalence of varus deformity, it showed slightly inferior functional results.

Original Article A Comparison of Skin vs. Keywords children, displaced supracondylar fracture of the humerus, skeletal traction, skin traction, treatment outcome. Citation J Kuzma. Abstract Background: Although current literature supports percutaneous pinning for displaced supracondylar fractures of the humerus as a preferable treatment option, this is not easily applicable in a low-technical setting.

Inclusion criteria The study included all consecutive patients admitted to the orthopaedic units with the radiological diagnosis of displaced Gartland type II and III supracondylar fracture of the humerus. Exclusion criteria The exclusion criteria were: type I undisplaced or open, or flexion type supracondylar fractures, intrarticular fractures, associated the affected limb fractures, any visceral or head injury, or any previous treatment at a hospital elsewhere for the same injury.

With the considerable advances in the discovery of newer orthopaedic implants such as intramedullary nails, locked plates, most adult patients with femoral shaft fractures are being treated early surgically. Most of these femoral shaft fractures occurred as a result of a road traffic accident.

This finding confirms the fact that the major risk-takers on our roads are the male gender. This study had shown that the application of skin traction resulted in a decrease in pain intensity on the Visual Analogue Scale VAS from 7 in most patients to 1 or 2 after admission.

In both study groups, pain reduced from 7 to 1 in most patients. Post-operatively pain had been consistently 1 on VAS after 8 hours, 16 hours and 24 hours. This finding is consistent with a study done by Alireza Manafi Rasi et al. Shortening is frequently observed due to the pull of the hamstrings and quadriceps muscles which act as deforming forces after a fracture. In proximal fractures in the subtrochanteric region , the proximal segment is typically flexed, abducted, and externally rotated by the muscular pull of the hip abductors, external rotators, and iliopsoas 5.

Shortening before traction in the study population with femoral shaft fracture was between 1cm and 5 cm. Shortening before surgery in the skin traction group revealed that, 30 patients had a residual shortening of 1cm while 12 patients had residual shortening of 2 cm before surgery.

In the skeletal traction group, 37 patients had residual shortening of 1cm before surgery, and only seven patient had 2 cm residual shortening before surgery. This finding did not translate into increase blood transfusion requirement and is consistent with a study done by Kajja et al. In this study, there was no single demonstrable skin allergy to plaster in the skin traction group while in the Skeletal traction group, 10 Pre-operative skin traction can be considered a suitable and cost-effective method of maintaining alignment and pain relief in adult femoral shaft fractures.

National Center for Biotechnology Information , U. Journal List Ghana Med J v. Ghana Med J. Author information Copyright and License information Disclaimer. Corresponding author: Daniel Yao Dodzie Agbley moc. Summary Objectives This study is to compare the outcomes of pre-operative skeletal and skin traction in adult femoral shaft fractures awaiting surgical fixation within two weeks of presentation to the Accident Center of Korle Bu Teaching Hospital.

Methods This study was a clinical trial on 86 recruited patients with closed femoral shaft fractures sustained within 24 hours of presentation grouped into 2 groups. Conclusion This study has shown that both Skeletal traction and Skin traction were equally effective in controlling pre-operative pain in adult patients with femoral shaft fractures and does not affect intra-operative blood loss and post-operative management. Funding Personal Funding.

Introduction Fractures of the femoral shaft are among the most common fractures that orthopaedic surgeons encounter in Korle-Bu Teaching Hospital. Methods Patient selection and Data source In this prospective randomized study, assuming a medium effect size 0. Assessment Group A: Patients had skin traction applied at the Accident Center with an adhesive plaster on the skin of the thigh and the leg, wrapped around with bandage.

Table 1 Demographic data of the participant in the study. Open in a separate window. Table 2 Outcomes of interventions.

Table 3 Comparison of the mean VAS of patients in two group in the different time points. Table 4 Complications of interventions. Discussion Femoral shaft fractures in adults are reasonably common and can occur in isolation or in association with other injuries. References 1. Korle Bu Teaching Hospital, author. Annual Report. J Am Acad Orthop Surg. Pre-operative skeletal versus cutaneous traction for femoral shaft fractures treated within 24 hours.

J Orthop Trauma. Skeletal versus skin traction before definitive management of pediatric femur fractures: a comparison of patient narcotic requirements. J Pediatr Orthop. Parker M, Handoll H. Pre-operative traction for fractures of the proximal femur in adults. Cochrane Database of Syst Rev.