Traction and Orthopedic Apliances

'•

Traction and Orthopaedic Appli?nces JOHN D.l\1.. STE\\' ART !>.ti\ (CantJb}, FRCS (EngbnJ} Cousull2111 01 thop•cdic Surgeon, Chid;cs1cr, a!'ld \Vunhinc Dis1ric1 Group~ of llospiub.

JEFFREY P. HALLETT MA (Oxon), FRCS (England) Consult3nt OnJ1opacdic Surgeon, ·rhe lpswii.:h flospiuls

SECOND EDITION

I> D t> c::J c::J c::J

[:]c::JD C=7

CHlJRClllLL LIVINGSTONE EDINBURGH LONDON i\1.ELBOURNE AND NE\V YORK 1983

CHURCHILL LIVINGSTONE Medical Divhion or Longman Group Limi1cd Dimibu1cd in 1he United States of America by Churchill Livincstone Inc., 1560 Broadway, New Yor~ , N .Y. 10036, and by auociatcd companies, branches and aprcsentalivcs 1hrou ghout the world. ~ Lo n~m1n

Grou p UmiicJ 1975, 19!1)

All r ichu reserved. No pm of 1his publication m2y be

reproduced, Slored in a retrieval sysiem, or transmiued in any form or by any means, electronic, mechanical, phoiocopying, recording or oiherwise, without the prior permission of 1he publishers (Churchill Livini;>1onc, Rober! Stevenson llouse, 1·3 Burcr's Place, Lcilh 'l'allt, Edinburgh EH I JAF). First edi tion 1975 Second cc.Jilion 1983 Reprinted 1985 IS BN 0 443 0200-I 3

\

Brirish Library Cataloguing in Publirnion Dara Srewan, John D.M. T raction and ort hopaedic applianccs.- 2nd ed l. Orthopedic appar>1 us I. Title II. ..hlle11, Jdfay P. 6 17'}07 R075,S Library of Congress Caulo,ing in Publica1ion Sicwan , John D .M . Traction and onhopaedie a ppliances. Includes bibliographics a.nd index. I. Orthopedic trac1ion. 2. O n hopcdic appuatus. I. Hallett, Jerrrcy P. 11. Title. (ONLM: I. Onhopcdic equipment. 2. Tract ion. WE 26 S849t) RDH6.T7S7l 198) 617'.) 82-9632 Produced by Longman G roup (Fl!) Ltd Printed in Hong Kong

o..u

Contents

I Tr:ic1ion

2 The Thomas's and F isk splints 3 l'ixcd lr:ic tion 4 Sliding tr:iction 5 Suspens ion of :ippli:inccs 6 Spin:il tr;iction 7 Spliming for congcni1:.1l disloc:u ion oft he hip 8 M :in:igcmcnt ofp:iticnrs in tr:iction 9 Prescrip tion of on hoses 10 Spinal orthoscs 11 Lower limb orthoscs 12 Footwear 13 Splinting and casting m :ucrials J.1 l'laster-of·l'aris cas1:; 15 Function al bracing 16 External skclc:tal fixation 17 Wallcing aids 18 Crutch walking 19 Tourniquets Appcndi': I Append ix 2 Index

I

13 18

26 56 71

92 105 11!!

129 151 171

195 205

2 15 235 246 259 269 287 293

303

. .,

.. ·.

. . ~

..

:

Preface to the Second Edition This book is still intended for 1he use of junior doclors and the 01hi:r staff of orthopaedic and traun1a wards and clinics, who are conc~rned in the d:iy lo day fflar;agement of p:nients. 1'hc new techniques which have becon1c popular in the treatment of fractures, trac1ion in the n1anage1nent of fractures of the upper lintb, the prescription of on hoses and the new 1crminology used in l}l(:ir description, a!i well as the n1any new casting materials which have been developed, have be-en described. In addition the previous clt:3ptcrs on ltfa11agen1e11r of JJarienls in 'fn1c1ivn and 1'ourniquets have ln:cn completely rewritccn. ~ wish to thank the n1my people who have assisted us in 1he prcpar:.uion of 1hls edition, in particular 1'1.r G. L. \V. Bonney for his help with the: ch:Jptc:r on Tourniquets; /viiss J. Thonu.s and A1.rs A. Stickland for their instruccivc criticisn1 of the chapter on Af.a11agem~11l of Patie11ts in Trac1it111; A1r J. Florence for his assistance with the .unravelling of the tangled v,,•cb of Orthoric lerminology ;i:nd the prescription of orthosc:s; A1.r P. Sh;iw for shOwi.ng us how surgical fool \Year is n1ade; and fin;dly the n1any n1anufacturer ~d distributors of the splinting and casting matt:rialS discussed in Chapter

J.D.M.S., J.P.H.

Bognor Rcgis,_ 1983

-

-

Preface to the First Edition This book is written primarily for the use of orthopaedic house surgeons and junior registrars, and of the ,nursing and physiotherapy. staff of accidenr and orthopaedic wards. Many of the procedures and appliances described here are in common us:ige. The details, however, of hoW to carry out these procedures, 1heir contra· indications and complications, and how to check the various applicances, are nor available in the standard textbooks. This book is intended to rectify thb: ontlssion and co be a practical source of instruction in these matters. I wish to ihank chc many people who htcd me in the preparation of 1his book, in particular Mr W. H. Tuck,. without whose considerable guidance the chapters on Spinal Supporu, Lower Li1nb Bracing and Footwear would h:ive been incomplete; Dr J. D.- G. Troup for his help with the section on the biomechanics of the spine; Mr F. G. St C. Strange and Mr G. R. Fisk who have kindly helped me in rhc description of their methods of applying traction to the lower 1irnb; a.nd to the staff of the Physiotherapy Department of che Royal National Orthopaedic Hospi1al for rheir assistance with the chapters on \~'alking r\ids .and Crutch \Valking. I also wish to e>cprcss n1y gratitude co Professor R. G. Burwell who advised me on the original scrip!, to 1\1.r J. Cr;nvford Adan1s \Vho read the final drafl, and to Dr R. R. Mason for his careful re.axi mum tracrion weight which can be :applied with skin traction is I Sib (6 . 7kg)..

.

Two methods of applying skin trac1ion arc commonly used.

Adhesive skin tractio11 Adhesive s1r:1pping wh ich can be strelched only 1r:insvcrscly is usc