General Rules for Fracture Treatment and Traction for the Orthopedic Technologist
Third-Place Article, 2015 Paper of the Year Competition
by BreAnne Bibeau OTC, CMA
The general idea of early fracture management is to provide pain relief and place the bone in a position in which it can heal properly. These steps will optimize the conditions for fracture union and minimize potential complications. It’s always the goal to get the patient back the function that they had before the injury.
For hundreds of years, traction has been used for management of fractures and dislocations that may or may not be able to be treated with casting. With the advancement of orthopedic technology and operative techniques, traction is rarely used for full term fracture management. It is used to wait for swelling or other conditions to dissipate before surgery can be performed. Or it can be used to help realign and maintain the fracture alignment while splinting or casting.
There are two types of traction: skin traction and skeletal traction.
An example of skin traction would be finger traps, hanging from an IV pole with ten pounds of weight hanging over the upper arm. This works best for distal radius fractures. I perform this in clinic often.
An example of skeletal traction is using a Steinmann pin, which are placed in the bone distal from the fracture. Weights should then be applied to this pin, and the patient is placed in an apparatus to facilitate traction. A femur fracture would be something that could benefit from Steinmann pin.
If the fracture in question is displaced, shortened, or angulated, a closed reduction should be attempted. Using skin traction often makes this easier to achieve. A closed reduction is a vital role for the orthopedic technologist to know and practice. Doing this and padding appropriately will minimize potential skin issues. Applying traction to the long axis of the injured limb and then reversing the mechanism of injury/fracture is the best way to do this. Once a closed reduction done, use plaster or a fiberglass splint to immobilize and then mold the splint to reduce the bone (plaster typically molds best). Usually splinting is done in these cases, as there may be some swelling in the upcoming days.
A closed reduction is contraindicated when these conditions are presented:
1.It is an un-displaced fracture.
2. If displacement exists, but is not necessary to fix for the functional outcome (ex. most humeral shaft fractures).
3. If reduction is impossible; it may have the ability to achieve the reduction, but it immediately or soon after cannot be maintained. Surgical fixation is the best option for these types of patients.
Some closed reduction tricks and tips will be a great way to have success. Make sure the patient can relax enough so a closed reduction can be performed. The ten-pound weight is often successful with this, as it exhausts the muscles quickly. Always make sure you immobilize the joint above and below the fracture. Remember, the goal is to correct and restore length, rotation, and angulation of the fracture. A three point contact mold is necessary for this to be successful. This will provide the best outcome.
A saying often used in the office is “crooked casts make strait bones”. Splints commonly used with fractures are “Bulky” Jones, Sugar-tong, Coaptation, Ulnar gutter, Volar / Dorsal hand, Thumb spica, Posterior slab (ankle) +/- U splint.
The timetable for follow-up visits will vary, depending on the nature of the injury. All patients must be monitored closely for potential complications. At the time of discharge, after the initial care of the fracture, the patient should be made aware of all the follow-up requirements specified by the treating physician.
At the end of the day, the orthopedic technologist plays a vital role in helping the patient heal. An orthopedic technologist is there to place the bone back in the correct position, help the patient gain confidence to work on range of motion, and lets the patient know they can still do things while recovering from an injury. Be proud and confident in what you do. The patient will mirror that attitude and it will make for a great recovery!
About the Author:
BreAnne Bibeau is a Orthopaedic Technologist as well as a Certified Medical Assistant. She started her career in sports medicine in 2007, moving on to the surgery portion of Orthopaedics in 2009, and now has settled into specifically casting. She is an active member of the NAOT, and AAMA. She plans to continue writing articles on the specifics of casting in Orthopaedics. She enjoys teaching others about Orthopaedic Technology and spends a lot of time teaching residents and students from the University of Minnesota.