DrVirgo
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What are the indications for Traction before surgery in case of a fracture?
eg. when is the answer to a fracture simply open reduction and internal fixation.
And in which of these cases do we need traction before it?
Thanks.
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| madoo
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traction before surgery ?? i read about trials show it good effect on reducing pain and to avoid malunion after surgery but r they going to ask about this
for closed reduction Vs ORIF hope this could help
as a general rule
>>> broken bones that are not badly displaced or angulated can be satisfactory aligned by external manipulationand could be immobilized in a cast "eg. most of colles fractures"
>>> if a fracture cant be aligned or severely diplaced or angulated it require ORIF
for example those of the femoral neck
Galeazzi fractures, Monteggia fracture :- the broken bone is fixed with ORIF while the dislocated one undergoes closed reduction
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| DrVirgo
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Thanks.
There was this question in UW:
A 37 year old man is brought to the ER immediately after being smashed in a hydraulic press at a local factory. He is alert and oriented. Despite 10mg of IV morphine given by the paramedics, he is crying with pain. his blood pressure is 110/70mm Hg, Pulse is 110/min, and Resp: 18/min. Apparently, his left humeral shaft is fractured adn the left arm is severely deformed being bent medially 90 degrees. Left radial artery pulse sensation and muscle strength in the left forearm are decreased compared to the right side. his right leg is shortened adn externally rotated. Deformity of the right thigh is noted. Pedal pulses are symmetric. He has pain in the left anterior chest on antero-posterior sternal compression, but breath sounds are normal. Physical exam otherwise shows no abnormalities. the paramedics have placed 2 peripheral IV lines and immobilized the fractured limbs. Which of the following is the most appropriate next step in management?
A. X-ray of the left arm, right leg and chest
B. Repeat 10mg morphine
C. Induction of general anesthesia for operative reduction of the fractures
D. Gentle traction of the left forearm to attempt alignment of the fragments of the humerus
E. Gentle traction of the right leg to attempt alignment of the fragments of the femur
Please explain..
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| madoo
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ops your qs become harder and harder
i don't think there is a big need to do any manipulation of these fractures before having x ray
ok he has many fracture including suspected pelvis fracture but why to skip x ray
,another morphine may lower his blood pressure
so i would answer A. X-ray of the left arm, right leg and chest
(even if his leg was adducted and internaly rotated which is posterior dislocation of the hip and it is an orthopedic emergency and emergency reduction is required but u get x ray first )
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| DrVirgo
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This was a hard one... Actually I though A too, but that was the wrong answer.
The right answer is D. Gentle traction of the left forearm to attempt alignment of the fragments of the humerus
Here is the explanation:
Neurologic deficit is not uncommon after humeral shaft fractures. Radial nerve injuries are most common. Most of them resolve spontaneously after a few monhts. Compression of the brachial artery could cause pulse asymmetry, not necessarily indicating serious vascular injury. An attempt to align the humerus should be made first. If successful it takes 30 sec and will, to some extent, restore the normal anatomy of the limb. It would decrease the patient's pain and discomfort. then, the pulses must be checked again.
Failure to perform the alignment easily indicates that muscles, nerves or vessels are entrapped in the fracture site. In such a case, operation is required.
A, B, C, E ARE correct, but D should be attempted FIRST.
Key to know:
Gentle traction to attempt alignment of the fragments of a fractured long bone is important to prevent further vascular and neurological damage and it should be attempted immediately.
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| madoo
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seems orthopedic is so tricky for usmle board exam
i think i have to study it from a another source
Edited by madoo on 10/28/07 - 07:29 PM
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| DrVirgo
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Don't worry, according to UW, very few people got this question right.
I'm still confused on when to do traction? What are the indications for it? This is NOT mentioned in Kaplan... Any ideas?
Thanks.
Edited by DrVirgo on 10/29/07 - 07:55 AM
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| madoo
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i am confused too
but for my own notes i will add this explanation as an indication for immediate traction
great q 
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