Rehabilitation during conservative treatment of a femoral neck fracture

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Skeletal traction for a tibia fracture helps restore the correct position of the fragments for their successful fusion or fixation through surgery. At the moment, it is considered a high-quality method of treating bone injuries, but this method has its advantages and disadvantages.

Damage to the bone tissue of the leg requires serious treatment

• When to use this method
• Progress of the procedure
• Evaluation of tension efficiency
• Positive and negative aspects of the method

Skeletal traction for a tibia fracture as a treatment method

Skeletal traction for a tibia fracture helps restore the correct position of the fragments for their successful healing or fixation through surgery. At the moment, it is considered a high-quality method of treating bone injuries, but this method has its advantages and disadvantages.

Damage to the bone tissue of the leg requires serious treatment

When to use this method

Leg traction for a tibia fracture is used if the following features of the injury are present:

• if the fracture resulted in fragments;
• if bone damage occurs in multiple quantities;
• when fragments of injured bone or multiple fragments are displaced due to injury;
• in the event that a certain amount of time has passed after the injury and medical care was not provided in a timely manner;
• as preparation for surgery to fix bone fragments;
• used for recovery after surgery if the injury is a closed type or there is fragmentation of bone tissue.

Progress of the procedure

Tools for performing skeletal traction
Skeletal traction is a serious procedure and requires compliance with certain rules to guarantee the safety of the patient and the achievement of the expected effect from it.

Table No. 1. Conditions for applying traction and the course of the procedure:

When traction is performed for a fracture of the tibia, the pin is passed through the lower region of the supramalleolar part of the tibia. If an ankle injury occurs, the entry point of the needle is the heel bone.

Important: the needle is installed strictly perpendicular to the axis of the bone through which it passes.

When calculating the cargo, not only classical calculation formulas are taken into account, but also the following factors:

• how much the fragments are displaced relative to each other;
• in what specific place the bone fracture occurred;
• the degree of damage to soft tissues - muscles and skin;
• how long ago the fracture occurred;
• how old is the patient;
• how developed the patient’s skeletal muscles are;
• Is the fracture complicated?

Whether the method will be used depends on the characteristics of the injury.
Important: a gradual increase in load is the basis for proper muscle tension and installation of debris in their correct place.

Evaluation of tension efficiency

The main method that helps the doctor determine how successfully the procedure was performed is taking x-rays.

Here are the instructions for further treatment after installation of traction:

1. On the third or fourth day from the moment of traction, an x-ray is taken.
2. If the debris has not changed its position in the direction of its normal location, then the placement of the load is corrected to see if its quantity decreases. If necessary, additional rods are installed.
3. Two days after adjusting the load or tension, the radiography is repeated.
4. Provided that the debris has changed its position, then they gradually begin to reduce the load, for a start they remove 1 or 2 kg.
5. After two weeks, the weight of the load is from 50% to 70% of the required weight. A control photograph is taken to assess the location of the debris.
6. Skeletal traction for fractures of the leg bones is removed based on the results of an x-ray, as a rule, this occurs in the interval from 20 to 50 days.
7. Removing the spokes occurs very carefully. At the end of the procedure, the wounds are treated and sterile dressings are applied.
8. After the traction is removed, a conclusion is made about the condition of the affected limb and a plaster or adhesive tension is applied.

Fixation of the leg after removing the traction
Important: how long they lie in traction for a tibia fracture is determined by the doctor, assessing the speed of reposition of the fragments; the generally accepted period of a patient's stay in the hospital for such an injury is from 1.5 to 2 months.

The photos and videos in this article will show what a tibia fracture looks like in traction.

Vernal view of traction on the heel bone

As medicine develops, this method also improves. Classic traction can be described as a rather rough procedure that brings pain to the patient.

Even with minimal movement of the patient on the bed, the structure changes the tension force and the patient begins to feel not the most pleasant sensations. The goal of improving the method is to minimize the pain of the procedure for the patient and facilitate the process of his recovery.

Positive and negative aspects of the method

The use of skeletal traction has its pros and cons, like most instrumental methods in the treatment of violations of the integrity of bone structures.

Table No. 2. Evaluation of the traction method:

It is important: in order for this method of treatment to have the necessary effect, the placement of the needle must be completed in a timely manner; for this, the person must seek help immediately after the injury has occurred; the cost of delay in this situation is very high.

A limb bone fracture takes time to fully recover

A fracture of the tibia in traction requires time and patience from the patient to successfully reposition the bone fragments. This procedure must be performed under sterile conditions, in an operating room or in a sterile dressing room. Treatment with this method can only be performed in a hospital, under the constant supervision of hospital staff.

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When to use this method

Leg traction for a tibia fracture is used if the following features of the injury are present:

• if the fracture resulted in fragments;
• if bone damage occurs in multiple quantities;
• when fragments of injured bone or multiple fragments are displaced due to injury;
• in the event that a certain amount of time has passed after the injury and medical care was not provided in a timely manner;
• as preparation for surgery to fix bone fragments;
• used for recovery after surgery if the injury is a closed type or there is fragmentation of bone tissue.

Indications and features of leg traction for a fracture

A hip fracture is a serious injury that can even lead to death. It happens because bones lose their strength (especially in old age). It can be triggered by a fall or blow. A distinctive feature of the pathology is that in the treatment of the disease, needles for immobilization, a three-bladed nail, and an external fixation device are used.

What is the procedure

Skeletal traction for a hip fracture (traction) is a manipulation that involves the gradual return of bone fragments to their normal physiological position using a knitting needle and special weights.

They are used until the damaged tissue is regenerated (callus does not form). It takes several weeks, or even months. To do this you need to take into account:

• health status and age category of the patient;
• nature of the injury (presence or absence of displacement at the fracture site, open or closed, number of fragments, presence of contamination);
• localization;
• complications;
• degree of soft tissue injury;
• correct placement of fragments, staticity, absence of soft tissue structures between them;
• uniform (metered) load distribution.

Main indications

Skeletal traction is prescribed for:

• multiple fractures in the lower leg and thigh (helical or splintered);
• injuries to the diaphyseal part of the humerus or femur, as well as trochanteric injuries, if the neck is injured or there are fractures in the area of ​​the condyles;
• the presence of displacements, suppurations, burns;
• fractures of the pelvic bones (with or without displacement);
• crushed fractures of the arms and legs (as well as unilateral ones);

The method is also used in the preoperative period (to correct fragments before fixation) and at the postoperative stage (to consolidate the result of surgical intervention and prevent re-divergence).

Technique

The traction procedure is similar to surgery. It is carried out in the operating room, under sterile conditions. Anesthetize the limb using a one percent solution of novocaine, 10-15 ml on each side (first the skin and soft tissue, then the periosteum).

The leg is fixed and the needles are inserted into the places designated by the surgeon (manipulation is performed using a drill), which are passed through the bone.

The exit sites are isolated with sterile napkins or a bandage is applied. At the end of the procedure, the staples are secured, weights are attached, and the limb is taut.

Possible complications

Complications can arise for various reasons, which may result in:

• Blood clot formation. This outcome can occur as a result of long-term immobility of the limb. In accordance with this, the patient needs to use drugs aimed at thinning the blood.
• The development of pneumonia due to the use of a large number of drugs and the immobility of the body.
  To avoid this outcome, it is necessary to include breathing exercises, which will provide improved blood circulation in the bronchi and lungs. Which in turn contributes to oxygen saturation of the blood and all organs in general. Bedsores and atrophy of the limbs occur during a long stay in a supine position.
• To avoid such a complication, you need to include some types of massage that will increase local blood circulation. Physiotherapy will also be beneficial, as it will promote tissue regeneration.
• Digestive problems due to taking medications and prolonged horizontal position. To do this, the patient is offered dietary nutrition that will help not only restore the disturbed intestinal microflora, but also ease the load on the gastrointestinal tract, which begins to work slowly when lying down. In addition, a diet rich in foods rich in vitamins can support the immune system, which also suffers due to the onset of the disease.

Skeletal leg traction

Skeletal traction is one of the main treatment methods in traumatology, which is widely used in medical institutions. A distinctive feature of this method is the fact that the traction itself is carried out using a special bracket or knitting needle, which is attached directly to the bone. This method allows for the elimination of pain, while the muscles relax and gradual reduction and retention of bone fragments in the desired position occurs until the formation of a primary callus.

Advantages and disadvantages of this treatment method

Like any other treatment method, skeletal traction has its advantages and disadvantages. The disadvantages of skeletal traction include restrictions on use for the elderly and children, as well as the significant duration of this method of treatment, which can be up to two months. Another serious disadvantage of this method is the possibility of purulent infection during needle insertion. However, this is a rather complicated procedure and any violations can become a serious problem.

But this method has many more advantages, which ensures its widespread use. Thus, this method is minimally invasive, it avoids secondary displacement of fragments, and the rehabilitation time is much shorter. At the same time, the doctor has the opportunity to conduct constant visual monitoring of the injured limb.

Indications and contraindications

The main indications for the use of this method of treatment are unstable fractures of the femur, tibia and humerus in cases where a standard plaster cast cannot provide ideal fixation of bone fragments after immediate reduction. For stable fractures, this method is used when rapidly increasing local tissue swelling is observed.

Contraindications to the use of this method include the presence of inflammatory processes at the site of the wire and the fracture area, damage to large areas of soft tissue, as well as inappropriate behavior of the patient during intoxication and mental disorders. Also, the use of this method is impossible without a mobile X-ray machine.

Performing traction

When using this method of treatment, depending on the location of the fracture, a Kirschner wire is passed through a certain point. The process of its introduction is minimally invasive and is carried out under local anesthesia. Skeletal traction involves, in case of a fracture of the femur or pelvis, passing the wire through the tibial tuberosity or supracondylar region, in case of a fracture of the shoulder or scapula - through the olecranon process, in case of a fracture of the tibia, the wire is passed through the supramalleolar region, and in case of damage to the ankle joint - through the heel bone.

After inserting the needle, it is secured in a special bracket, after which a reduction weight is installed using a special system of blocks, the weight of which depends on the location of the fracture and the weight of the patient. For example, in case of a shoulder fracture, the primary load can be from 2 to 4 kilograms, in case of a tibia fracture - a tenth of the patient’s weight, etc. A day after the control radiograph, an individual reduction weight is selected. 1-2 days after changing the weight of the load or when changing the direction of the reduction loops, an X-ray examination of the fracture site is also performed.

During treatment, the injured limb is fixed in a forced position. So, with a fracture of the scapula, the arm is abducted 90 degrees at the shoulder joint and bent 90 degrees at the elbow. When a shoulder is fractured, the position is almost the same, only the shoulder joint is bent to an angle of 90 degrees. For leg fractures, a Beler splint is used to ensure uniform relaxation of all muscles.

In fact, treatment can be divided into 3 phases.

1. The first phase is repositioning, it lasts up to 3 days. During this time, a gradual reduction of the fragments occurs, which should be monitored using radiography.
2. The second phase is retention, it lasts 2-3 weeks. During this period, the fragments must be kept in a state of reposition.
3. The third phase is the reparative phase, which lasts up to 4 weeks until signs of callus formation appear and the desired consolidation is achieved.

The duration of treatment for a fracture can generally range from 4 to 8 weeks - the period depends on the location. Thus, injuries of the lower leg and upper extremities in some cases require only 4 weeks of treatment, and fractures of the hip and pelvis can require up to 8 weeks.

The main criterion for sufficiency is the disappearance of pathological mobility at the fracture site. This fact must be confirmed x-ray, after which the treatment method changes to fixation.

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Advantages, disadvantages and contraindications

Skeletal traction for a hip fracture has advantages and disadvantages.

The advantages of this method of treating fractures:

• possibility of constant visual monitoring;
• absence of secondary displacements;
• the time to recover from injury is reduced.

• there is a risk of purulent infections and bedsores;
• the need to comply with bed rest in a forced position;
• pathologies of the heart and blood vessels develop;
• problems arise with digestion and intestinal function.

The use of traction is unacceptable for:

• children (up to five years of age)
• old people;
• patients who have ulcerative formations, excoriations, ulcers.

Skeletal traction for a hip fracture is a long procedure that requires a lot of strength and patience both from the patient himself (he will have to spend a month or two in an uncomfortable position) and from his family and friends (the patient needs constant care). But the method is very effective, as it provides the injured limb with complete rest, minimizes the risk of developing undesirable consequences (repeated displacements, etc.), it is possible to constantly monitor the patient’s condition and provide him with timely medical care (if necessary).

Skeletal traction for fractures

The skeletal traction technique involves the installation of special knitting needles that fix the bones and relieve tension from the muscle tissue. The method is used when there is displacement or a large number of bone fragments that cannot be fixed with plaster due to the high dynamics of their movements.

Skeletal traction of the heel bone, femur or tibia does not require the application of a plaster cast.

Features of the procedure

The skeletal traction method is used in the following cases:

• Damage to tubular bones;
• Splintered, helical, oblique nature of the fracture;
• Trauma to the pelvic bones;
• Damage to the spinal column;
• Calcaneal fracture;
• Ankle injury;
• Strong displacement;
• A large number of small bone fragments.

It is contraindicated to use the skeletal traction method in the following cases:

• The presence of purulent neoplasms;
• Ulcers on the skin;
• Abrasions and other skin damage.

Traction is used as the main and auxiliary method of treatment. In the following cases, traction is used as an additional method of treating a fracture:

• Reduction before surgery for a medial fracture;
• Old bone injuries, improperly fused bones after old fractures;
• Displacement along the entire length of the bone body;
• Lengthening of a bone after its deformation;
• Rehabilitation after arthroplasty.

How long you need to lie in traction depends on the severity of the injury, the number of bone fragments, and the intensity of bone tissue fusion.

Advantages and disadvantages of the technique

The most common method for treating bone displacement during a fracture is Kirschner tension. This method is very common and the only one that can be used to correct fractures with multiple fragments when the bones cannot be completely immobilized using a plaster cast.

Traction of the spine (traction), heel bone, and ankle has the following advantages:

• Shortening the rehabilitation period;
• Minimal risks of complications;
• There is no chance of improper bone fusion if the doctor works correctly.

Another advantage of this method of treating a fracture is the ability to constantly monitor the healing process and the degree of fusion of bone tissue, while with a cast, radiography is impossible. If necessary, the plaster cast must be removed to monitor the treatment process.

The bone traction method also has a number of disadvantages:

1. The patient has individual hypersensitivity to the material from which the instruments used to fix the bones are made.
2. The second disadvantage of the procedure is that you need to lie in traction for at least 6 weeks; therefore, the technique is rarely used in the treatment of fractures in the elderly and children.

The duration of treatment, the number of pins used for fixation, and other nuances of the technique used are selected individually for each patient.

How is skeletal tension installed?

Before installing the knitting needles, the place where special instruments will be inserted is thoroughly disinfected. Painkillers are administered. For the purpose of fixation, the limb (back, if spinal traction is performed) is placed in a special splint.

The needle is inserted directly into the bone, and fasteners are used to secure the ends of the needle. To stretch the bone, loads are used, the number and weight of which is selected individually. In case of a hip fracture, the load should be equal to the weight of the leg; if the shin is fixed in traction, a load equal to half its weight is placed.

After all the instruments have been installed, the patient is placed in a bed, the lower part of which is raised at an angle of 50 degrees. This is done to create a counterbalance to the patients’ own body weight. On the hood, the load is installed gradually, at first no more than 50% is placed. Gradual installation of the load prevents stretching of muscle tissue. The ability to constantly monitor the condition of the bone helps to adjust the location of the spokes and the weight of the load.

Depending on which bone needs to be fixed, the angle of insertion of the needle is determined. Extraction of shin bone fragments is carried out by inserting a wire perpendicular to the direction of the bone. The weight of the load is up to 10% of the total weight of the patient. If a person breaks a bone in the hip, then it is necessary to fix the pin in the foot so that the limb is completely immobilized. This prevents limb deformation and shortening.

The most difficult type of operation is spinal traction, since when fixing fragments there is a risk of careless movement by the doctor, injury to soft tissues and nerve roots. Spinal traction with fixation of bone fragments is carried out only by an experienced doctor.

Instruments for fixing bone fragments

How many instruments are needed to fix the damaged bone and correct the misalignment?

1. A medical drill, manual or electric, is necessary for drilling out the bone in order to insert a knitting needle into it.
2. The bracket is in the shape of a horseshoe, has clamps for fixing the ends of the knitting needles, weights are attached to the bracket, which are compared with the weight of the patient, depending on which bone with a fracture needs to be resuscitated.
3. Knitting needles.
4. A wrench used to secure spokes in clamps.
5. A wrench of a special structure required to correct the tension of the spokes. The tension key has a thread with a hole, tension is carried out using a pin.

Types of spinal traction

Spinal traction involves the use of various tools - knitting needles, straps, clamps, which are selected individually, depending on the location of the injury. To fix the fragments in the cervical region, a special Glisson loop is applied. It is possible to use a traction on the cranial bones, it all depends on the severity of the clinical case. When using a Gleason loop, the patient is placed on a bed with the head of the bed elevated.

The Gleason loop for correcting displaced fragments consists of several straps that are pulled under the chin and through the back of the head. A loop on one of the straps is attached to the bed. No load is required; in this case, traction of the spine in the cervical region occurs under the weight of the patient himself.

The fixation period is up to 1 month. A cushion is placed under the neck if the vertebrae are displaced due to a careless, sharp turn of the neck when bending. If the displacement occurs during extension, a pillow is placed under the head.

When skeletal traction of the vertebrae in the thoracic and lumbar spine is performed, the algorithm of actions is identical to that used for fixation of the cervical spine using a Glisson loop. The straps are secured under the armpits and secured to the bed. The period of stay in a fixed state is from 2 to 3 months. During the recovery period, when the instruments are removed from the bones, the patient must wear a corset.

Adhesive tension method

In many cases, with the skeletal traction method, loads weighing no more than 5 kg are used, including on the hip area. To do this, the injured area is fixed with bandages, or special adhesive plasters up to 10 cm wide are used. To secure the loads, you can also use special adhesive bases made of zinc and gelatin, for example, Finka's kleon or Unna paste. Before using the adhesive base, the skin is thoroughly wiped with degreasing agents.

To carry out adhesive tension, strips of adhesive plaster are glued in the longitudinal direction. Sticks are attached to the free ends, acting as spacers; the load is attached to laces extending from the center. If it is necessary to install an adhesive stretch on the shin area, the patch is glued in one solid strip.

Additional treatment methods

To speed up the healing time of the bone, which is in a fixed state, a set of physiotherapeutic procedures is prescribed. Unlike being in a cast, when rehabilitation can be carried out only after removing the plaster cast, electrophoresis, UHF therapy during traction can be carried out almost immediately, due to the availability of free access to the damaged bone. Rehabilitation is necessary for rapid recovery and restoration of bone tissue.

The diet must be adjusted; a large number of dairy products, which are enriched with calcium, necessary for bone tissue, are added to the menu. Calcium is also taken in tablets. Vitamin complexes are prescribed to restore the entire body.

While in traction, regular x-ray examinations are performed to monitor the dynamics of bone tissue fusion. The needles are removed under local anesthesia. After the bone is released from the pressure, a rehabilitation period is carried out. Active physical activity is excluded. Physical therapy exercises are selected individually. The first classes are carried out only under the supervision of a doctor, since incorrect execution technique can cause negative complications.

Exactly when a person will be able to return to their usual lifestyle with normal physical activity depends on the severity of the injury, the presence or absence of complications, the rate of fusion of bone tissue and a number of other factors.

Skeletal traction for a fracture can be prescribed to adults and children after 5 years.

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Recovery

The length of time the patient remains in traction is directly related to the type and complexity of the injury received, as well as the presence of any complications. If the patient has a confirmed fracture of the bones of the upper limb or lower leg, then the average period of his stay in the hospital will be about 1.5-2 months. For injuries to the pelvic bones and hip bones, the victim will have to remain in bed for a couple of months.

A patient who is in skeletal traction needs not only a daily examination by a traumatologist and a nurse, but also the care of junior medical staff and relatives.

What is the procedure

Skeletal traction has a great advantage over other methods - treatment of a closed fracture using a closed method. This method cannot ensure the connection of bone fragments, but thanks to the functions of the body and the use of this technology, the bones begin to heal during the natural process of fracture renewal. In this case, no additional manipulations are performed. One of the disadvantages of the method is that the patient remains immobile for a long time, which has consequences in the form of complications. As a result, traumatologists began to combine the traction technique with a plaster cast, which is applied after signs of bone fusion appear. With the combined method, the patient can spend the rest of the rehabilitation period at home, and also have the ability to travel to other medical institutions for subsequent treatment.

When a bone is fractured, the patient feels a sharp pain, so when installing the device, a 1% solution of novocaine is injected into the tissue of the broken limb, so that the patient does not feel severe pain. Establishment of skeletal traction occurs using a Kirschner wire, which is passed through a point in the damaged bone using a special drill. Then special brackets are installed and weights are attached to tighten the limb.

A fracture of the femoral neck is considered the most severe case, so here it is necessary to maintain complete immobility, because even a small movement can lead to a shift in the center of gravity of the load, which in the future will provoke improper growth of bone tissue.

At the moment, each traumatology department is equipped with a place for such an operation and the necessary equipment. Every year the method of limb traction is improved, which gives improved results.

The essence of the technique

The essence of skeletal traction is to create conditions for the formation of bone tissue, which subsequently connects bone fragments. With this technique, the bone tissue forms a callus, which prevents the fragments from moving.

Spoke attachment points

The skeletal traction technique involves the exact location of the needle:

• In case of damage to the pelvic and femoral bones, the pin is inserted into the tuberosity on the tibia.
• In case of an ankle fracture - in the heel area.
• A tibia fracture involves inserting a pin into the area above the ankle.

Load weight determination

To determine the mass of skeletal traction, a conclusion from a radiologist is required, who installs it immediately before starting treatment. For a fracture of the femur, 15% of the body weight is taken, for damage to the tibia - 10%. The average weight of hip fractures is 1/7 of body weight, which is from 6 to 12 kg, shin fractures are from 4 to 7 kg, which is 1/14 of body weight, and shoulder fractures are from 3 to 5 kg.

The weight of the load depends on how much the bone fragments are displaced, on the time of the fracture, and on the total weight of the patient. Initially, use a weight that is 1/3 of the total weight, then for every hour add 1 kg to the weight of the load.

Position of the injured limb

When establishing skeletal tension, it is necessary to relax the muscles and then secure the limb in a comfortable position. The broken leg must be placed in a Beler splint, which is a metal mechanism consisting of two frames. Also, the Beler tire performs the function of supporting loads, so it must be stable and free of damage. A broken scapula in the shoulder joint should be abducted to an angle of 90 degrees.

Timing of traction

Lying in traction with a hip fracture lasts quite a long time - from one and a half to two months, while the patient should observe strict bed rest. In other cases, the duration of traction depends on the nature of the fracture.

In order to understand the end of treatment, it is necessary to undergo an examination by a radiologist; in case of successful treatment, the patient is given a plaster cast, thanks to which the patient can go for home treatment.

How to remove a leg from traction

If the inflammatory process has begun, or the treatment has come to an end, then it is necessary to remove the skeletal traction. First, the weight is removed, then the skin is treated with an antiseptic at the site where the needle is inserted, after which the staple is unclenched and the needle is bitten near the leg itself and carefully removed.