orthopedics, medical specialty concerned with deformities, injuries, and diseases of the bones, joints, ligaments, tendons, and muscles. Most of the early advances in orthopedics were made by practicing physicians, many of them surgeons, to correct deformities such as clubfoot and to provide supports for broken or diseased bones. The first institute for correcting skeletal deformities was opened in Switzerland in the 18th cent. The development of bone grafting, the advent of surgical methods for treating fractures, and other advances led to the recognition of orthopedics as a distinct medical specialty by 1920. Clubfoot, the aftereffects of poliomyelitis, fractures, spinal deformities, and arthritic disorders are among the conditions that require the attention of an orthopedist. Treatment provided by an orthopedist may include manipulation, the fitting of braces or other appliances, exercising, and surgery.

or orthopedic surgery

Medical specialty concerned with the skeleton and its associated structures. Orthopedists treat fractures, strained muscles, torn ligaments and tendons, and other injuries and deal with acquired and congenital skeletal deformities and the effects of degenerative diseases such as osteoarthritis. Originally dependent on heavy braces and splints, orthopedics now uses bone grafts, hip and other joint replacements, prostheses (see prosthesis), special footwear, and braces to enhance mobility. Orthopedics uses the techniques of physical medicine and rehabilitation and occupational therapy in addition to those of traditional medicine and surgery.

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In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the skeletal system. There are two types of traction: skin traction and skeletal traction.

It is largely replaced now by more modern techniques, but certain approaches are still used today:

• Bryant's traction
• Buck's traction - hip fractures
• Dunlop's traction - humeral fractures in children
• Russell's traction
• Milwaukee brace

Skeletal traction

Although the use of traction has decreased over the years, there is an increasing number of orthopedic practitioners that are using traction in conjunction with bracing (see Milwaukee brace). The section below provides some details on traction and its use.

Bryant's Traction

Bryant's traction is mainly used in young children who have fractures of the femur or congenital abnormalities of the hip. Both the patient's limbs are suspended in the air vertically at a ninety degree angle from the hips and knees slightly flexed. Over a period of days, the legs hips are gradually moved outward from the body using a pulley system. The patient's body provides the countertraction.

Purpose

The purpose of traction is to:

• To regain normal length and alignment of involved bone.
• To reduce and immobilize a fractured bone.
• To lessen or eliminate muscle spasms.
• To relieve pressure on nerves, especially spinal.
• To prevent or reduce skeletal deformities or muscle contractures.

In most cases traction is only one part of the treatment plan of a patient needing such therapy. The physician’s order will contain:

• Type of traction
• Amount of weight to be applied
• Frequency of neurovascular checks if more frequent than every four (4) hours.
• Site care of inserted pins, wires, or tongs
• The site and care of straps, harnesses and halters
• The inclusion of any other physical restraints / straps or appliances (eg. mouth guard)
• the discontinuation of traction

Responsibility of initial application

The physician is typically responsible for initial application of traction and weights while the adjustment or removal (to perform ablution functions / physiotherapy) of skeletal traction weights will be based on the doctors charted plan.

In most cases cervical traction may be adjusted or temporarily removed, per physician order, by an orthopedic nurse who has documented competency to do so.

The alignment and moving of the patient will only be changed on physician's directive and the affected extremity will need to be maintained in proper alignment at all times with the ropes and traction straps - making sure the mentioned is unobstructed and weights hanging freely.

If it is necessary to move the patient while skeletal traction is in place, the patient should be moved in the bed with weights hanging freely.

In most cases traction will be applied for a number of weeks to months and Neurovascular checks will need to be performed by a nurse as ordered by the physician or as dictated per traction unit policy.

Traction is an appropriate treatment for a number of medical problems including spinal deformities such as scoliosis.

References

External links

• About
• Byrne T "The setup and care of a patient in Buck's traction.". Orthop Nurs 18 (2): 79–83.
• "Split Russell's / Buck Traction"
• - Bryant's traction