PORTABLE VERSION OF BRYANTS TRACTION

Abstract : For years Bryants method of traction has been used in management of femur fractures in children under 2 years. However, the construct of Bryants traction is cumbersome and difficult to maintain occupying a large amount of space. Feeding, comforting and perineal care of the children were also difficult leading. Several modifications of Bryants traction have been described to make the construct less cumbersome and easier to use. We describe a modification of Bryants traction, simple and portable. The portable version of Bryants traction is made using a Thermacol sheet, Earthaflex foam and a Light-weighted aluminum frame. The clearance of the childs buttocks just off the bedding was considered sufficient traction. The neonates were managed in Neonatal ICU with phototherapy, nursing care and feeding in no way hindered by the traction. Compliance of the children and parents were better in older children. The only complications noticed were the frequent loosening of the traction and occasional development of skin blisters. Only Patients, below 2 years and weighing below 20kg, with femur shaft fracture and post-arthrotomy septic arthritis of hip were provided traction in this frame. This even facilitated breast feeding by the mother in case of infants, and also better nursing care. The child can be transported without removing or disturbing the traction and can also be transported for investigations like ultra sonogram. Most importantly, none of the cases had any ischaemic injury.Our modified version of Bryants traction is a compact, light-weighted and portable device with high safety and efficacy profile and most importantly good compliance from the child and the parents. They can be used in selected cases of femur shaft fractures and post-arthrotomy septic arthritis. Their efficacy in managing different stages of developmental dysplasia of hip is to be tested.