Bohler braun splint
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I now have comprehensive information. Here is a detailed overview of the Bohler-Braun splint:
Bohler-Braun Splint
Overview
The Bohler-Braun splint (also called the Bohler-Braun frame) is a fixed metal frame apparatus used in orthopaedic wards to provide balanced skeletal or skin traction to the lower limb. It is named after Lorenz Bohler (Austrian trauma surgeon) and Heinrich Braun (German surgeon). In the 1930s, Bohler used a Steinmann pin through the tibial tuberosity with the lower leg supported on Braun's original frame - his modification added extra pulleys to allow traction in multiple planes.
Structure / Components
The frame consists of an iron A-frame (inclined frame) that sits on the bed under the injured limb, with two inclined planes:
| Component | Description |
|---|---|
| Proximal inclined plane | Supports the thigh, typically at ~45° to horizontal |
| Distal inclined plane | Supports the lower leg at a steeper angle, creating knee flexion |
| Canvas slings / foam padding | Cushions placed on both inclined planes to support the limb |
| Pulleys (3-4) | Redirect traction cords at specific angles |
| Traction cord and weights | Apply the pulling force; weight approx. 10% of body weight |
| Bohler stirrup / traction bow | Attached to the skeletal pin to connect to the traction cord |
The 4 Pulleys and Their Roles
The basic Braun splint had only 1 pulley (for distal tibia/calcaneal traction). Bohler's modification added pulleys for proximal segments:
| Pulley | Direction | Used For |
|---|---|---|
| 1st (lowermost) | - | Tibia and fibula injuries |
| 2nd | - | Supracondylar fracture femur |
| 3rd | Directed away from patient | Fracture shaft of femur (middle third) |
| 4th (topmost) | Directed toward patient | Prevents foot drop |
In the 3-pulley version commonly described:
- Proximal pulley - prevents foot drop
- 2nd pulley - traction in line with the femur
- 3rd pulley - traction in line with the leg
Indications
With traction (skeletal):
- Fracture shaft of femur (pre-operative stabilization, maintains length and reduces pain)
- Trochanteric fractures of femur
- Supracondylar fracture of femur
- Tibial and fibular fractures with displacement/fragment overlap
- Acetabular fractures (maintains femoral head in socket)
- Paediatric femoral fractures (>10 years, awaiting ESIN)
- DDH/Perthes disease (historical use)
Pin sites for skeletal traction:
- Femur fractures: pin through tibial tuberosity in adults, just above condyles in children
- Leg fractures: pin through calcaneal tuberosity
Without traction:
- Compound fractures with no overlap (for dressing, wound care, and immobilization)
- Soft tissue injuries to the leg
- Post-operative limb elevation
Advantages
- Traction unit is self-contained - easy application
- Limb maintained in a comfortable, anatomical position (hip and knee flexed)
- Angle of traction is adjustable
- Wound care is possible without removing the splint
- Multipurpose - simultaneous traction through calcaneal/distal tibia AND proximal tibia/distal femur is possible
- Patient can be nursed comfortably, can use a bedpan
- Allows physiotherapy exercises (quadriceps, ankle mobilization)
Comparison with Thomas Splint
| Feature | Bohler-Braun | Thomas Splint |
|---|---|---|
| Portability | Fixed to bed - hospital only | Portable (field/ambulance use) |
| Setup | Requires bed attachment and hanging weights | Self-contained ring and side bars |
| Traction planes | Multiple (adjustable angles) | Single axis |
| Nursing access | Good | Moderate |
| Primary use | Hospital pre-operative management | Emergency/field transport of femur fractures |
Nursing Care
- Check traction weights are hanging freely and not resting on bed/floor
- Inspect pin sites daily - clean with chlorhexidine or saline; look for redness, discharge, loosening
- Heel protection - gel heel protectors; heel is most at-risk pressure area
- Reposition patient every 2 hours minimum; use pressure-relief mattress
- Passive mobilization of the patella to prevent patellofemoral adhesions
- Chest physiotherapy to prevent pulmonary complications
- Apply anti-embolism stocking to the unaffected leg
- Check neurovascular status of the limb regularly (sensation, capillary refill, pulses)
- For supracondylar femur fractures: provide padding at fracture site to prevent angulation; avoid padding at the knee
- Bed linen: use two separate folded sheets (head and foot) so one half can be changed without moving the splint
Complications
| Complication | Mechanism | Prevention/Management |
|---|---|---|
| Pressure sores (heel, sacrum, elbows) | Prolonged immobility over bony prominences | Gel protectors, 2-hourly repositioning, pressure-relief mattress |
| Pin site infection | Staphylococcus aureus tracking along pin; can progress to osteomyelitis | Daily pin care, no occlusive dressings, antibiotics for superficial infection, remove pin for deep infection |
| DVT/PE | Immobility | Anti-embolism stockings, early mobilization, anticoagulation |
| Peroneal nerve palsy | Pressure at fibular neck from sling or frame | Careful sling positioning, regular neurovascular checks |
| Knee stiffness | Prolonged immobility | Quad exercises, early conversion to definitive fixation |
| Muscle wasting | Disuse atrophy | Isometric exercises, minimize traction duration |
| Malunion/shortening | Inadequate traction weight or loss of traction | Regular radiographs, verify weight and alignment |
| Foot drop | Peroneal nerve injury or disuse | Proximal pulley, foot exercises |
Key Clinical Points
- The Bohler-Braun is a bridge to surgery, not a definitive treatment. In modern practice, femoral shaft fractures should proceed to intramedullary (IM) nailing within 24-48 hours - prolonged traction dramatically increases DVT, pressure sore, knee stiffness, and muscle wasting risk.
- Traction weight is approximately 10% of body weight.
- Unlike the Thomas splint (portable, used in field/ambulance), the Bohler-Braun is a hospital-based system requiring a fixed bed frame.
- Post-traction X-rays should be taken to confirm alignment and adjust weight as needed.
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