Upper Extremity Traction

Dunlop or modified Dunlop skin traction. This type of traction is occasionally useful for the management of supracondylar humeral fractures . Place the patient supine and suspend the arm in skin traction with the shoulder abducted and slightly flexed. In addition, slightly flex the elbow. Modification of this type of traction provides counteraction on the humerus, which can be achieved with the arm over the edge of the bed and counterweight suspended from a felt cuff over the humerus, or with a felt cuff over the forearm pulling laterally with the elbow flexed . Two disadvantages of Dunlop traction are that it cannot be applied over skin injuries and that elevation of the humeral fracture above the level of the heart is not possible with this method.

Overbody or lateral skeletal traction In the management of extraarticular humeral shaft and metaphyseal fractures, it is occasionally desirable to maintain the shoulder in flexion without abduction but with the elbow at a right angle by placing the arm over the body. Maintain this position through olecranon skeletal traction, which allows some flexion and extension of the elbow if the traction pin is properly inserted. Because the hand and wrist usually tire in this position, support the wrist with a plaster splint. Skeletal traction through the olecranon may also be used in the lateral position 

A special, rarely used adaptation of upper extremity olecranon traction may be made by placing the patient in a shoulder spica cast that incorporates an olecranon pin into the plaster to apply fixed skeletal traction. This adaptation allows the patient to be ambulatory.