beckycoloma@yahoo.com Manage fractures in an effort to realign broken bones, as a temporary measure when operative fixation is not available

Skin traction example: Buck’s traction is commonly used in patients with hip fracture

Skeletal traction associated with complications relating to pin insertion, infection from the site of pin insertion

Reduce, realign and promote healing of fractured bones.

Decrease muscle spasms that may accompany fractures or follow surgical reduction.

Prevent soft tissue damage through immobilization. Prevent or treat deformities. Rest an inflamed, diseased, or painful joint. Reduce and treat dislocations and subluxations. Prevent the development of contractures. Reduce muscle spasms associated with low back

pain or cervical whiplash Expand a joint space during arthroscopy or before

major joint reconstruction.

RUSSELL TRACTION A system of suspension and traction pull is

used. Adhesive strips are applied as in Buck's extension, and the knee is suspended in a sling. A rope is attached to the sling's spreader bar. This rope passes over a pulley which is attached to an overhead bar and is then directed to a system of three pulleys at the foot of the bed: first to a pulley on the bed's foot bar, next to a pulley attached to the foot spreader bar, and then back to a second pulley on the bed's foot bar. There is an upward pull from the sling pulley and a forward pull from the pulleys at the foot of the bed.

Dunlop’s Traction An orthopedic mechanism that helps

immobilizes the arm to treat abnormal shortening of the muscle or fracture of the elbow. The mechanism employs a system of traction weights, pulleys, and ropes. It is usually applied to one side of the arm but sometimes both sides.

Halo femoral traction It is gradually improve the coronal and

sagittal deformity and restore the trunk balance through the elongation of the spine. Halo-femoral traction was a safe and effective method for the treatment of severe idiopathic and congenital scoliosis patients. The patient is supine and traction forces are applied through a halo and a femoral pin.

Halo pelvic traction A pelvic ring is affixed to the patient and a

series of threaded rods connect the cranial halo to the pelvic ring to apply an adjustable force separating the two rings. In procedures using the halo, the patient is either immobile or severely restricted in mobility

Bryant’s Traction It 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 counter traction.

- Traction only in one direction, both hips flexed at 90 degrees, buttocks slightly off crib mattress.

Buck’s Skin Traction- Buck's skin traction stabilizes the knee, and reduces muscle spasm for knee injuries not involving fractures. In addition, splints, surgical collars, and corsets also may be used.

Stove in Chest Traction Applied for patients with severe chest injury with multiple rib fracture.

Overhead It is a vertical traction to humerus and horizontal suspension to for arm. 

Ninety Degree Traction For fracture of the femur

Balanced Suspension TractionSupport the affected extremity off bed and allows for some patient movement without disruption of the pull.

Support the affected extremity allows for some patient movement and facilitates patient’s independence and nursing care while maintaining effective traction.

Maintain the anatomical position of the fractured bone

Invasive. Requires procedure in which pins, screw or wires are surgically installed for use in longer term traction requiring heavier weights (25-40lbs / 11-18kg)

Pin traction – fractures of the pelvis, hip or femur

Overhead arms traction – upper arm fracture

Cervical traction – neck, vertebrae fracture

Thomas splint – placement of the thigh Pearson Attachment – placement of the leg Steinman’s holder Steinman’s pin Traction weight

◦ 10% of the body weight◦ Inside the suspension rope

Suspension weight◦ 50% of the traction weight

Rest splint 3 ropes

◦ Thigh rope – shortest◦ Suspension rope – longest◦ Traction rope

Slings & pins Foot board

Verify doctor’s order Inform the patient about the procedure Preparation

◦ Identify the different parts of the orthopedic bed◦ Assemble the needed equipments◦ Know the affected extremity◦ Know where to stand – look for the last pulley and

stand on the side

Mount the Thomas & Pearson on the rest splint using the 5 principles in application of slings to be emphasized◦ Not too tight not too loose/close◦ 1” distance between the slings to promote

ventilation◦ Popliteal and heel portion should be free from

sling◦ Smooth & right side should come in contact with

the patients skin◦ 2 longer and wider slings for thigh potion & 3 for

the leg

Start from the medial side to the lateral side Secure both ends together Fan fold nicely on the lateral aspect and

secure with pin or clip Observe the principle of not too tight & not

too loose and avoid hitting the patient’s extremity with the pin

The thigh rope should be attached on the medial aspect to the lateral aspect

3 manpower needed to insert the whole apparatus under the affected extremity

Manual traction to be released after the completion of traction weight on the 3rd pulley

To lift the affected extremity, simultaneously count of (3),

Instructions to the patient – hold on the trapeze, flex the unaffected leg at the count of (3)

3 manpower must do their work simultaneously

Rope to be attach to the steinman’s pin holder to run along the 3rd pulley and attached to the prescribed weight

Check the principles of sling application and make the necessary adjustments and also check the correct alignment

1 end of the thigh rope to be attached to the lateral aspect of the ischial ring with a slip knot

Attach suspension rope on the mind part of the thigh rope, to the 1st pulley

Insert the suspension weight Hang it on the 1st pulley Then pass it on the 2nd pulley under the rest

splint and clove it with hitch knot on the thomas splint

And another clove hitch knot on the pearson and finally, close it with a knot to secure it

*be sure to maintain the traction rope inside and the suspension weight should be outside

Remove the rest splint Apply foot support Check the principle of traction. Emphasizing

the 5 principles of traction and discuss the nursing care

Patient should be on the dorsal recumbent position

Line of pull should be in line with the deformity positioning of a diamond bar & positioning of a pulley◦ 1st pulley should be in line with the thigh◦ 2nd pulley should be in line with the knee or screw◦ 3rd pulley should be in line with the 1st and 2nd

pulley Should be always continuous, emphasize

the importance of manual traction

Avoid friction◦ Should be running along the groove of the pulley◦ Knots should be hanging freely◦ Observe for wear & tear of rope & bags

Provide counter traction – patient’s body weight will serve as counter traction

Apply rest splint Hang suspension weight on the 1st pulley Complete removal of suspension weight –

remove the knot on the peason & thomas Manual traction on the steinman’s pin

holder Remove the traction weight on the 3rd

pulley, secure the traction rope on the rest splint another on the thomas & pearson attachment

A. MINIMIZING THE EFFECTS OF IMMOBILITY Encourage active exercise of uninvolved muscles

and joints to maintain strength and functions. Dorsiflex feet hourly to avoid development of foot drop and aid in venous return.

Encourage deep breathing hourly to facilitate expansion of lungs and movement of respiratory secretions.

Auscultative lungs field twice a day. Encourage fluid intake of 2,000 to 2,500 ml daily.

Provide balanced high- fiber diet rich in protein; avoid excessive calcium intake.

Establish bowel routine through use of diet and/ or stool softeners, laxatives, and enemas, as prescribed.

Prevent pressure on the calf and evaluate periodically for the development of thrombophlebitis.

Check traction apparatus at repeated intervals-the traction must be continuous to be effective, unless prescribed as intermittent, as with pelvic traction.◦ With running traction

The patient may not be turned without disturbing the lie of pull◦ With balanced suspension traction.

The patient may be elevated, turn slightly, and moved as desired.

Examine bony prominences frequently for evidence of pressure or frictions irritation.

Observe for skin irritation around the traction bandage. Observe for pressure at traction-skin contact points. Report compliant of burning sensation under traction Relieve pressure without disrupting traction

effectiveness.◦ Ensure that linens and clothing are wrinkle-free◦ Use lambs wool pads, heel/ elbow protection, and special

mattresses as needed. Special care must be given to the back at regular

intervals, because the patient maintains a supine position.◦ Have patient use trapeze to pull self up and relieve back

pressure.◦ Provided backrubs.

Monitor vital signs for fever or tachycardia. Watch for signs of infection, especially around the pin tract.  The pin should be immobile in the bone and the skin wound

should be dry. Small amount of serous oozing from pin site may occur.

If an infection is suspected, percuss gently over the tibia; this may elicit pain if infection is developing.

Assess for other signs of infection: heat, redness, fever.  If directed, clean the pin tract with sterile applications and

prescribed solution/ ointment- to clear drainage at the entrance of tract and around the pin, because plugging at this site can predispose to bacterial invasion of the tract and bone.

Assess motor and sensory function of specific nerves that might be comprised.◦ PERONEAL NERVE

Have patient point great toe toward nose; check sensation on dorsum of foot; presence of foot drop.◦ RADIAL NERVE

Have patient extend thumb; check sensation in web between thumb and index finger.◦ MEDIAN NERVE

Thumb- middle finger apposition; check sensation of index finger.

Determine adequacy of circulation (ex. Color, temperature, motion, capillary refill of peripheral fingers or toes).

With Buck’s traction, inspect the foot for circulatory difficulties within a few minutes and then periodically after the elastic bandage has been applied.

Report promptly if charge in neurovascular status is identified.