Tractions and Fixators

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SUBMITTED BY:- MANREET

KAUR

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INDEX

SR.N

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PARTICULARS PAGE NO.

1. CARE OF PATIENTS WITH TRACTION & FIXATORS 3-4

2. SKIN TRACTIONS 4-9

3. SKELETAL TRACTIONS 9-10

4. TYPES OF FIXATORS 10-11

5. SCIENTIFIC PRINCIPLES IN OL ED IN TRACTION 11-12

!. CO"PLICATIONS OF TRACTION APPLICATION# 12-15

$. GENERAL CARE OF PATIENTS WITH TRACTION AND FIXATORS 15-1$

%. REFERENCES 1%

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CARE OF PATIENTS

W I T H T R AC T I ON

& FIXATORS

Fix a t o r- Metallic p late or screw p la c e d on the bone to p r o v id e support. It fixesthe origin of p r im e movers so that the m us c le acts in an exerted at thei ns e r ti o n

T r a ct io n- is the a pp lic a ti o n of a pulling force, used to stretch soft tissue and toseparate join s ur f a c e s on bone f r a gm e nts . It invo lv e s a pp ly ing as a forceo f s uf f ic ie nt magnitude and duration while s im ul ta ne o us r e s is ti ngmovement o f the b o d y

P U R P OS E :

Used primarily as a short term i nte r v e ntio n until other m o d a liti e ss uch as e x te r na l or internal f ix a to r are p o ss i b le r e duc ing the risk ofd is u s e s y nd ro m e.

o r e lie v e p a in. !educe, a lign and immobili"e f r a c tur e s , to reduce d e f or m it ie s andto inc r ea s e space between o pp o s ing s ur f a c e s.

o m a inta in proper a lignm e nt until bone d e v e lo p s.

I ND I C A T I ON S :

o reduce f r a c tur e s # the a pp lic a ti o n of traction overcomes theinj ur e d limbs tendency to shorten $due to m us c le spasm% and ho ld sthe li mb constantly in a p o s iti o n of corrective e x te ns io n with theends of the f r a c tur e d bone a lig ne d .

Immobili"ation of an area before s urg e r y.&ontrol and r e lie v e of painful m us c le s p a s m.

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'tretching a d hes io n.

reatment of painful a r thr iti s , sore m us c le s and li g a m e nts ,d is lo c a ti o ns , degenerated or ruptured i nte r v e r te b r a l d is k s and s p ina lc o r d c o m p r e ss io n

(egenerative joint d is ea s e.

)erve root syndromes and herniated d is c s.

!elief from g e ne r a l, vague back p a in.

C ON T RA I ND I C A T I ON S :

*atients with str uc tur a l d is ea s e s secondary to tumor or i nf e c ti o n ,r he um a to id a r thr iti s and severe vascular c o mp r o m is e .+ c ute s tr a ins , s p r a ins and i nf la mm a ti o n c o nd iti o nsM a lig na nc y

a ne ur y s m

APPLICATION OF T RA C T I ON :

1. S K I N !+& I,)

- In skin traction, the pull is a pp lie d to the c lie nt s skin which tr a n s m itte dthe pull to the m us c ul o s k e leta l structures. + b e lt, head h a lte r , foamr ubb e r wrapped with an e la s ti c bandage, or a foam boot is a pp lie d to thec lie nt s skin before the appendage is attached to tr a c ti o n.

TYPES OF SKIN

T R A C T I ON

a. P !"icT r a ct io n

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Used in pelvic f r a c tur e s to support separated bones. his tractionm a y be a pp lie d by e ithe r a b e lt or a sling. he pelvic b e lt causesd o wnwa r d pull on the p e lv is , while the pelvic sling supports the

p e lv is off the b e d . ith a pelvic b e lt, the upper rim of the b e ltshould rest at the top of the iliac crest and not around the

abdomen. his type of traction is a running traction that is used toreduced muscle spasm of the l o wer back, r e lie v e s c ia ti c a ,immobili"e a f r a c tur e d p e lv is , or correct l ate r a l d e v ia ti o ns of thes p ine .

It is us u a lly a pp lie d inte r m itte ntl y , on / hours, off / hours, while thec lie nt is awake. e ig hts on the traction are i nc r ea s e d g r a d ua lly .

) e v e r remove or changed the we ig hts on any traction d e v ic e withouta p hy s ic ia n s or d e r .

Ca r #or $ati nt% &it' $ !"ic t r a ct io n :

0nsure that the pelvic g ir d le is p ro p e r ly s i" e for p a ti e nt

0nsure that pelvic g ir d le fits s nug ly over iliac crests

and p e lv is

0nsure i nte g r ity by providing back care 1 2 h

M a int a in sling p la c e m e nt beneath lower back with buttockse le v ate d f r o m mattress. ! e p la c e s o ile d s ling .

3 if t and turn patient4s use of trape"e if it a lte r s c o mp r e ss iv e forceson p e lv is

M a int a in bed in f la t p o s iti o n

&hange bed li ne n from head to foot rather than from s id e to s id e

(. )*c+,% T r a ct io n -)*c+,% Ex t n % io n

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Is a running skin traction that can be used te mp or a r ily toimmobili"e a f r a c tur e of the hip5femur until it is p o ss i b le to dosurgery. It can a ls o b e used to r e lie v e m us c le spasms in the lower

back, to p r e v e nt c o ntr a c tur e a f te r computation, or to r ea lign thevertebrae in a c lie nt with s c o lio s is .

he l e g is wrapped with an e la s ti c roller bandage or tape. ractionis a pp lie d through a we ig ht attached to a spreader bar below thefoot. + foam boot may a ls o be used. he traction pull is toward the

pulley a t the bottom of the b e d .

Ca r o# $ati nt% &it' )*c+/% T r a ct io n :

0nsure skin i nte g r ity by a v o id ing pressure on he e l, dorsum or foot,f i b ul a r head, or m a lle o lus

M a int a in counteraction by e le v a ti ng foot of bed or k ee p ing head of bed

f la t

0 nc o ur a g e ind e p e nd e nc e with use of tr a p e " e

c. R * %% !!, % T r a ct io n -)a!anc 0 T r a ct io n

(ownward pull, as in 6 uc k -s traction, may be a pp lie d to thel e g , but a n a dd iti o na l overhead pulley system isinc or p or ate d into the tr a c ti o n apparatus with the l e gsupported by a sling. he pull is up $toward the ceiling% andtoward the foot of the b e d .

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Ca r o# $ati nt% &it' R * %% !!/ % T r a ct io n :

+ ss ur e skin i nte g r ity by a v o id ing pressure on he e l,dorsum of foot, f i b ul a r head, or m a lle o lus

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M a int a in counteraction by e le v a ti ng foot of bed or k ee p inghead of bed f la t

0 nc o ur a g e ind e p e nd e nc e with use of tr a p e " e

0nsure sling is smooth and does not a pp ly undue pressure on p o p litea l s p a c e or p e r o ne a l nerve or l ate r a l aspect of k ne e

0. )r1ant,%T r a ct io n

Is used to immobili"e a f r a c tur e of the femur in c hi ld r e n whowe igh le ss than 27 pounds $89./ kg.%. his skin traction is as imp le r unni ng traction in which the l e g s are r a is e d at :7degree a ng le to the b o d y . 6oth l e g s are he ld in traction forcomport and b a la nc e even though only one l e g is a ff e c te d .

Ca r #or $ati nt% &it' )r1ant/% T r a ct io n :

! a is e buttocks slightly from m a ttr e ss

bserve bandages c a r e f ul ly for s li pp a g e and bunching overhe e l c or d s

bserve for skin s lo ug hi ng on both l e g s

&heck f ee t for color, pulses, warmth, and sensation 1/h to1 2 h

Use harness r e s tr a int to prevent turning o v e r

+void thick, wide d ia p e r s between l e g s

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Used in c hi ld r e n younger than ; years, we ig hi ng le ss than;7 l b

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+pply b ilate r a lly with hips with hips f le x e d 2< degreesand l e g s in e x te ns io n

0nsure skin i nte g r ity with no na d he s iv e straps and wrapsthat do no t im p a ir neurovascular s t a tus

0nsure buttocks are e le v ate d 8 to / in. from m a ttr e ss

0nsure p a r e nts 4 und e r s ta nd ing of the purpose and use oftr a c ti o n

Utili"e j a c k e t or vest r e str a int to prevent child from rotatingin the b e d

. C r"ica! H a0 Ha!t rT r a ct io n

=or neck p a in, neck s tr a in and whi p la s h, traction can be a pp lie dto the c e r v ic a l s p ine by means of a head ha lte r . he pull ofc e r v ic a l s k in traction should be f e lt as an upward pull on the

back of the neck. + s lig ht change in the l e v e l of the head of the bed is often the key to correct a pp lic a ti o n of this type oftraction. 6 e c a us e this is a form o f skin traction, it cannot be usedfor p r o lo ng e d p e r io d s .

his type of traction is often used by c lie nt at home with thec lie nt s itti ng in a c ha ir .It can be used to a lle v ia t e painful m u s c lespasm of the neck, to create a lignm e nt, or to prevent d e f or m iti e s .

Ca r #or $ati nt% &it' C r"ica! t r a ct io n :

+pply m a nu a l traction if pin l oo s e ns or penetration occurs. )otify

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p hy s ic ia n imm e d iate ly .

May use turning f r a m e s or s p e c ia l beds for p o s iti o ni ng

*osition without p illo ws

ake care that we ig ht and pulley are f r ee of wa ll

bserve for pressure a r ea s

>a ws andea r s ' id e of he a d

6ack ofhe a d

*ad as necessary for c o m f or t

2 . SKELETAL T RA CT I ON

-is a a pp lie d d ir e c tl y to the bone with wires or p ins that arei ns e r te d dur ing s urg e r y .

TYPES OF S K E L ET A L T RA C T I ON

S+*!! T r a ct io n or H a0 T r a ct io n

this form of s k e leta l traction is a cc o mp lishe d by i ns e r ti ng a p o intsof a skull tong d e v ic e $such as ? ink e or &rutchfield tongs% i nto thes k ul l bone. It is used reduced a f r a c tur e of the c e r v ic a l vertebrae.

his typ e traction is often used only te m p o r a r ily until a ha lod e v ic e can b e p la c e d .

Ca r o# $ati nt% &it' S+ ! ta! T r a ct io n :

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&over ends of pin with c or k

bserve s ite of i ns e ti o n

! e d ness

' we lling

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( is c ha r g e d or 6 lee d ing

&lea n skin around puncture s ite s as or d e r e d

3 . RUNNI NG T R A CT I ON

Is a p ul le d in one d ir e c ti o n a g a in s t the long a x is of the body o r bone. ith this type of traction, the body must be a lig ne d wi th the pulling force to be e ff e c ti v e

4 . C o n t i n u o u s or I n t !" i tt n t T ! # $ t i o n

TYPES OF

F I XA T OR

EXTERNAL

F I X ATO R

is the d e v ic e is used to manage c o mp le x f r a c tur e s that a ss o c iate dwith s o f t tissue damage or with open wounds in the f r a c tur e s area.+ p hy s ic ia n ins e r t s m ul ti p le p ins that protrude through thec lie nts of skin i nto the b o ne f r a g m e nts . he e x t e r na l fixationd e v ic e is a m e t a l frame that, on the o uts id e of the body, ho ld sthe p ins in p la c e and m a inta ins immobili"ation. he p ic tur eshown is an e x a mp le of e x te r na l f ix a to r b e ing used in thetr ea tm e nt of a f r a c tur e d r a d ius b o ne .

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INTERNAL FIXATORS

Inte r na l fixation is done through open reduction, the surgeon p la c e s a p in, wire, screw, p late , nail or rod i nto or onto the bone to keep itr e d uc e d $ p ro p e r ly a lig ne d %, immobili"ed, or both. his procedure isc a lle d o p e n reduction, i nte r na l fixation $,!I=% and is the treatment ofcho ic e for c e r ta in f r a c tur e s in which casting is g e ne r a lly imp o ss i b le$hip f r a c tur e %.

Inte r na l fixation can be performed u s ing v a r io us d e v ic e s . It is m o s tfre1uently with f r a c tur e s of the l e g s long bones, in which case thes p ik e is c a lle d intr a m e d ul la r y na il

SCIENTIFIC PRINCIPLES IN2OL2ED IN T RA C T I ON

3. Anato41 an0 $' 1 % io!o 5 1

raction care i nvo lv e s the m us c ul o s k e le t a l system. )urses should

b e k no wl e dg ea b le of the body parts a ff e c te d to preventc o mp lic a ti o ns . he knowledge about s k e leta l system whichinc lud e s the bones, j o ints and the skin involved r e g a r d ing tothe care of the patients wi th traction. he nurse should knowthis to imply the d iff e r e nt a r ea a ff e c te d and to make nur s inginte r v e ntio ns i mm e d iate ly if the p a ti e nt undergone d iff e r e ntc o m p lic a ti o ns towards the p ro c e d ur e .

6. 7 icr o ( io!o 5 1

*atients who have traction are of great risk for skin i nf e c ti o n b e c a us e the skin i nte g r ity is b e ing a lte r e d . he nurse observes the pin s it e s a t lea s t every 9 hours for d r a ina g e , color and severeredness whi c h ind ic a te inf la mm a ti o n and p o ss i b le inf e c ti o n. o

prevent i nf e c ti o n to happen the nurse must observe this p r inc i p le .

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If constipation d e v e lo p s # he r a p e uti c measures may i nc lud e As to o l s o f te ne r s

o i mp r o v e patient4s appetite, the nurse i d e nti f ie s and i nc lud e sthe patient4s food p r e f e r e nc e s , as a pp ro p r iate , within the

p r e s c r i b e d therapeutic d ie t.

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2. 2ENOUS THRO7)OE7)OLIS7 8 venous s ta s is that p r e d is p o s e sthe patient to venous thr o mb o e mb o lis m occurs with i mm o b ility .

he nurse teaches the patient to perform a n k le and foote x e r c is e s wi thi n the limits of the traction therapy every 8-/hours when awake to prevent ( ? .

he patient is encouraged to drink fluids to preventdehydration a nd a ss o c ia te d hemoconcentration, whichc o ntr i b ute s to s ta s is .

he nurse monitors the patient for s ig ns of (? includinguni late r a l c a lf tenderness, warmth, redness and swelling$inc r ea s e d c a lf c ir cum f e r e nc e %

he nurse promptly reports finding to the p hy s ic ia n ford e f ini ti v e e v a lua ti o n and the r a p y .


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b la dd e r r e late d to p o s iti o ni ng of the bed can result in ur ina r y s ta s is ininf e c ti o n. In a dd iti o n, the patient may find use of the bedpanunc o m f o r ta b le and may limit fluids to m ini m i" e the fre1uency ofur ina ti o n.

he nurse monitors the fluid i nta k e and character of the ur ine .

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he nurse teaches the patient to consume ade1uate amounts off lui d and to void every ;-2 hour sIf the patient e xhi b its s ig ns or symptoms of ur ina r y tract i nf e c ti o n,the nurse no ti f ie s the p hy s ic ia n


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C.8.C * r e ss ur e

- is there pressure on the l a t e r a l aspect of the l e g over thehe a d of the fibulaD *ressure in this area may result in a p a ls y of the

p e ro ne a l ne r v e .

C.8.9 *atient4s &o m f or t

- traction should never be a source of undue d is c o m f or t forthe patient. 3 is te n c a r e f ul ly and heed c o mp la ints of d is c o m f o r t.

C.8.: &o mp lic a ti o n

- because of the p r o lo ng e d bed rest and minimal a c ti v ity ,hypostatic pneumonia is a constant threat, p a r ti c ul a r ly to the e ld e r ly

p a ti e nt. 0 nc o ur a g e coughing and deep b r ea thi ng .


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- ins p e c t skin fre1uently to be sure that it is not b e ing rubbed,macerated by traction e1uipmentE r ea d jus t s p lint or the e x tr e m ity in thes p lint to f r ee the

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skin from p r e ss ur e- keep skin areas around the pin s ite s c lea n and d r y

C. =. T U R N I N :

- )ever li f t or change traction we ig hts without a doctor4s or d e r

- (o not remove traction or i nc r ea s e or decrease the amount of thewe ig ht without s p e c if ic o r d e r s

- + lwa y s t e ll the patient when you4re g o ing to remove or r e -a pp ly thete ns io n

- )ever drop a we ig ht when r ea pp ly ing traction but g r a d ua lly lowerthe we ig ht so the patient does not undergo sudden extreme s tr e ss

- a patient who may have the head rest up and down should be p o s iti o ne d c o mp lete ly f la t at lea s t half the time to prevent hip flexionc o ntr a c tur e s .

- hen traction is a pp lie d to the l e g a foot p late may be a pp lie d to p r e v e nt foot d ro p

- If patient4s l e g is in traction the foot should never r e s t

- urning to any p o s iti o n is g e ne r a lly p e r m itte d as long as theinte g r ity o f the traction is not c o mp r o m is e d and the patient is

c o m f or ta b le .

- prevent rotation of the l e g and s p lint. he he e l should not rest on the b e d or pressure ne c ro s is will d e v e lo p

- If pillows are used they should be f ir m e d so they will p r o v id ea d e 1 ua te support and will m a inta in a lignm e nt of the limb of thetraction a pp a r a tus .

- the e le v a ti o n of the h ee l should not hyperextend the k n ee

>. TOI L ET I N :

- use a f r a c tur e pan with b la nk e t roll or p a dd ing as support under the b a c k - protect the hom a s r ing s p lint with water proof m a te r ia l whenf e m a le patients are u s ing the bed p a n.

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