TRACTIONSThe principles of traction are a pulling force that is applied to part of the body, the limbs, the pelvisor the spine and a pulling force applied in the opposite direction called countertraction. The forces involvedin traction are based on Newton’s third law of motion, which states that for every action there has to be anequal, and opposite reaction. In other words to pull an object into one direction an equal counter-thrust inthe opposite direction has to be present.Uses- To relieve muscle and nerve compression- For alignment of the bone structures cause by fracture & contracturesDifferent types 1.Russell s Traction (Knee Contracture)a.Indications To reduce fractures of the femur hips Treatment of specific types of knee injuries or contractures.b. Mechanism of ActionTraction force is applied to the limb through application of skin traction. This can beaccomplished with traction tapes or a traction boot in older individuals.c. Nursing Consideration Application of elastic bandages:

Wrap bandages from ankle to thigh on patients younger than 2. Older patients should have bandages wrapped from ankle to knee.Proper application of the tapes prevents neurovascular compromise and ensures proper andadequate pull on the extremity. Place foot support against both feet.This prevents footdrop. Keep the heel free from the bed.Prevents pressure sores and ensures continuous tractionpull. Carefully assess the popliteal space for signs of pressure form the knee sling.Preventspressure sores, or neurovascular compression.  2.Buck’s Traction (Hip Fracture) a. IndicationsUsed to correct or prevent knee and hip contractures, to rest the limb, to prevent spasm ofinjured muscles or joints, or to temporarily immobilize a fractured limb.b. Mechanism of ActionThe traction force is delivered through traction boot or skin traction in a straight line.c. Nursing Considerations Patients should be encouraged to move themselves around the bed using the “MonkeyBar” and it is suggested to have the side rail of the bed up to assist in movement Deep breathing and ankle pump exercises as well as the use of TEDS stockings andanticoagulant therapy are waysto prevent DVT or Pulmonary Embolism.  Calves should be inspected for tenderness, unusual warmth and redness and any signs ofdyspnea and tachypneacan indicate a Pulmonary Embolism.

 Neurovascular checks and assessment of movement should be done before applyingtraction then hourly for the first twenty-four hours and if all is well four-hourly thereaftertoprevent peripheral dysfunction such as compartment syndrome or nerve paralysis Patients should be encouraged to take analgesia before pain becomes severe. Education with regards to addiction fears and risk of constipation need to be provided. The use of fracture pans, provision of privacy, high fluid intake, roughage in the diet and ifneeded aperients can all help in promoting normal bowel elimination

 3.Dunlop’s traction (overhead 90-90  a. IndicationsUsed to treat fractures of the humerus and injuries in or around the shoulder girdle.b. Mechanism of ActionTraction force is applied usually through skin traction on the upper arm only. Occasionally,skeletal traction through an olecranon screw or pin in the distal humerus may be indicates. Thelower arm is held in balanced suspension only. The elbow is maintained at 90 degrees of flexionor slightly more.c. Nursing Considerations Make sure that the traction tapes are properly adhered and wrapped.It prevents damageto the skin and ensures proper pull.  Assess the neurovascular status of the extremity every 2 hours.Elastic bandages can causecirculatory or neurologic compromise. Early detection can prevent patient harm.  4.  Bryant’s Traction (Femur Fracture) a. Indicationso To reduce fractures of the femur in children younger than age 2 or weighing less than 30lbs (14kg)o Also used to stabilize the hip joint when casting is not indicated.o Preoperatively to attempt reduction of a congenitally dislocated hip in the same age-group.b. Mechanism of ActionInvolves the bilateral vertical extension of the child’s legs. The child’s weight serves as thecounter traction. Skin traction is applied to both limbs to minimize potential trauma andmaintain stability and alignment of child.c. Nursing Considerations Maintain appropriate position:o 

The legs are extended at right angles to the body.o The hips are elevated slightly form the bed.o The buttocks are elevated slightly from the bed.This ensures proper traction pull. o The heels and ankles are free form pressure.Prevents skin breakdown. Proper positioning is needed to achieve desired results. Check condition and position of elastic bandages every shift. Rewrap as indicated andpermitted by the health care provider.Elastic bandages can cause compression andcompromise circulation. In addition, force across skin surfaces needs to be constant and freefrom constriction to prevent skin breakdown and ensure adequate traction force. 5. Cervical Tractiona. IndicationsUsed for stabilization of spinal fractures or injuries, muscle spasms, muscle contractures.b. Mechanism of actionTraction force applied through a head halter (skin traction) or directly to the skull by means ofCrutchfield tongs or halo apparatus.c. Nursing Considerations Head halter must be assessed for proper positioning. It should not place pressure on ears,or throat.Prevents pressure sores.  Maintain flat be position.Proper spinal alignment is critical to prevent further injury.  Keep the child in proper position and alignment. Crutchfield tongs or halo pin sites should be treated as skeletal traction sites.Preventsinfection.  If permissible, place the child on a Stryker frame or specially equipped bed. Allows the childto be repositioned without disrupting spinal alignment.

Different Types Of Skeletal TractionBalance suspension traction is used to stabilize fractures of the femur. It can be the skin or skeletal type.

Balanced Suspension Traction

Balanced suspension traction is used to stabilize fractures of the femur. It can be the skin or skeletal type. If it is skeletal, a pin or wire is surgically placed through the distal end of the femur. If it is skin traction, tape and wrapping or a traction boot of the kind described under Buck’s traction is used.

The patient is in the supine position, with the head of the bed elevated fro comfort. As the name suggests, the affected leg is suspended by ropes, pulleys, and weights in such a way that traction remains constant, even when the patient moves the upper body.

Two important components of balanced suspension traction are the Thomas splint and the Pearson attachment. The Thomas splint consists of a ring, often lined with foam, that circles and supports the thigh. Two parallel rods are attached to the splint and extend beyond the foot. A Pearson attachment consists of a canvas sling that supports the calf.

Parallel rods lead from the pin sites on the distal and of the attachment for the rope. Traction to the femur is applied through a series of ropes, pulleys, and weights. These weights hang freely at the foot off the bed.

The skin should be inspected frequently to identify problems early. The ring of the Thomas splint can excoriate the skin of the groin. Special padding may have to be used. Again, the foot should always be at a right angle on the footrest to prevent footdrop. If pins are used for fixation, aseptic technique must be used around pin sites until they have healed. From then on, clean technique can be used. The pin sites are cleansed carefully with soap and water and rinsed thoroughly, unless this varies from policy. An antiseptic, such as povidone-iodine ointment, may then be applied. Dressings are usually not required. You should, however, constantly assess for infection at the pin sites. Indications include redness, heat, drainage, pain, or fever. Review your facility’s policy on pin care.

Skull Tongs Traction

Skull tongs are used to immobilize the cervical spine in the treatment of unstable fractures or dislocation of the cervical spine.

Although Crutchfield tongs were used almost exclusively in the past, Gardner-Wells skull tongs are in wide use. Some think these

are less likely to pull out than the Crutchfield tongs. The patient is prepared for either type with a local anesthetic to the scalp. The

tongs are surgically inserted into the bony cranium, and a connector half-halo bar is attached to a hook from which traction can be

applied.

The patient is supine and is usually on a special frame instead of the regular hospital bed. If a hospital bed is used, two or more

people are required to assist the patient with any turning movements. The head of the bed may be elevated to provide counter

traction.

Because patients remain in this type of traction for an extended period, observe the precautions taken for the patient in other types

of skeletal traction. Difficulties with the performance of activities of daily living, infection at the tong sites, and restlessness and

boredom are common. It is useful to teach the patient range-of-motion exercises, provide good nutrition and suggest recreational or

occupational activities.

Halo Traction

Halo traction provides stabilization and support for fractured cervical vertebrae. The surgeon inserts pins into the skull. A half circle

of metal frame connects the pins around the front of the head. Vertical frame pieces extend from a halo section to a frame brace that

rests on the patient’s shoulders. The halo traction allows the patient to be out of bed and mobile while stabilizing the cervical

vertebrae could injure the spinal cord.

 raction

Definition

Traction is the use of a pulling force to treat muscle and skeleton disorders.

Purpose

Traction is usually applied to the arms and legs, the neck, the backbone, or the pelvis. It is used to treat fractures, dislocations, and

long-duration muscle spasms, and to prevent or correct deformities. Traction can either be short-term, as at an accident scene, or

long-term, when it is used in a hospital setting.

Traction serves several purposes:

it aligns the ends of a fracture by pulling the limb into a straight position

it ends muscle spasm

it relieves pain

it takes the pressure off the bone ends by relaxing the muscle

There are two main types of traction: skin traction and skeletal traction. Within these types, many specialized forms of traction have

been developed to address problems in particular parts of the body. The application of traction is an exacting technique that requires

training and experience, since incorrectly applied traction can cause harm.

Positioning the extremity so that the angle of pull brings the ends of the fracture together is essential. Elaborate methods of weights,

counterweights, and pulleys have been developed to provide the appropriate force while keeping the bones aligned and preventing

muscle spasm. The patient's age, weight, and medical condition are all taken into account when deciding on the type and degree of

traction.

Precautions

People who are suffering from skin disorders or who are allergic to tape should not undergo skin traction, because the application of

traction will aggravate their condition. Likewise, circulatory disorders or varicose veins can be aggravated by skin traction. People

with an inflammation of the bone (osteomyelitis) should not undergo skeletal traction.

Description

Skin traction

Skin traction uses five-to seven-pound weights attached to the skin to indirectly apply the necessary pulling force on the bone. If

traction is temporary, or if only a light or discontinuous force is needed, then skin traction is the preferred treatment. Because the

procedure is not invasive, it is usually performed in a hospital bed.

Weights are attached either through adhesive or nonadhesive tape, or with straps, boots, or cuffs. Care must be taken to keep the

straps or tape loose enough to prevent swelling and allow good circulation to the part of the limb beyond the spot where the traction

is applied. The amount of weight that can be applied through skin traction is limited because excessive weight will irritate the skin

and cause it to slough off.

Specialized forms of skin traction have been developed to address specific problems. Dunlop's traction is used on children with

certain fractures of the upper arm, when the arm must be kept in a flexed position to prevent problems with the circulation and

nerves around the elbow. Pelvic traction is applied to the lower spine, with a belt around the waist. Buck's skin traction is used to

treat knee injuries other than fractures. The purpose of this traction is to stabilize the knee and reduce muscle spasm.

Skeletal traction

Skeletal traction is performed when more pulling force is needed than can be withstood by skin traction; or when the part of the body

needing traction is positioned so that skin traction is impossible. Skeletal traction uses weights of 25-40 pounds.

Skeletal traction requires the placement of tongs, pins, or screws into the bone so that the weight is applied directly to the bone. This

is an invasive procedure that is done in an operating room under general, regional, or local anesthesia.

Correct placement of the pins is essential to the success of the traction. The pin can be kept in place several months, and must be

kept clean to prevent infection. Once the hardware is in place, pulleys and weights are attached to wires to provide the proper pull

and alignment on the affected part.

Specialized forms of skeletal traction include cervical traction used for fractures of the neck vertebrae; overhead arm traction used

for certain types of upper arm fractures; and tibia pin traction used for some fractures of the femur, hip, or pelvis.

Preparation

X rays are done prior to the application of both forms of traction, and may be repeated during treatment to assure that the affected

parts are staying in alignment and healing properly. Since the insertion of the anchoring devices in skeletal traction is a surgical

procedure, standard preoperative blood and urine testing are done, and the patient may meet with an anesthesiologist to discuss

any health conditions that might affect the administration of anesthesia.

Aftercare

Aftercare for skin traction involves making sure the limb stays aligned, and caring for the skin so that it does not become sore and

irritated. The patient should also be alert to any swelling or tingling in the limb that would suggest that the limb has been wrapped

too tightly.

Aftercare for skeletal traction is more complex. The patient is likely to be immobile for an extended period. Deep breathing exercises

are taught so that respiratory function is maintained during this time of little activity. Patients are also encouraged to do range-of-

motion exercises with the unaffected parts of the body. The patient is taught how to use a trapeze

Traction refers to the usage of a pulling force and special devices, such as a cast or splint, to treat muscle and skeletal disorders. It

is used to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities. The illustration

above features several commonly used forms of traction.

(Illustration by Electronic Illustrators Group.)

(an overhead support bar) to shift on and off a bedpan, since it is not possible to get up to use the toilet. In serious injuries, traction

may be continued for several months until healing is complete.

Risks

The main risks associated with skin traction are that the traction will be applied incorrectly and cause harm, or that the skin will

become irritated. There are more risks associated with skeletal traction. Bone inflammation may occur in response to the

introduction of foreign material into the body. Infection can occur at the pin sites. If caught early, infection can be treated with

antibiotics, but if severe, it may require removal of the pin.

Both types of traction have complications associated with long periods of immobility. These include the development of bed sores,

reduced respiratory function, urinary problems, and circulatory problems. Occasionally, fractures fail to heal. Being confined to

traction for a long period can take a an emotional toll on the patient, also.

Normal results

When correctly applied, traction generally produces very good, if slow, results.

Resources

Traction is a pulling force which is applied to a part of the body while a countertraction pulls in the opposite direction. Listed here are the different types of traction with their corresponding indication.

1. Balance Suspension Traction – femoral affectation

2. Boot Leg Cast Traction – hip and femur affectation

3. Braun Splint Traction – temporary traction before Balance Suspension Traction

4. Bryant’s Traction – femoral fractures, hip injuries for children below 4 yrs. old

5. Buck’s Extension – fractured femur and hip

6. Dunlop’s Traction – supracondylar fracture of the humerus

7. Halo Femoral – severe scoliosis

9. Halo Pelvic Girdle – scoliosis and severe back pain

10. Hammock Suspension Traction – affectation of the pelvis

11. Head Halter – cervical spine affectation

12. Pelvic Girdle – lumbosacral affectation, HNP

13. Russel’s Traction – fracture of the femur

14. Skeletal Leg Traction – fracture of the femur

15. Stove-in-Chest – severe chest injury with multiple fracture

• Skin traction is used to control muscle spasms and to immobilize an area before surgery.

• Skin traction is accomplished by using a weight to pull on traction tape or on a foam boot attached to the skin. The amount

of weight applied must not exceed tolerance of the skin.

No more than 2 to 3.5 kg (4.5 to 8 lb) of traction can be used on an extremity. Pelvic traction is usually 4.5 to 9 kg (10 to 20 lb),

depending on the weight of the patient.

Types of skin traction: used for adults include Buck's extension traction (applied to the lower leg), the cervical head halter (occa-

sionally used to treat neck pain), and the pelvic belt (sometimes used to treat back pain).

Skeletal Traction

• to treat fractures of the femur, the tibia, and the cervical spine. The traction is applied directly to the bone by use of a

metal pin or wire

Nursing Process:

The patient in Traction

• Assessment:

• evaluate the body part to be placed in traction and neurovascular status (ie, color, temperature, capillary refill, edema,

pulses, ability to move, and sensation) and compare it to the unaffected extremity.

Nursing Intervention:

• promoting understanding of treatment regimen:

• Reducing Anxiety.

• Achieve a maximum level of comfort.

• Achieving Maximum self care.

• Attaining maximum Mobility with traction.

• Monitoring and managing potential complication.

Types of Traction

Bryant’s traction: used for children younger

than 3 years and weighing less than

35 pounds who have a fractured femur or

congenital hip dyplasia

Buck’s traction: used for knee immobilization

or for short-term immobilization of a fracture

Dunlop’s traction: used for supracondylar

fractures of the humerus

Russell’s traction: used for fractures of the

femur and lower leg

physiologic effect:

Directly or indirectly relate to decreased muscle activity and have an impact on all systems

Integumentary

Red or irritated skin

Presence of ulceration or drainage

Gastrointestinal

Decreased mobility leads to constipation

Nursing Considerationsfor the Child in a Cast or in Traction

Keep cast or other appliance clean and dry (especially from urine or feces)

Monitor bowel sounds

Assess for abdominal distention

Provide optimal nutrition for bone healing, growth, and development

Neurovascular assessment every 1 to 2 hours after application of device

Assessment of strength of pulse distal to the site

Assessment of capillary refill

Assessment of five P’s

Reposition every 2 hours; encourage mobility within the confines of traction or cast

Prevent skin breakdown