Traction

 Define traction
 Understand the principles of traction
 Enlist the different types of traction
 Discuss the advantages, disadvantages
and complications of traction
 List the specific traction system and
their uses
 Explain the nursing management.

 ‘’Traction is the application of a pulling force
for medical purposes, to treat muscle or
skeletal disorder - for example, to reduce
fracture, maintain bone alignment, relieve
pain, or prevent spinal injury”

The use of traction
dates as far back as
3000 years ( ancient
Egyptians ).
Hippocrates (350BC)
wrote manual traction
and the forces of
extension and counter
extension.
Used extensively in
civil war for
fractured femurs.

Counter traction must be
used to achieve effective
traction.
TRACTION MUST PRODUCE A
PULLING EFFECT ON THE BODY.
Precise amount of weight must
be applied. The weights must hang
freely .

To relieve pain caused by muscle spasm
To reduce and immobilize fracture.
To restore and maintain proper
alignment of the injured bone.
To treat dislocations and spinal cord
compressions due to prolapsed inter
vertebral disc .
To prevent and correct deformities.

 Decrease pain.
 Maintains functional position until
healing is complete.
 Restricts movements while the
injury heals
 Prevent or reduce skeletal
deformities
 Allows more joint mobility than
plaster

Costly in terms of hospital stay
Hazards of prolonged bed rest :
DVT, Pulmonary embolism, Pressure
wounds/ulcer, Pneumonias
Requires meticulous nursing care
Can develop contractures

Types
Based on
mechanism
Fixed
traction
Sliding
traction
Based on
method
Skin
traction
Skeletal
traction

 BASED ON MECHANISM
 Fixed traction
 By applying force against a fixed point
of body. Ex: fixed traction by Thomas
splint.

•Sliding traction
 By tilting bed so that patient tends
to slide in opposite direction to
traction force. Ex: Hamilton Russell
traction, Perkins traction.

 BASED ON METHOD
 SKIN TRACTION
 The traction force applied over a large area
of skin.

•Applied directly to the
bone either by a pin or
wire through the bone.
(eg- Steinmann pin,
denham pin, kirschner
wire

SKIN TRACTION SKELETAL TRACTION
Indication Mild to moderate
force
Moderate to severe
force
Weight
permitted
3-4kg Up to 20kg
Applied with Adhesive /non
adhesive tape
e.g: Buck’s
Traction/ Gallow’s/
Bryant
Steinmann
pin,Kwire
Crutchfield
tong/Ilizarow wire/
Denham pin
Applied on Skin Bone
Age used Child Adult
Used for short duration long duration

 Traction force is applied over a large area of
skin.
 Traction force transmitted from skin to deep
fascia and intermuscular septa to bone.
 Applied over limb distal to fracture site.
 Anteromedial and posterolateral
part should be covered with cotton.

Skin damage can result
from too much of traction
force.
´Maximum weight
recommended for skin
Traction is 6.7 kgs
´Depending on size and
weight of the patient

 Adhesive skin traction :
Prepare the skin by shaving as well as washing &
applying tincture benzoin which protects the skin
and acts as an additional adhesive.
Avoid placing adhesive strapping over bony
prominences, if not, cover them with cotton
padding and do the strapping.
Leave a loop of 5 cm projecting beyond the distal
end of limb to allow movement of fingers and foot.

 Useful in thin and atrophic skin.
 Frequent reapplication may be
necessary.
 Attached traction weight must not
be more than 4.5 kgs.

Temporary management of neck of
femur fracture.
Femoral shaft fracture in children.
Un displaced fracture of acetabulum.
After reduction of dislocation of Hip.
To correct minor fixed flexion
deformities of hip and knee.
Management of low back ache.

 Abrasions and lacerations of skin in the
area to which traction is to be applied
 Varicose veins, impending gangrene
 Dermatitis
 Patients with loose skin.

 Allergic reactions from the adhesive material.
 Blister formation and pressure sores from
slipping straps.

• Compartment syndrome from over-tight wrap.
• Peroneal nerve palsy from wraps about the knee.

 BUCK’S TRACTION
 HAMILTON RUSSEL TRACTION
 GALLOW’S OR BRAYANT’S TRACTION
 PELVIC TRACTION
 DUNLOP TRACTION

 Femoral neck fracture
 Inter Trochanteric fracture
 After reduction of a hip
dislocation
 To correct minor flexed
deformities of the hip or knee
 Management of low back pain.
 Not more than 4.5 kgs.

• Used in femur trochanteric # .
• Bucks with sling

 Fracture shaft of femur in <2yrs age.
 Skin traction is applied to both legs
child is suspended from a beam
 Raise mattress for counter traction
 Rarely used currently.

• Treatment of tibia and femur
from the sub trochanter
region distally.
• Denham pin is inserted
through upper end of tibia
for fracture of femur, the mid
tibia for fracture of condyles
of tibia

 Agnus hunt traction is used for
correction of mild flexion deformity
of hip joint in poliomyelitis.

 Used for supracondylar
and transcondylar
fractures in children
 Forearm skin traction
with weight on upper arm
 Elbow flexed at 45
degrees.

 It may be used as a
means of reducing or
maintaining the
reduction of a fracture
 It should be reserved for
those cases in which
skin traction is
contraindicated.

 steel pins of varying lengths 4 – 6 mm
in diameter. Bohler stirrup is attached
to steinmann pin which allows the
direction of the traction to be
changed without turning the pin in the
bone.

 Denham Pin Identical to stienmann
pin except for a short threaded
length in the center . This threaded
portion engages the bony cortex
and reduce the risk of the pin
sliding.

 Kirschner wire They are easy to
insert and minimize the chance of
soft tissue damage and infections,
It easily cuts out of the bone if a
heavy traction weight is applied,
Most commonly used in upper limb
eg. Olecranon traction

 Use GA or LA.
 Paint the skin with iodine and spirit.
 Mount the pin/wire on the hand drill.
 Identify the site of insertion and
make a stab wound.
 The pin should pass only through
skin, SC tissue and bone avoiding
muscles and tendons.

 To hyper extend the head and
neck of patients with fractured
cervical vertebrae for the
purpose of immobilizing and
aligning the vertebrae

Introduction of infection into bone.
Incorrect placement of pin.
allows pin to cut out of bone.
makes application of splint difficult.
Large traction force
Distraction at fracture site.
Ligamentous damage .
Damage to epiphyseal growth plates
in children.
Depressed scar and stiffness of
joints.

 Impaired Physical Mobility
 Risk for Impaired Skin Integrity
 Risk for Infection
 Ineffective Tissue Perfusion

 Encourage active exercise of uninvolved
muscles and joints.
 Encourage deep breathing and coughing
 Auscultate lung fields twice per day.
 Encourage fluid intake of 2,000 to 2,500 ml daily.
 Provide balanced high-fiber diet rich in protein.
 Prevent pressure on the calf, to prevent
thrombophlebitis.
 Check traction apparatus at repeated intervals.

 Examine bony prominences frequently for
evidence of pressure or friction irritation.
 Observe for skin irritation around the
traction bandage.
 Observe for pressure at traction skin
contact points.
 Report complaint of burning sensation
under traction.
 Relieve pressure without disrupting
traction effectiveness.

 Watch for signs of infection, especially
around the pin tract.
 Monitor vital signs for fever or tachycardia.
 If directed, clean the pin tract with sterile
applicators and apply the prescribed
solution/ ointment

 Assess motor and sensory function of
specific nerves that might be compromised.
 Determine adequacy of circulation (eg,
colour, temperature, motion, capillary refill
of peripheral fingers or toes).
 Report promptly if change in neurovascular
status is identified.

CARE OF CLIENT IN TRACTION
T Temperature
R Ropes hang freely
A Alignment
C Circulation check (5 P’s)
T Types and location of fracture
I Increase fluid intake
O Overhead Trapeze
N No weights on bed or floor
Extremity
infection

 PAIN
 PULSE
 PALLOR
 PARESTHESIA
 PARALYSIS
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