TRACTION
PURPOSE
•To relieve pain due to muscle spasm, maintaining the limb in a position of comfort and rest.
• To restore and maintain alignment of bone following fracture and dislocation.
•To help restore blood flow and nerve function.
• To allow treatment and dressing of soft tissues.
•To rest injured or inflamed joints, and maintain them in a functional position.
• To allow movement of joints during fracture healing.
•To gradually correct deformities dueto contraction of soft tissues, caused by disease or injury.
• To allow the patient to be moved with ease
TYPES
There are two major types of traction: skin and skeletal traction, within which there are a number
of treatments.
1. Skin traction
Skin traction includes weight traction, which uses lighter weights or counterweights to apply
force to fractures or dislocated joints. Weight traction may be employed short-term, (e.g., at the
scene of an accident) or on a temporary basis (e.g., when weights are connected to a pulley
located above the patient's bed). The weights, typically weighing five to seven pounds, attach to
the skin using tape, straps, or boots. They bring together the fractured bone or dislocated joint so
that it may heal correctly.
In obstetrics, weights pull along the pelvic axis of a pregnant woman to facilitate delivery.
In elastic traction, an elastic device exerts force on an injured limb.
Skin traction also refers to specialized practices, such as Dunlop's traction, used on children
when a fractured arm must maintain a flexed position to avoid circulatory
and neurological problems.
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.
2. Skeletal traction
Skeletal traction requires an invasive procedure in which pins, screws, or wires are surgically
installed for use in longer term traction requiring heavier weights. This is the case when the force
exerted is more than skin traction can bear, or when skin traction is not appropriate for the body
part needing treatment. Weights used in skeletal traction generally range from 25–40 lbs (11–18
kg). It is important to place the pins correctly because they may stay in place for several months,
and are the hardware to which weights and pulleys are attached. The pins must be clean to avoid
infection. Damage may result if the alignment and weights are not carefully calibrated.
Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis, hip, or
femur; and overhead arm traction, used in certain upper arm fractures.
Cervical traction is used when the neck vertebrae are fractured.
ESSENTIAL PRINCIPLES
• The grip or hold on the patient’s body must be adequate and secure.
• Provision for counter traction must be made.
• There must be minimal friction on the cords and pulleys.
•The line and magnitude of the pull, once correctly established, must be maintained.
•There must be frequent checks of the apparatus and of the patient to ensure that:
-the traction set-up is functioning as planned.
- the patient is not suffering any injury as a result of the traction treatment.
The grip or hold on the body is achieved:
- manually
-via theskin
-via the bone.
Poorly applied traction can cause considerable discomfort to the patient, and may retard
rehabilitation.
It is important, therefore, that staff responsible for setting up and maintaining traction are
thoroughly familiar with the principles of traction, so that the mechanics of each type of traction
set-up are well understood.
INDICATIONS
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.
APPLICATION
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.
Non adhesive skin traction :Useful in thin and atrophic skin. Frequent reapplication may
be necessary. Attached traction wt. must not be more than 4.5 kgs.
EQUIPMENT
• one adhesive or non-adhesive traction kit
• crêpe bandages (if not in the kit)
• padding (if not integral to the kit)
• tape
• scissors
PROCEDURE
Patient’s legs, heels, elbows and buttocks may develop pressure areas due to remaining in the
same position and the bandages.
Position a rolled up towel/pillow under the heel to relieve potential pressure.
Encourage the patient to reposition themselves or complete pressure area care four hourly.
Remove the foam stirrup and bandage once per shift, to relieve potential pressure and
observe condition patients skin.
Keep the sheets dry.
Document the condition of skin throughout care in the progress notes and care plan
Ensure that the pressure injury prevention score and plan is assessed and documented.
Traction care
Ensure that the traction weight bag is hanging freely, the bag must not rest on the bed or the
floor
If the rope becomes frayed replace them
The rope must be in the pulley tracks
Ensure the bandages are free from wrinkles
Tilt the bed to maintain counter traction
Observations
Assessment of pain is essential to ensure that the correct analgesic is administered for the
desired effect
Paracetamol, Diazepam and Oxycodone should all be charted and administered as necessary.
Pre-emptive analgesia ensures that the patient’s pain is sufficiently managed and should be
considered prior to pressure area care.
Activity
The patient is able to sit up in bed and participate in quiet activities such as craft, board
games and watching TV
Non-pharmacological distraction and activity will improve patient comfort.
The patient is able to move in bed as tolerated for hygiene to be completed
CONCLUSION
Skin traction is a nonsurgical treatment option that can help heal fractured bones or
orthopedic abnormalities. This treatment is often used for children, and almost always used to
help treat leg injuries or abnormal leg development. Traction pulls the skin that lies on or near
the affected bone, manipulating soft tissue and pulling the bone into a fixed, rigid position. This
forces the bone to stay in the corrective spot. Skin traction should only be applied by a team of
medical professionals, following a formal diagnosis and skin traction prescription.
REFERENCES
2. Perry A G, Potter P A. clinical nursing skills & techniques. 6th edition. 2006. Elsevier
mosby. USA
3. Proehl J A.emergency nursing procedure.Third edition.Missouri; Elsevier publications.
2004
4. Nancy sr. (2008)Principles & practice of nursing. 6 th edition
5. Jacob Annamma, R Rekha , Jadhav Sonali Tarachand.(2011) Clinical nursing procedures: the
art of nursing practice
6. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/skin_traction
7. file:///C:/Users/hp/Downloads/PUB-004721%20(1).pdf
8. https://www.surgeryencyclopedia.com/St-Wr/Traction.html#ixzz5aZdx25je