APPLICATION BALANCED SKELETAL TRACTION INDICATION: 1. To prevent or correct deformity 2. To maintain good body alignment 3.

To provide pain immobilization 4. To reduce pain and muscle spasm, reduce fracture. 5. To support the affected area PREPARATION PHASE: 1. Check for the doctors order 2. Inform and explain the purpose and procedure to the patient for easy installation and cooperation 3. Assemble all equipment Thomas splint with Pearson attachment Rest splint 5 Slings (variable sizes) 5 Paper Clips or Safety pins Cord Sash (different length) Short for thigh Long for traction Longest for suspension Weights and bags Traction wt. 10% of patients weight Suspension wt. (50% or lighter than traction bag) Foot support (prevent foot drop) Parts 1. 2. 3. 4. of an Orthopedic Bed Firm Mattress Fracture Board Bed Elevator or Shock Block Balkan Frame o 4 Vertical bars o 2 Horizontal bars o 1 diagonal bar o 1 Straight bar or cross bar o 1 Curve bar (optional) 5. 3 Pulleys with the clamps (hold place) 6. Overhead Trapeze

PROCEDURE PHASE: 1. Mount Thomas splint to Pearsons attachment Upper part is Thomas splint, which support the thigh Lower part is the Pearsons attachment, which will support the leg Check alignment of screw of Pearsons with knee joint 2. Attach / apply Rest splint to Thomas splint and Pearson attachment 3. Apply slings to Thomas splint and Pearson attachment Start from thigh area (Thomas splint) then to leg area (Pearson attachment) From medial to lateral upright Wider and long slings at thigh area Smooth / right side should be touching or in contract the patients skin Provide space or 1 inch apart between the slings for ventilation and prevent irritation Popliteal and heel / sole of the foot should be free sling Apply not to lose or not too tight to support and follow contour of leg 4. Tie the short rope (thigh rope) to medial portion of the Thomas splint with Slip Knot
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 Provide privacy 5. Apply the prepared set-up to the patient 3 Manpower Apply manual traction Apply manual traction Lifting the affected leg removing the Braun Bohler Insert the prepared set-up At the count of 3 do simultaneously Instruct the patient to flex the unaffected leg Hold on to the overhead trapeze Lift the buttocks 6. Tie the longer rope to the Steinmanns pin (slip knot), pass the 3rd pulley then hang and tie the traction weight bag (any kind of knot will do, securely tied and will not fall) 7. Finish or tie the other end of the short rope to the lateral aspect of the Thomas splint 8. Tie the longest rope to the middle of the short rope (slip knot) Insert to the 1st pulley Hang the suspension weight bag and anchor to the clamp insert the rope to the 2nd pulley 9. Tie to the Tomas splint using the clove hitch knot then to Pearson attachment. Be sure the rope is outside the traction rope Outside / under the rest splint (removed later) 10. Release suspension weight bag Check alignment of the traction 1st pulley in line with inguinal area 2nd pulley in line with the knee 3rd pulley in line with the 1st and 2nd 11. Apply foot support using Ribbon Knot 12. Remove the Rest splint 13. Check the efficiency of the traction Flex the unaffected side Hold on the overhead trapeze Swing the affect leg PRINCIPLES OF TRACTION APPLICATION Have an opposite pull or counter traction Line of pull should be in line of deformity Traction should be continuous Position of the point should be dorsal recumbent or supine Avoidance of friction a) Weight should be hanging freely b) Observe for signs of wear and tear on the ropes and bag c) Rope should run freely along the grove of the pulley NURSING CARE 1.) General hygiene and comfort Skin care Hair care Nail care Oral and perineal care Sponging of affected leg 2.) Conditioning exercises Deep breathing Coning exercise Address ROM exercise Static quadricep exercise
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 Dorsiflexion and plantar flexion of leg 3.) Provide diversional activities increase coping mechanics for boredom 4.) Meeting nutritional needs protein, vitamin c, calcium 5.) Working pertinent observation COMPLICATION AND NURSING MANAGEMENT a) Hypostatic pneumonia Deep breathing Keep back dry b) Bed sore /decubitus ulcer Linen free from wrinkles/ creases Keep back dry, lift buttock c) Joint contractor and muscleatrophy Active exercise (unaffected) Isometric (affected) d) Constipation Fluid intake High roughage diet Exercise Offer bedpan e) Infection Meticulous wound care REMOVAL 1) Attach the rest splint 2) Anchor the suspension weight to the pulley 3) Remove the suspension rope 4) Apply manual traction 5) Remove traction weight. Tie the rope the rest splint, Thomas splint and Pearsons attachment using the clove hitch knot. (READY TO TRANSFER) TRACTIONS TYPES INDICATION 1. BALANCE SKELETAL TRACTION Fracture of hip and femur 2. BOOST CAST TRACTION Post polio with residual paralysis 3. BRYANT TRACTION Fracture of hip and femur. For Congenital Hip Dislocation 4. BUCKS EXTENSION TRACTION Fracture of hip and femur 5. COTREL TRACTION For Scoliosis 6. CRUTCHFIELD ONG Fracture of cervical spine 7. DUNLOP TRACTION Fracture of the supracodylar of the humerus 8. HALO-FEMORAL TRACTION For Scoliosis 9. HALO-PELVIC TRACTION For Scoliosis (severe) 10. HAMMOCK SUSPENSION Fracture of the pelvis TRACTION 11. HEAD HALTER TRACTION Fracture of the cervical spine 12. 90 90 DEGREES Fracture of the subtrochanteric TRACTION 13. OVERHEAD TRACTION Fracture of the supracondyle of humerus 14. PELVIC GIRDLE Fracture of the lumbar spine. For Herniated nucleus Polposus 15. VINKES CALLIPER Fracture of the cervical spine 16. ZERO DEGREE TRACTION Fracture of the surgical humerus 17. Stove in chest Multiple rib fractures

BRACES 1. 2. 3. 4. 5. 6. TYPES BANJO SPLINT BILATERAL LEG BRACE CHAIR BACK BRACE COCKED-UP SPLINT DENNIS BROWN SPLINT FORESTER BRACE INDICATOR Peripehral nerve injury Post polio with residual paralysis, Lumbo-sacral affection Prevention of wrist drop Club foot deformity Cervico-thoraco-lumbar spine affection Cervical spine affection Dorso-lumbar spine fracture Upper spine fracture Scoliosis Peripheral nerve injury Cervical spine affection (thick) Cervical spine affection (soft) Post polio with residual paralysis scoliosis

7. FOUR POSTER BRACE 8. JEWETTE BRACE 9. KNIGHT/TAYLOR BRACE 10. MILWAUKEE BRACE 11. OPPEN HEIMER SPLINT/LIVELY FINGER 12. PHILADELPHIA COLLAR 13. SHANTZ COLLAR 14. UNILATERAL LEG BRACE 15. YAMAMOTO BRACE

GADGETS HARDWARE TYPES INDICATOR Crutch field Tong Cervical Spine Circlage Wiring Patella Gigli saw For amputations Antibiotic bead Osteomyelitis X pinning/Y bone pinning Supracondylar fx of the humerus Roger Anderson External Fixator Comminuted fracture of long bones (RAEF) Total knee Arthroplasty (TKA) Tibial & Femoral components Degenerative joint disease (osteoarthritis) Harrington Rod Instrumentation Scoliosis Hybrid External Fixator Periarticular injuries such as your knee & ankle joints Ilizarov external Fixator Mal-union, bone loss & bone lengthening Total replacement Hip Arthroplasty Femoral head, femoral neck including (TRHA) acetabulum Partial replacement Hip Prosthesis Femoral head and neck fracture (PRHP) Compression Hip screw Fixation Intertrochanteric fracture (CHSF) Tower/Interdental Wiring Fracture of mandible Intramedullary Nailing Fracture middle 3rd femur Tibidal Femural component Degenerative uses T-plate or buttress planting Proximal tibia Planting with Screw Radius ulna fracture Hoffmann external fixator Fracture of pelvis Spacer antibiotic Infected hip prosthesis Delta frame Periarticular injuries such as your knee & ankle joints 3 PRINCIPLES IN MANAGEMENT OF FRACTURE: 1. Close or Open Surgery reduction 2. Immobilization Traction, brace, cast 3. Rehabilitation restoration of function, Physical Therapy exercise OT & Surgery