INTRODUCTION

Orthopedic interventions are some of the oldest recorded areas of

medical practice. The nurse teaching the client with musculoskeletal
disorders is challenged to deal with traditional methods and to stay
current with change.

No matter what form of treatment the client undergoes, the nurse

can have a direct impact on the outcome for the client.

Tractions are one method that can be applied to a patient with

musculoskeletal impairment. It is used to minimize muscle spasms; to
reduce, align, and immobilize fractures; to reduce deformity; and to
increase space between opposing surfaces.

Therapeutic tractions is accomplished by exerting a pull in two

directions, that is, pull of traction and pull of counter traction. Traction
often is produce by weight. Counter traction maybe produced with either
(1) the person’s body weight or (2) other weights. The traction and
counter traction must be equal in order to be therapeutic.

Traction is used primarily as a short-term intervention until other

modalities, such as external or internal fixation is possible. This reduces
the risk of disease syndrome and minimizes the length of hospitalization,
often allowing the patient to be cared for in the home setting.
 TRACTION

- It is the application of a pulling force to an injured body part or extremity

while a counterattraction pulls in the opposite direction to treat muscle or
skeletal disorders.

- 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.

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:

• Reduce, realign and promote healing of fractured bones.
• Decrease muscle spasms that may accompany fractures or follow surgical
reduction.
• Prevent soft tissue damage through immobilization.
• Prevent or treat deformities.
• Rest an inflamed, diseased, or painful joint.
• Reduce and treat dislocations and subluxations.
• Prevent the development of contractures.
• Reduce muscle spasms associated with low back pain or cervical whiplash
• Expand a joint space during arthroscopy or before major joint reconstruction.

PREPARING THE PATIENT AND HIS UNIT FOR TRACTION

Both skin and skeletal traction require X-rays prior to application. If skeletal traction
is required, standard pre-op surgical tests are conducted, such as blood and urine
studies. X-rays may be repeated over the course of treatment to insure that alignment
remains correct, and that healing is proceeding.

A. There are many local variations in traction procedures, depending upon the
preferences of the orthopedic surgeons. The nursing procedures described for
the care of patient in traction are only guidelines and or subjects to
 amendment by specific orders of the medical officer. In Department of the
Army hospital, an orthopedic technician usually assists the physician in
application of traction. The nursing personnel maybe required assisting
occasionally, but it is not a nursing responsibility to construct traction. It is a
nursing responsibility to recognized and report defects in the traction system
so that the defects can be recorded by qualified personnel. The nursing
personnel’s primary responsibility lies in giving quality nursing care. In order
to give effective nursing care to a patient in traction, one should have an
understanding of the basic forms of traction and recognize some principle
features of standard traction apparatus.
B. Check the physician’s orders to determine the type and location of traction to
be applied before you prepare the patient for application of traction.

1. Remove pajama trousers for application of traction to a lower limb. A towel

should be provided for use as a loin-cloth style drape.
2. Remove pajama coat for application of arm or cervical traction. If a pajama
coat is used, it maybe worn backward, leaving the affected arm free.
3. Offer a bedpan or urinal prior to the start of the procedure.
4. Assemble any equipment or dressing materials that maybe needed.

C. Prepare the patient’s bed with a firm mattress and a bed board if one is
required. Make the bed with a draw sheet over the bottom linen and fold the
top linen back and live untucked. Depending upon the type of the traction to
be applied, assembly the following equipment

1. Provide a foot board or sandbags to support the foot that is not in traction.
Foot support for the leg in traction is usually provided by means of a foot rest,
attached and traction is applied.
2. Attach the overhead Balkan frame with trapeze or an orthopedic head or
footboard as appropriate.
3. Provide several firms, plastic-covered pillows.

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.
 TYPES OF TRACTION

● Russell Traction
- A system of suspension a n d traction pull is used. Adhesive strips are applied
as in Buck's extension, a n d t h e knee is suspended in a sling. A rope is
attached to t h e sling's spreader bar. This rope passes over a pulley which is
attached to an overhead bar a n d is then directed to a system of three pulleys
at t h e foot of t h e bed: first to a pulley on t h e bed's foot bar, n e x t to a pulley
attached to t h e foot spreader bar, a n d t h e n back to a second pulley on t h e
bed's foot bar. There is an upward pull from t h e sling pulley a n d a forward
pull from t h e pulleys at t h e foot of t h e bed.

- In Russell traction, t h e angle between t h e thigh a n d t h e bed is

approximately 20° a n d there is always slight flexion of both t h e hip a n d t h e
knee. The advantage of Russell traction is that some movement in bed is
permissible. The patient c a n t u r n slightly toward t h e side in traction for
back care, bedpan placement, or linen change.

● Dunlop’s Skin Traction

- An orthopedic mechanism that helps immobilizes the arm to treat abnormal
shortening of the muscle or fracture of the elbow. The mechanism employs a system
of traction weights, pulleys, and ropes. It is usually applied to one side of the arm but
sometimes both sides.

● Halo Femoral Traction

- It is gradually improve the coronal and sagittal deformity and restore the trunk
balance through the elongation of the spine. Halo-femoral traction was a safe and
effective method for the treatment of severe idiopathic and congenital scoliosis
patients. The patient is supine and traction forces are applied through a halo and a
femoral pin.

●Halo Pelvic Traction

- A pelvic ring is affixed to the patient and a series of threaded rods connect the
cranial halo to the pelvic ring to apply an adjustable force separating the two rings. In
procedures using the halo, the patient is either immobile or severely restricted in
mobility.

● Bryant’s Traction
- It is mainly used in young children who have fractures of the femur or congenital
abnormalities of the hip. Both the patient's limbs are suspended in the air vertically at
a ninety degree angle from the hips and knees slightly flexed. Over a period of days,
the legs hips are gradually moved outward from the body using a pulley system. The
patient's body provides the counter traction.
- Traction only in one direction, both hips flexed at 90 degrees, buttocks slightly off
crib mattress.
● Buck’s Skin Traction
- 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.

● Balanced Suspension Traction

- Support the affected extremity off bed and allows for some patient movement
without disruption of the pull.

● Balanced Skeletal Traction

- Support the affected extremity allows for some patient movement and facilitates
patient’s independence and nursing care while maintaining effective traction.

● Stove in Chest Traction

- Applied for patients with severe chest injury with multiple rib fracture.

● Overhead
- It is a vertical traction to humerus and horizontal suspension to for arm.

● Ninety Degree Traction

- For fracture of the femur
 NURSING INTERVENTIONS FOR TRACTION
A. MINIMIZING THE EFFECTS OF IMMOBILITY
1. Encourage active exercise of uninvolved muscles and joints to maintain
strength and functions. Dorsiflex feet hourly to avoid development of foot drop
and aid in venous return.
2. Encourage deep breathing hourly to facilitate expansion of lungs and
movement of respiratory secretions.
3. Auscultative lungs field twice a day.
4. Encourage fluid intake of 2,000 to 2,500 ml daily.
5. Provide balanced high- fiber diet rich in protein; avoid excessive calcium
intake.
6. Establish bowel routine through use of diet and/ or stool softeners, laxatives,
and enemas, as prescribed.
7. Prevent pressure the calf and evaluate periodically for the development of
thrombophlebitics.
8. Check traction apparatus at repeated intervals-the traction must be continuous
to be effective, unless prescribed as intermittent, as with pelvic traction.
a. With running traction
⇒ The patient may not be turned without disturbing the lie of pull
b. With balanced suspension traction.
⇒ The patient may be elevated, turn slightly, and moved as desired.
B.MAINTAIN SKIN INTEGRITY
1. Examine bony prominences frequently for evidence of pressure or frictions
irritation.
2. Observe for skin irritation around the traction bandage.
3. Observe for pressure at traction-skin contact points.
4. Report compliant of burning sensation under traction
5. Relieve pressure without disrupting traction effectiveness.
a. Ensure that linens and clothing are wrinkle-free
b. Use lambs wool pads, heel/ elbow protection, and special mattresses as
needed.
6. Special care must be given to the back at regular intervals, because the patient
maintains a supine position.
a. Have patient use trapeze to pull self up and relieve back pressure.
b. Provided backrubs.
C. AVOIDING INFECTION AT PIN SITE.
1. Monitor vital signs for fever or tachycardia.
2. Watch for signs of infection, especially around the pin tract.

a. The pin should be immobile in the bone and the skin wound should be
dry. Small amount of serous oozing from pin site may occur.
b. If an infection is suspected, per cuss gently over the tibia; this may elicit
pain if infection is developing.
c. Assess for other signs of infection: heat, redness, fever.

3. If directed, clean the pin tract with sterile applications and prescribed
solution/ ointment- to clear drainage at the entrance of tract and around the
pin, because plugging at this site can predispose to bacterial invasion of the
tract and bone.
D.PROMOTING TISSUE PERFUSSION
1. Assess motor and sensory function of specific nerves that might be comprised.
a. PERONEAL NERVE
⇒ Have patient point great toe toward nose; check sensation on
dorsum of foot; presence of foot drop.
b. RADIAL NERVE
⇒ Have patient extend thumb; check sensation in web between thumb
and index finger.
c. MEDIAN NERVE
⇒ Thumb- middle finger apposition; check sensation of index finger.
2. Determine adequacy of circulation (ex. Color, temperature, motion, capillary
refill of peripheral fingers or toes).
a. With Buck’s traction, inspect the foot for circulatory difficulties within a
few minutes and then periodically after the elastic bandage has been
applied.
3. Report promptly if charge in neurovascular status is identified.