TRACTIONS

Tractions
• Refers to the practice of slowly and gently pulling on a
fractured or dislocated body part
• Often done using ropes, pulleys, and weights. These tools
help apply force to the tissues surrounding the damaged area.
Indications
• to guide the body part back into place and hold it steady.
• stabilize and realign bone fractures, such as a broken arm or
leg
• help reduce the pain of a fracture before surgery
• treat bone deformities caused by certain conditions, such as
scoliosis
• correct stiff and constricted muscles, joints, tendons, or skin
• stretch the neck and prevent painful muscle spasms
Types of Traction
1. Skeletal Traction
 Involves placing a pin, wire, or screw in the
fractured bone. After one of these devices has
been inserted, weights are attached to it so the
bone can be pulled into the correct position.
 Skeletal traction is most commonly used to treat
fractures of the femur, or thighbone.
 It’s also the preferred method when greater
force needs to be applied to the affected area.
The force is directly applied to the bone, which
means more weight can be added with less risk
of damaging the surrounding soft tissues.
Sites for Skeletal Traction
2. Bryant's Traction
 Applied to the management of femoral fractures

 The development of ischemia of the lower leg through

reduced perfusion resulted in limitation of its

application to the short-term management of a fractured

femur

 A modification of his traction has been shown to reduce

the risk of limb ischemia and may be applicable where

prolonged traction is required in an infant

POSITION OF BED AND PATIENT
1. With the bed in a level position and
body flat on the bed, vertical
suspension traction of the legs should
be set up so that the hips are flexed at
right angles.

2. When the traction is in place, the

buttocks should just clear the mattress.

3. Lift the buttocks a few inches off the

mattress. When the buttocks are released,
the child should return to the “just clear”
position described above. If not, check
with the attending physician regarding a
possible change in the amount of weight.
TIPS AND PRECAUTIONS
1. Warning: Dangerous complications leading to ischemic contractors can occur.
Check both feet at least every two hours for color, pulse, motion, temperature, and
sensation.
2. Check for undue pressure:
a. Over the outer head and neck of the fibula.
b. On the dorsum of the foot.
c. On the Achilles tendon.
3. Check to see that bandages, boots, etc., have not slipped and become bunched
around the toes or ankles.
4. Problems with this type of traction are difficult to define due to the age of the
child. These problems include:
 Inability to communicate wants and needs.
 Toilet needs.
 Feeding.
 Diversion.
 Maintaining position which makes it sometimes necessary to use some form of jacket or restraint,
especially to keep the child from “rotating” around the traction apparatus.
Nursing Responsibilities

show the patient how much movement he's allowed and instruct him not to adjust equipment.
tell the patient to report any pain or pressure from traction equipment
at least once per shift, make sure traction equipment connections are tight.
check for impingements, such as ropes getting caught between pulleys.
inspect equipment to assure correct alignment.
make sure ropes are positioned properly in the pulley track.
make sure all rope ends are taped above the knot.
inspect traction weights regularly to make sure they hang freely. weights that touch the floor,
bed, or each other reduce traction.
about every 2 hours, check the patient for proper body alignment and reposition as needed.
provide skin care, encourage coughing and deep-breathing exercises, and assist with ordered
range-of-motion exercises for unaffected extremities.
check elimination patterns and provide laxatives, as ordered.
3. Skin Traction
 is far less invasive than skeletal traction.

 It involves applying splints, bandages, or adhesive tapes to the skin directly below the fracture.

 Once the material has been applied, weights are fastened to it. The affected body part is then pulled into
the right position using a pulley system attached to the hospital bed.

 used when the soft tissues, such as the muscles and tendons, need to be repaired.

 Less force is applied during skin traction to avoid irritating or damaging the skin and other soft tissues.

 Skin traction is rarely the only treatment needed. Instead, it’s usually used as a temporary way to stabilize
a broken bone until the definitive surgery is performed.
4. Buck's Traction
 is a form of traction where pull is exerted in one plane

 It is used when partial or temporary immobilization is

required

 it is used to provide comfort following injury while

awaiting surgical fixation, especially in hip and femur

injuries.
POSITION OF BED AND PATIENT
The patient should be flat on back with the foot of the bed elevated.

TIPS AND PRECAUTIONS

1. Pulley bars must be placed so that the line of pull aligns distal to proximal.
2. Cover exposed adhesive side of Skin-Trac Traction Strips (if used) near ankles
with strips of felt or sheet wadding to help prevent the Skin-Trac Traction Strips
from sticking onto the foot and ankle.
3. Make sure wrappings are not too tight across the dorsum of the foot. Excess
pressure can cause severe complications.
4. Pressure on the heels can cause irritation and skin breakdown. Make sure
heels are not digging into the mattress. If necessary, place small foam pads,
folded blankets, etc., under full length of the calf to keep heels off the bed.

5. Make sure pressure is kept off the peroneal nerve or foot drop may occur.

6. A bed cradle may be used to keep bed covers from resting on the feet.

7. Encourage activity as tolerated, including active and passive exercises. The

patient should use the trapeze for moving about in bed.
5. Russell's Traction
can be used for fractures of the tibial
plateau, it works by supporting the
flexed knee in a sling and applying a
horizontal pulling force by use of
traction tape and elastic bandage
attached to the lower leg
POSITION OF BED AND PATIENT
Proper countertraction is obtained either by elevating the foot of the bed,
or by gatching the bed at knees with the patient flat on back. In certain
instances, the head of the bed may be elevated, but only at the discretion
of the attending physician. The physician may also order a pillow placed
under the affected leg. If so, this must be checked frequently to make
sure proper alignment is maintained.
TIPS AND PRECAUTIONS
1. Make certain the knee sling is smooth and that its edges do not cut into the soft tissues.
2. Due to the pulley arrangement, the pull on the foot is double that of the weight applied.
3. If a pillow is ordered for under the calf when the traction is initially set up, it must remain in
place. Removing it can change the vectors of force and alignment.
4. Arrangements of Russell’s Traction vary. Therefore, be aware of how it was set up initially.
5. Nursing care is simplified by suspension of the limb, which allows the patient to lift and
move about with minimal disturbance to the line of pull. This suspension is achieved through
the delicate balance of traction and countertraction resulting from the distribution of weight
through the various elements.
6. Proper application of Skin-Trac Traction Strips and wrapping of elastic bandages are crucial
to the prevention of peroneal nerve damage. Neurovascular checks must be made at least every
two hours.
7. Active and passive exercises should be done routinely. The patient should be encouraged to
do as much for himself or herself as possible. Good skin care is also imperative.
8. An anti-embolism stocking should be applied to the unaffected leg on all adult patients.
6. Dunlop's Traction

is used for fractures of the upper

extremities. It works in the form of horizontal

traction which is applied to

BRAU PLEASE KOG BUTANG UG IMAGE
the abducted humerus, while vertical traction ANI NGA TRACTION PLEASE
THANKS!
is applied to the flexed forearm.
Nursing Responsibilities
Perform a skin-traction assessment per facility policy. This assessment includes:

 checking the traction equipment

 examining the affected body parts

 maintaining proper body alignment

Remove the straps every 4 hours per the physician’s order or facility policy.

Check bony prominences for:

 skin breakdown

 abrasions

 pressure areas
 Assess the extremity distal to the traction for edema, and assess peripheral pulses

 Assess the temperature, color and capillary refill, and compare with the unaffected limb

 Check for pain and inability to move body parts distal to the traction, pallor, and abnormal sensation

 Assess for indicators for deep-vein thrombosis, including calf tenderness and swelling

 Ensure the patient is positioned in the center of the bed with the affected leg aligned with the trunk of

the patient’s body

 Examine the weights and the pulley system

 Weights should hang freely, off the floor and bed

 Knots should be secure.

 Ropes should move freely through the pulleys.

 The pulleys should not be constrained by knots

 Perform range-of-motion exercises on all unaffected joint areas unless contraindicated. Encourage the

patient to cough and deep breathe every 2 hours

 Raise the side rails. Place the bed in the lowest position that still allows the weight to hang freely
Cervical Traction

 A metal brace is placed around your neck. The brace is then

attached to a body harness or weights, which are used to
help correct the affected area.

 Cervical traction might be used in two different situations.

BRAU PLEASE KOG BUTANG UG IMAGE
 First, it may be done to gently stretch the neck muscles so ANI NGA TRACTION PLEASE
THANKS!
muscle spasms can be relieved or prevented.

 It may also be performed to immobilize the spine after a

neck injury.
Nursing Responsibilities
 Verify that the head of the bed (HOB) is adjusted per physician’s order.

 Verify that suction is available at the patient’s bedside.

 When conducting Cardiopulmonary resuscitation (CPR), use jaw lift maneuver to open the airway
without hyperextending the neck. Realign patient horizontally if HOB is elevated and put board behind
patient’s neck.

 If the patient requires logrolling, the RN or licensed practitioner shall direct patient movement from
head of bed.

 Patients shall be turned every two (2) hours per physician order. The skin shall be assessed with each
turn for evidence of pressure, paying close attention to the occipital area, any bony prominences and
traction sites.
ORTHOPEDIC BED

BRAU PLEASE KOG BUTANG UG IMAGE ANI PLEASE

THANKS!
a. The basic orthopedic bed is a standard hospital bed with a firm mattress. A slatted orthopedic bed board

may often be placed under the mattress for extra support

b. The basic orthopedic bed often requires an over bed frame to accommodate any traction or suspension

system that may be required. The framework is inserted into or clamped to the corners or ends of the

hospital bed. The frame allows the utilization of adjustable pulleys, slings, harnesses, clamps, and other

attachments

The Balkan frame, is

one example of an
over bed frame
c. The trapeze is an attachment that is used to assist the patient in movement during activities of daily

living. Bathing, linen changes, bedpan use, and repositioning are made easier with the use of the

trapeze. The trapeze is grasped firmly with the hands and a "pull-up" movement lifts the upper body

and buttocks from the bed. The patient may use an unaffected leg for assistance by flexing the knee,

placing the foot flat on the mattress, and pushing down on the bed while pulling straight up on the

trapeze.
 SPECIAL ORTHOPEDIC BEDS--TURNING FRAMES
a. Turning frames are devices used to provide immobilization and to facilitate nursing care for the patient who,
while immobilized, requires frequent repositioning from supine to prone. In addition to its orthopedic
applications, a turning frame is used in the treatment of patients with such conditions as spinal cord injuries and
severe burns.

b. The major advantage in the use of turning frames is the prevention of the following complications:
 Pressure sores. With relief of pressure from body weight on bony prominence and pressure areas, blood supply
is improved. Additionally, large body areas may be exposed for skin care.
 Respiratory congestion. Rotation of the patient from face-up to face-down aids in loosening and ridding the
lungs of fluid accumulation. The patient can cough and expectorate more effectively in the prone position.
 Kidney and bladder complications. Rotation of the patient aids in elimination of urine sediments that are
potential causes of kidney stones.

c. Nursing management of a patient in a turning frame is the same as for any other immobilized patient. The
nature of the care required depends upon the reason for immobilization (casts, traction, paralysis, and so forth).
 TYPES OF TURNING FRAMES
a. Double Frames. The Foster reversible
orthopedic bed and the Stryker turning frame are
commonly used. Both are double frames, which
are rotated on the longitudinal (side-to-side)
axis. The operation of both is similar in
principle, with variations in the details of
preparation for use. Both have a rotary-bearing
turning apparatus at each end, which allows
traction to be maintained during the turning
process. The patient is "sandwiched" between
two canvas-covered frames when he is turned.
The anterior frame, on which the patient lies
prone, is constructed of either two pieces of
canvas or one piece of canvas with a
perineal cutout. The posterior frame, on
which the patient lies supine, is constructed
with two pieces of canvas that have an open
space between them for the buttocks. A
canvas buttocks strap is used between the
two sections to keep the buttocks from
sagging. This strap is removed only for skin
care or bedpan use.

A - CART E - OVERHEAD BAR

B - LOCK PIN F - ANTERIOR FRAME
C - LOCKING NUT G - POSTERIOR FRAME
D - PIVOT PIN H - UTILITY TRAY
b. Improvised Litter Frames. Two canvas litters, padded
with blankets, may be used as anterior and posterior
frames when commercially manufactured frames are not
available. The frames are placed on sawhorses for greater
stability, but may also be used with standard litter
brackets. Litter straps are used to bind the two frames
together for turning.

c. Circo-Electric Beds. A circo-electric bed is an

electrically powered apparatus, which can be used as a
turning frame for vertical (end-over-end) rotation. It can
also be utilized as a tilt table and for unrestricted gatch
positioning.