BALANCE SKELETAL TRACTION APPLICATION Traction : is the act of pulling or drawing which is associated with counter traction.

The pulling force is applied to a part of the bodywhile a counter traction pulls in the opposite direction. In straight or running traction coutertraction is supplied by the patientsbody with the bed in one of the following positions; 1.Flat 2.Tilted away from the traction pull 3.Altered by elevating the head and / or knee gatch THE PROCEDURE I.Purpose and identification of tractiona. Purpose: used in the treatment or fractured extremities; 1.To lessen muscle spasm 2.To reduce fracture 3.To provide immobilization 4.To maintain alignment 5.To correct or prevent deformities in the case of arthritis patient with flexion contraction 6.To help lessen the curvature of the spine before correction surgeryb. Basic types of traction; 1.Skin traction 2.Skeletal traction 3.Manual traction2

Check for Doctors Order Identification of parts a.Orthopedic bed/ Balkan frame2 horizontal bars- diagonal bar

-4 vertical bars3 pulleys -ClampsOverhead trapezeCross barFirm mattressFracture board-Shock blocks / lockb. BST equipmentsThomas splintPearson attachment -Rest splint-Cord/ -Safety pins/ paper clipsThigh rope(shortest)Suspension rope(longest)Traction rope(longer)Traction weight-Suspension weight

a.Thomas splint and pearson splint 1.Attach the rest splint to the Thomas splint with Pearson attachment 2.Upper part is the Thomas splint which will support the thigh and lower part is the Pearson attachmentthat will support the leg. 3.Tie the short rope to the medial upright of the Thomas splint with slip-knot to ensure privacy to thepatient. b.Application of slings to the Thomas splint and Pearson attachment. 1.Start from the large and wide slings (at least 2 pcs) to the Thomas splint and 3 slings smaller andnarrower to the Pearson attachment.c.Principles of sling application1.Smooth side should be touching the patient skin for comfort

2.At least 1 inch apart in between slings for ventilation 3.Not to tight not too loose to support the normal structure of the leg 4.Provide space at the popliteal and heel area to provide ventilation and prevent irritation. 5.Insertion of apparatusa.Patients instructions 1.Instruct the patient to flex the unaffected leg and hold on the overhead trapeze barb.3 manpower team1.Apply manual traction (1stnurse) of the affected leg 2.In the count of 1,2, & 3 with the coordination in movement, simultaneously, 2ndnurse lifting theaffected leg and 3.3rdnurse removing the Braun Bohler while inserting the assembled apparatus (Thomas splint, Pearsonattachment & rest splint). 6.Application of traction weight a.Application of traction weight (10% of the body weight) 1.There should be continuous traction, so dont remove the manual traction until kthe longer rope hasbeen tied to the steinman pin holder (club hitch knot/ eight knot), then insert the other end of the ropeto the third pulley to the traction weight(club hitch knot) and securely tied. 2.Check the groin part of the thigh if resting on the half ring to promote comfort.b.Application of suspension weight (50% of the traction weight) 1.Tie first the other end of the short rope on the lateral aspect of the Thomas splint. 2.Tie the longest rope to the middle of the short rope with slip knot. 3.Insert the other end of the rope to the first pulley, passing through the hanged suspension weight, tothe 2nd pulley 4.Prior in tying the rope make it sure the rope is inside thetraction rope for support and prevent theaffected leg from swaying sideways. Then tie to the Thomas splint using clove hitch knot then to thePearson attachment. 5.Release the suspension weightc.Removal of the rest splintd.Applying of foot support 1.You may start applying ribbon knot at the lateral and medial side of the Thomas splint, then to Pearsonattachment. 7.Checking efficiency of tractiona.Principles of Skeletal Traction 1.Have an opposite pull or counter traction.

2.The application of shock block or lock and weight of the patient serve as the counter traction . 3.Line of pull should be in line with the deformity. The 1st pulley should be in line with the groin. The 2ndpulley should be in line with the knee, and traction line should be straight with the deformity.4.Traction should be continuous and weights should be hanging freely. 5.The position of the patient should be in dorsal recumbent or supine position . 6.It should be free from friction;-Weights should be hanging freely.-Observe for signs of wear and tear on the ropes and bags.-Ropes should run freely along the grove of the pulley.-Knots should be away from the pulley. 8.Transport/removal of traction ( what is being 1st assembled should be the last to remove) ;a.Attach the rest splint, b.Anchor the suspension weight, c.Remove the suspension rope, d.Apply manual traction,e.Remove traction weight, then tie the rope to the rest splint, Thomas and Pearson using the clove hitch knotf.Patient is ready for transfer to the stretcher, andg.Instruct the patient to flex his unaffected leg while holding on the trapeze bar and simultaneously helping thepatient transfer to the stretcher. 9.Nursing care to patient in tractiona.Should be free from any of the following; 1.Impaired circulation of the extremeties, 2.Respiratory distress, 3.Emphasize good condition of the skin particularly at ischial, sacral, poplitieal, dorsum of foot, and heelpart, 4.Contracture of joint like footdrop 5.Signs of infection;-Assess skin integrity-Traction pin site dressing regularly-Monitor for temperature, color, odor of the affected part. b.Should have bone alignment and position of extremity in which the purpose of traction should be accomplished.c.Provide patients comfort such as; 1.Traction should never be a source of undue discomforrt,2.Care of the skin, mouth, hair, nails, toes, and genitals should be included in the plan of daily care. d.Provide exercises such as;1.ROM exercise of all the unaffected joints

2.Static quadriceps exercises, 3.Flexion and extension of the toes and fingers in traction. e.Provide supportive therapyf.Monitor the nutritional status of the patientg.Complaint of the patient should be assessh.Check the traction set-up if; 1.The apparatus is accomplishing each purpose of traction, 2.The equiments are safe as possible, 3.Sash, cords and pulleys is unobstructed, 4.Knots, clamps, and weighs are secured, and 5.Weights are free from any friction, 10.What are the complications to patient with traction? a.Fat embolism 1.Patient with long bone fracture is prone like; tibia, fibula, radius, ulna, femur, and humerus. Fattyglobules from the bone goes to the lungs and usually occurs within 48 hours. 2.Signs/symptoms: restlessness, altered LOC, tachycardia, tachypnea, BP, petichial rash over the upperchest/neck.

Page 4 3.Nursing consideration: inform the doctor.b.Compartment syndrome 1.Increase pressure within one or more compartment causing massive compromise circulation, leading to tissue perfusionanoxia. This is w/n 4-6 hrs pc the onset neurovascular damage irriversible. 2.Sx/Sy:pain & swelling, pain unrelieved by analgesic,distal pulse, & loss of sensation.3.Nsg consideration: Assess VS, & notify the doctor.c.Infection/ osteomyelitis1.Is an acute/chronic inflammatory process of the bone and its structures secondary to infection withpyogenic organisms.2.Sx/Sy: fever, pain, edema, warmth, tender, reduction in the use of extremity,WBC & pulse. 3.Nsg consideration: Assess, notify the doctor.d.Avascular necrosis 1.Interruption of the blood supply to the bone tissuebone death. 2.Sx/Sy: pain &sensation

3.Nsg consideration: assess & notify doctor11.What are the possible nursing diagnosis? a.Painb.Highrisk for infectionc.Impaired physical mobilityd.High risk for skin integritye.High risk for injuryf.High risk for altered tissue perfusiong.High risk for self-esteem disturban