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 body while a counter traction pulls in the opposite direction. In straight or
running traction counterattraction is supplied by the patient’s body 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 traction
a. 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 surgery
b. Basic types of traction;
1. Skin traction
2. Skeletal traction
3. Manual traction
2. Check for Doctor’s Order
3. Identification of parts
a. Orthopaedic bed/ Balkan frame
- 2 horizontal bars
- Diagonal bar
- 4 vertical bars
- 3 pulleys
- Clamps
- Overhead trapeze
- Cross bar
- Firm mattress
- Fracture board
- Shock blocks / lock
b. BST equipment
- Thomas splint
- Pearson attachment
- Rest splint
- Cord/Sash
- Foot rest
- Safety pins/ paper clips
- Thigh rope (shortest)
- Suspension rope (longest)
- Traction rope (longer)
- Traction weight
- Suspension weight
4. Traction set-up
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 attachment that will support the leg.
3. Tie the short rope to the medial upright of the Thomas splint with slip-knot to ensure
privacy to the patient.
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 and narrower to the Pearson attachment.
c. Principles of sling application
1. 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 apparatus
a. Patient’s instructions
1. Instruct the patient to flex the unaffected leg and hold on the overhead trapeze bar
b. 3 manpower team
1. Apply manual traction (1st nurse) of the affected leg
2. In the count of 1, 2, & 3 with the coordination in movement, simultaneously, 2 nd nurse
lifting the affected leg and
3. 3rd nurse removing the Braun Bohler while inserting the assembled apparatus
(Thomas splint, Pearson attachment & rest splint).
6. Application of traction weight
a. Application of traction weight (10% of the body weight)
1. There should be continuous traction, so don’t remove the manual traction until the
longer rope has been tied to the steinman pin holder (club hitch knot/ eight knot), then
insert the other end of the rope to 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, to the 2nd pulley
4. Prior in tying the rope make it sure the rope is inside the traction rope for support and
prevent the affected leg from swaying sideways. Then tie to the Thomas splint using
clove hitch knot then to the Pearson attachment.
5. Release the suspension weight
c. Removal of the rest splint
d. Applying of foot support
1. You may start applying ribbon knot at the lateral and medial side of the Thomas
splint, then to Pearson attachment.
7. Checking efficiency of traction
a. 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 2nd pulley 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 knot
f. Patient is ready for transfer to the stretcher, and
g. Instruct the patient to flex his unaffected leg while holding on the trapeze bar and
simultaneously helping the patient transfer to the stretcher.
9. Nursing care to patient in traction
a. Should be free from any of the following;
1. Impaired circulation of the extremities,
2. Respiratory distress,
3. Emphasize good condition of the skin particularly at ischial, sacral, popliteal, dorsum
of foot, and heel part,
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 patient’s comfort such as;
1. Traction should never be a source of undue discomfort,
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 therapy
f. Monitor the nutritional status of the patient
g. Complaint of the patient should be assess
h. 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. Fatty globules 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 upper chest/neck.
3. Nursing consideration: inform the doctor.
b. Compartment syndrome
1. Increase pressure within one or more compartment causing massive compromise
circulation, leading to tissue perfusion Šanoxia. This is w/n 4-6 hrs pc the onset
neurovascular damage F irreversible.
2. Sx/Sy: pain & swelling, pain unrelieved by analgesic, distal pulse, & loss of sensation.
3. Nsg consideration: Assess VS, & notify the doctor.
c. Infection/ osteomyelitis
1. Is an acute/chronic inflammatory process of the bone and its structures secondary to
infection with pyogenic 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 tissue Šbone death.
2. Sx/Sy: pain & sensation
3. Nsg consideration: assess & notify doctor
11. What are the possible nursing diagnosis?
a. Pain
b. High risk for infection
c. Impaired physical mobility
d. High risk for skin integrity
e. High risk for injury
f. High risk for altered tissue perfusion
g. High risk for self-esteem disturbance