TRACTION
Traction is the use of a pulling force to
treat muscle and skeleton disorders.
Skin traction
Skin traction uses five- to seven-pound weights
attached to the skin to indirectly apply the
necessary pulling force on the bone. If traction
is temporary, or if only a light or discontinuous
force is needed, then skin traction is the
preferred treatment. Because the procedure is
not invasive, it is usually performed in a
hospital bed.
Weights are attached either through adhesive
or non-adhesive tape, or with straps, boots, or
cuffs. Care must be taken to keep the straps or Splints or "half-casts" provide less support than
tape loose enough to prevent swelling and
allow good circulation to the part of the limb
beyond the spot where the traction is applied.
The amount of weight that can be applied
through skin traction is limited because
excessive weight will irritate the skin and
cause it to slough off.
Skeletal traction
Skeletal traction is performed when more
pulling force is needed than can be withstood
by skin traction; or when the part of the body
needing traction is positioned so that skin
traction is impossible. Skeletal traction uses
weights of 25-40 pounds.
Skeletal traction requires the placement of
tongs, pins, or screws into the bone so that the
weight is applied directly to the bone. This is
an invasive procedure that is done in an
operating room under general, regional, or
local anesthesia.
Correct placement of the pins is essential to the
success of the traction. The pin can be kept in
place several months, and must be kept clean
to prevent infection. Once the hardware is in
place, pulleys and weights are attached to wires
to provide the proper pull and alignment on the
affected part.
The purpose of traction is to:
• To regain normal length and alignment
of involved bone.
• To reduce and immobilize a fractured
bone.
• To lessen or eliminate muscle spasms.
• To relieve pressure on nerves,
CAST
An orthopedic cast, or surgical cast, is a
shell, frequently made from plaster,
encasing a limb (or, in some cases, large
portions of the body) to hold a broken
bone (or bones) in place until healing is
confirmed. It is similar in function to a
splint.
Purpose:
Splints and casts support and protect injured
bones and soft tissue, reducing pain, swelling,
and muscle spasm. In some cases, splints and
casts are applied following surgery.
casts. However, splints can be adjusted to
accommodate swelling from injuries easier
than enclosed casts. Your doctor will decide
which type of support will be best for you.
Materials:
Fiberglass or plaster materials form the hard
supportive layer in splints and casts. Fiberglass
is lighter in weight, longer wearing, and
"breathes" better than plaster. Plaster is less
expensive than fiberglass and, shapes better
than fiberglass for some uses.
Both materials come in strips or rolls, which
are dipped in water and applied over a layer of
cotton or synthetic padding covering the
injured area. X-rays to check the healing
process of an arm or leg within a splint or cast
penetrate or "see through" fiberglass better
than plaster.
Nursing care for orthopedic casts:
• Mild swelling of the injured area is
common during the first few days.
Swelling may make your cast feel tight
initially. To reduce swelling, keep the
cast above the level of your heart for 24
to 48 hours. This can be accomplished
by resting it on pillows. Also, gently
move your fingers or toes (where the
cast is located) frequently.
• Ice helps keep the swelling down.
Apply a bag of ice (or a bag of frozen
vegetables) covered with a thin towel to
the cast for 20 minutes every two hours
while awake. Do not apply ice directly
to the skin.
• Take your pain medicine if you have
pain. After the first few days, you may
 especially spinal. be able to take a non-prescription pain
• To prevent or reduce skeletal medication, such as ibuprofen (Advil,
deformities or muscle contractures Motrin) or acetaminophen (Tylenol and
others).
Risks:
• Do not get the cast or splint wet. To
The main risks associated with skin traction are bathe with a cast, cover the cast with a
that the traction will be applied incorrectly and
plastic bag, tape the opening shut, and
cause harm, or that the skin will become
irritated. There are more risks associated with hang the cast outside the tub. Even
skeletal traction. Bone inflammation may occur when covered with plastic, you should
in response to the introduction of foreign not place the cast in water or allow
material into the body. Infection can occur at water to run over the area. Waterproof
the pin sites. If caught early, infection can be cast covers are available at medical
treated with antibiotics, but if severe, it may supply stores, but are not completely
require removal of the pin.
waterproof.
Both types of traction have complications
associated with long periods of immobility. • If the cast becomes wet, you can dry it
These include the development of bed sores, with a hair dryer on the cool setting. Do
reduced respiratory function, urinary problems, not use the warm or hot setting because
and circulatory problems. Occasionally, this can burn the skin. You can also use
fractures fail to heal. Being confined to traction a vacuum cleaner with a hose
for a long period can take a an emotional toll attachment to pull air through the cast
on the patient, also.
and speed drying.
Nursing care for orthopedic tractions:
• Keep the cast clean and avoid getting
• During the initial stages of traction, the
dirt or sand inside the cast. Do not
involved extremity is checked every 2
apply powder or lotion on or near the
hours for quality of the distal pulse,
cast. Cover the cast when eating.
color, warmth, motion, sensation, pain,
and swelling. • Do not place anything inside the cast,
• Blood pressure, temperature, pulse, and even for itchy areas. Sticking items
respirations are recorded every 4 hours inside the cast can injure the skin and
until stable. lead to infection. Using a hair dryer on
• Pain is controlled, and the patient is the cool setting may help soothe
positioned as ordered. itching.
• If the patient is in balanced suspension, • Do not pull the padding out from inside
abduction of the leg and a 20-degree your cast.
angle between the thigh and bed are
maintained; the heel is kept free of the
sling under the calf.
• A harness restraint is used to prevent a
child in Bryant's traction from turning
over, and the child's buttocks are raised
slightly from the mattress.
• Bed linen is changed only as necessary,
and an air mattress is used when
required.
• Every 2 hours the patient is helped with
deep breathing and coughing exercises.
• Bony prominences are massaged, but
vigorous rubbing is avoided.

• Lotion is applied to the skin, which is

periodically inspected for signs of
redness, abrasions, blisters, dryness,
itching, excoriation, and pressure areas.
• For patients in skeletal traction, the pin
insertion sites are inspected for signs of
 infection.
• The patient is observed every 4 hours
for neurologic signs, such as tingling,
numbness, and loss of sensation or
motion; for thrombophlebitis in the
involved extremity; and for evidence of
a pulmonary blood clot or fat embolus,
as indicated by decreased breath
sounds, fever, tachypnea, diaphoresis,
anxiety, pallor, bloody or purulent
sputum, tachycardia, or acute, severe
chest pain.
• Oral hygiene is administered every 4
hours, and, unless contraindicated, a
daily intake of 2 to 3 L of fluids is
encouraged.
• As the patient's condition improves, his
or her position is changed every 4
hours; if the kind of traction permits
and if the upper extremities are not
involved, a trapeze is added to the bed.
• The patient is taught to perform range-
of-motion exercises with the
uninvolved extremities, dorsiflexion
and plantar flexion of the ankles, and
isometric exercises, such as gluteal and
abdominal contraction.
• A high-protein, low-carbohydrate diet
is served, and vitamin and iron therapy
may be ordered.
• The immobilized patient uses a flat,
fracture bedpan and usually requires
stool softeners or a mild laxative.
• To the greatest degree possible, the
nurse encourages the patient to
participate in self-care and to engage in
diversions, such as handicrafts, reading,
watching television, and listening to the
radio. If the patient is not allowed to
elevate to the head of the bed,
specialized glasses called prism glasses
aid in the ability to watch television.