 The skeleton is the basic framework of the

body and joint movement is controlled by

the balanced action of opposing groups of
muscles.
 If any part of the framework is broken ,that
part becomes unstable and the pull of the
muscle over the distal fragment may cause
overlapping and consequent shortening or
deformity
 If a joint is damaged or infected, muscles
controlling the joint immediately go into spasm,
which holds the joint in the position of greatest
comfort and prevents friction of joint surfaces
which would otherwise occur in movement.
 This is useful as it provides rest to the joint,
but if prolonged it will lead to fixed
deformities, e.g. contraction or even
ankylosis in a bad or abnormal position.
 Traction therefore is used to overcome
muscle spasm and to reduce or prevent
deformity.
Traction is the exertion of a
pulling force applied in two
directions to reduce and immo­
bilize a fracture.
Traction provides proper bone
alignment and reduces muscle
spasms
Traction is applied when it
is needed
 To secure immobility in the desired
position when the bone structure is
affected
 To prevent the surrounding ' muscles from
pulling the joint into an unwanted position
by Protective muscle spasm.
 To prevent overriding of frag­ments and
faulty alignment in fractures, especially in
long bones such as the shaft of the femur
when the fracture line is oblique and the
muscles are powerful.
 Efficient traction and immobilization stops
muscle spasm and pain
 To reduce, align, and immobilize fractures
until bony union occurs.
 To lessen, prevent, or correct deformity
associ­ated with bone injury and muscle
disease.
 To reduce muscle spasm in fracture of a long
bone or back injury.
TYPES OF TRACTION
 The force can be applied
through ad­hesive applied
directly to the skin (skin
traction) or through a metal
pin or wire inserted directly
into or through a bone
(skeletal traction).
 Fixed traction
 Skeletal traction
 Skin traction
 Balanced suspension traction
Fixed traction
Traction is 'fixed' when it is
attached to a stationary point.
 An extension is tied to the end
of Thomas's splint with the ring
against the ischial tuberosity as
a point of counter-traction
 Limb is described as being in
fixed traction.

 It facilitates transportation, the

limb remaining undisturbed.
 Great restricted movements in bed .
 Difficulty in preventing pressure sores
occurring under the ring especially in very
fat or very thin patients.
 If too tight it will cause
constriction, if too loose it will
produce friction and may slip
right over the ischial tuberosity
instead of resting against it.
 The area of skin under the ring must always
be kept clean and powdered and the ring
should be moved two or three times daily to
prevent pressure sores
 Traction is applied
mechanically to the bone
with pins, wires, or tongs
 Skeletal traction is used to
stabilize fractures / dislocations
.
 Two types of Skeletal traction
used for cervical injuries are :
1. Skull (cervical) tongs
2. Halo traction (halo Fixation
device).
 Skull tongs are inserted
into, the outer aspect of
the client's-skull, and
traction is applied.
 Weights are attached to
the tongs, and the client
is used as counter
traction.
 Monitor neurological status of the client.
 Check the amount of weight prescribed
for the traction.
 Ensure that weights hang securely and
freely at all times.
 Ensure that the ropes for the traction
remain within the pulley
 Maintain body alignment
using special bed ( Foster
frame) .
 Turn the client every 2
hours.
 Assess- insertion site of the
tongs for infection.
 Provide sterile pin site care
as prescribed.
 Halo traction is a
static traction
device that
consists' of a
headpiece with
four pins, two
anterior and two
posterior,
inserted into the
client's-skull.
 The metal halo
ring may be
attached to-a
vest (jacket) or
cast when the
spine is stable,
allowing
increased client
mobility.
 Monitor the client’s
neurological status .
 Never move or turn the
client by holding or rolling
on the halo traction device.
 One liner can be placed under
the jacket to prevent rashes.
 Assess skin integrity to ensure
that the jacket or cast is not
causing pressure
 Provide sterile pin site care
 Monitor color, motion, and
sensation of the affected
extremity.
 Monitor the insertion sites
for redness, swelling, or
drainage.
Notify the physician if the
halo vest (jacket) or ring bolts
loosen.
Use foam inserts to relieve
pressure points.
Keep the vest lining dry.

Clean the pin site daily.

Notify the physician if
redness, swelling, drainage,
open areas, pain ,tenderness
or a clicking sound occurs
from the pin site.
A sponge bath or tub bath is
allowed; showers are
prohibited'
Assess the skin under the
vest daily for breakdown,
using a-flash light
Do not use any products
other than shampoo on the
hair.
 When shampooing the hair,
cover the vest with plastic.
 When getting out of bed, roll
onto the side and push on the
mattress with the arms.
Never use the metal frame
for turning or lifting.
Adapt clothing to fit over
the halo device.
Use a rolled towel or
pillowcase between the
back of the neck and the
bed or next to the cheek
when lying on the side, and
raise the head of the bed to
increase sleep comfort.
Eatfoods high in protein
and calcium to promote
bone healing.

Have the correct-size

wrench available at all
times for an emergency.
 If cardiopulmonary resuscitation
is required, the anterior portion
of the vest will be loosened and
the posterior portion will remain
in place to provide stability

Traction is applied by the
use of elastic bandages or
adhesive on the skin
 Cervical skin traction (Head Halter
Traction)
 Buck's (extension) skin traction
 Russell's skin traction.
 Pelvic skin traction
Cervical skin
traction relieves
muscle spasm and
compression in the
upper extremities
and neck.
Cervical skin
traction uses a
head halter and
a chin pad to
attach the
traction
 Use powder to protect the
ears from friction rub.
 Maintain the client in a
sitting position or with the
head of the bed elevated 30
to 40 degrees, and attach
the weight to a pulley
system over the head of the
bed
 Buck's skin
traction is used
to alleviate
muscle spasms
and immobilizes
a lower limb by
maintaining a
straight pull on
the limb with the
use of weights.
 Used to stabilize a fractured
femur before surgery
 Similar to Buck's traction but
provides a double pull with the
use of a knee sling
 Traction that pulls at the knee
and the foot
 See that the heel clears the bed.
 Too much weight will cause a flexion deformity
of the knee.
 See that the bandage below the knee is not
creased and causing sores, and is not so tight that
it causes a venous thrombosis
 In addition to the above
slings, a crepe bandage
may be applied below the
knee and tied to a cord
leading to another pulley
to check external
rotation.
 This should be loosely
applied and no pressing
upon the lateral popliteal
nerve
Pelvic skin
traction is used
to relieve low
back pain , or leg
pain and to
reduce muscle
spasm.
Apply the
traction snugly
over the pelvis
and iliac crest
and attach to the
weights.
 Maintain correct amount
of weight as ordered.
 Ensure that weights hang
freely.
 Check ropes for fraying
and be sure that they are
appropriately on the
pulleys.
 Monitor neurovascular
status of involved
extremity.
 Monitor for signs and
symptoms of immobi­
lization; constipation and
skin breakdown.
Use measures as prescribed
to prevent the client from
slipping down in bed.
Provide therapeutic and
divers ional play
 Balanced suspension traction is used with
skin or skeletal traction.
 It is used to approx­imate fractures of the
femur, tibia, or fibula.
 It is produced by a counterforce other than
client.
 Counter-Traction: When a force is applied to
pull an object in one direction, there must
be equal force to pull in the opposite
direction .
 Traction must be combined with counter-traction;
this can be effected by using a weight and pulley
system
 When traction is applied to the leg,
counter-traction can be produced by
elevating the bottom end of the bed, the
body weight then slides by force of
gravity in the opposite direction.

 It is essential that the traction and

counter-traction are balanced.

 The greater the weight applied, the

higher the bed will require to be
elevated.
Thomas's splint is most commonly
used for supporting the limb.
 The splint plays no part in the actual
traction but facilitates suspension of
the limb.

The advantages of continuous traction
are numerous Provided the apparatus is
properly applied.
 The patient can move relatively freely
without interfering with the efficiency of
the traction.
 The mobility diminishes joint stiffness,
muscle wasting decalcification, pressure
sores and all other complications
associate acted with immobilization.
 The pulleys should be smooth-
running.
 The cords should run in straight
lines and without knots
 Friction on bed should be
prevented.
The limb should be able to
move freely, i.e. no
obstruction from sandbags,
bedclothes and cradles .
 Never allow weights to rest
on the bed.
 Elevation of the bottom of
the bed must be maintained
at all times so that traction
and counter-traction are
continuous.
 Position the client in low Fowler's .
 Maintain a 20-degree angle from the thigh
to the bed.
 Protect the skin from breakdown.
 Provide pin care if pins are used with the
skeletal traction.
 Clean the pin sites with sterile normal
saline and hydrogen peroxide or povidone-
iodine (Betadine) as prescribed or as per
agency procedure.
 Maintain correct amount of weight as
ordered.
 Protect the skin from breakdown.
 Provide pin care if pins are used with the
skele­tal traction
 Ensure that weights hang freely.
 Check ropes for fraying and be sure that
they are appropriately on the pulleys.
 Monitor neurovascular status of involved
extremity.
 Monitor for signs and
symptoms of immobi­lization;
constipation and skin
breakdown of involved
extremities.
 Provide therapeutic and
divers ional play.
 Horizontal traction is used to
align fractures of the humerus.
 Vertical traction maintains the
forearm in proper alignment.

Nursing care is similar to that for
Buck's skin traction.
The lower leg is supported by a boot cast or a
calf sling.
 Maintain correct amount of weight as
ordered.
 Ensure that weights hang freely.
 Check ropes for fraying and be sure that they
are appropriately on the pulleys.
 Monitor neurovascular status of involved
extremity.
 Monitor for signs and symptoms of immobi­
lization; constipation and skin breakdown of
involved extremities.
 Provide therapeutic and divers ional play.
 Maintain proper body
alignment
 Ensure that the weights
hang freely and do not
touch the floor.
 Do not remove or lift the
weights without a
physician's order
Ensure that pulleys are not
obstructed and ropes in the
pulleys move freely
Place knots in the ropes to
prevent slipping.
Check the ropes for fraying
 Ring of Thomas's splint should be little
large when applied to a fresh fracture as
the thigh may continue to swell for 24
hours.
 Skeletal traction has the advantage of not
harming the skin and of leaving the leg
free from bandages but it can give trouble
from sores and infection, especially with
fat legs and thin, soft, bones.
 Skin traction can be used for long periods
but it is liable to slip if much weight is used
 It can cause serious blistering if the
strapping has wrinkles in it or if the
circulation and nutrition of the skin have
been impaired .
 This form of splint age and
immobilization is often
extended over a period of
time.
 Time to time observation of
the splints and pulleys
should be done.
 The nurse must be aware of the whole
patient
1. The diet
2. State of skin
3. Fluid balance
4. Their bowels
5. The general well-being.
Young people on traction can get very bored
so cheerful nurses ,doctors , occupational
therapists and other health members can do
much to counteract this state.