MANAGEMENT AND SCIENCE UNIVERSITY

FACULTY OF HEALTH AND LIFE SCIENCES

SMS 0082

ORTHOPAEDIC

TITLE: TRACTION & APPLICATION PLASTER OF PARIS (POP)

LECTURE: MR KANAHENDRAN

NAME : SHAM NAZRIN BIN SUFFIAN

MATRIX NO : 012009050979

PROGRAM : DIPLOMA IN MEDICAL ASSISTANT

 CONTENT

ACKNOWLEDGEMENT
ALHAMDULILLAH,

I, Sham Nazrin Bin Suffian 012009050979 take this great opportunity to express my
heartfelt gratitude and would like to thanks my lecture MR KANAHENDRAN for the
untiring efforts contributing towards my practical and teory.Thank you and GOD bless
you sir.

I also would like to thanks to all my classmates that help me to complete this task when
I’m having trouble while doing the task. Last but not least, I would like to thanks to my
beloved family that gave me a fully support during I’m doing the my assignment.
INTRODUCTION

In orthopedic medicine, traction refers to the set of mechanisms for

straightening broken bones or relieving pressure on the spine and skeletal system.
There are two types of traction: skin traction and skeletal traction.

It is largely replaced now by more modern techniques, but certain approaches are still
used today:

 Bryant's traction
 Buck's traction - hip fractures
 Dunlop's traction - humeral fractures in children
 Russell's traction

DEFINITION

Traction is force applied by weights or other devices to treat bone or muscle disorders

or injuries.

PROPOSE
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, especially spinal.
 To prevent or reduce skeletal deformities or muscle contractures.
In most cases traction is only one part of the treatment plan of a patient needing such
therapy. The physician’s order will contain:

 Type of traction
 Amount of weight to be applied
 Frequency of neurovascular checks if more frequent than every four (4) hours.
 Site care of inserted pins, wires, or tongs
 The site and care of straps, harnesses and halters
 The inclusion of any other physical restraints / straps or appliances (eg. mouth
guard)
 the discontinuation of traction

DESCPRITION

Traction is referred to as a pulling force to treat muscle or skeletal disorders. There are

two major types of traction: skin and skeletal traction, within which there are a number

of treatments.

SKIN TRACTION

Skin traction includes weight traction, which uses lighter weights or counterweights to
apply force to fractures or dislocated joints. Weight traction may be employed short-
term, (e.g., at the scene of an accident) or on a temporary basis (e.g., when weights are
 connected to a pulley located above the patient's bed). The weights, typically weighing
five to seven pounds, attach to the skin using tape, straps, or boots. They bring together
the fractured bone or dislocated joint so that it may heal correctly.

In obstetrics, weights pull along the pelvic axis of a pregnant woman to facilitate
delivery. In elastic traction, an elastic device exerts force on an injured limb.

Skin traction also refers to specialized practices, such as Dunlop's traction, used on
children when a fractured arm must maintain a flexed position to avoid circulatory and
neurological problems. Buck's skin traction stabilizes the knee, and reduces muscle
spasm for knee injuries not involving fractures. In addition, splints, surgical collars, and
corsets also may be used.

Skin Traction - Lower Extremity

Buck's skin traction is widely used in the lower limb for femoral fractures, lower
backache, acetabular and hip fractures. Skin traction rarely reduces a fracture, but
reduces pain and maintains length in fractures.
Method
The skin is prepared and shaved -it must be dry. Friar's balsam may be used to
improve adhesion. The commercially available strapping is applied to the skin and
wound on with an overlapping layer of bandage. The bandage should not extend
above the level of the fracture.

Dangers of Skin Traction

 Distal Oedema
 Vascular obstruction
 Peroneal nerve palsy
 Skin Necrosis over bony prominence's
(Please refer to appendix figure 1.1)

Avoid complications resist the temptation of trying to improve adhesion by wrapping

the bandages more tightly. If the tapes slip rather use skeletal traction if possible (not
a child)

SKELETAL TRACTION

Skeletal traction requires an invasive procedure in which pins, screws, or wires are
surgically installed for use in longer term traction requiring heavier weights. This is the
case when the force exerted is more than skin traction can bear, or when skin traction is
not appropriate for the body part needing treatment. Weights used in skeletal traction
generally range from 25–40 lbs (11–18 kg). It is important to place the pins correctly
because they may stay in place for several months, and are the hardware to which
weights and pulleys are attached. The pins must be clean to avoid infection. Damage
may result if the alignment and weights are not carefully calibrated.

Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis, hip, or
femur; and overhead arm traction, used in certain upper arm fractures. Cervical traction
is used when the neck vertebrae are fractured. (Please refer to appendix figure 1.2)

Proper care is important for patients in traction. Prolonged immobility should be

avoided because it may cause bedsores and possible respiratory, urinary, or circulatory
problems. Mobile patients may use a trapeze bar, giving them the option of controlling
their movements. An exercise program instituted by caregivers will maintain the
patient's muscle and joint mobility. Traction equipment should be checked regularly to
ensure proper position and exertion of force. With skeletal traction, it is important to
check for inflammation of the bone, a sign of foreign matter introduction (potential
source of infection at the screw or pin site).

PREPARATION

Both skin and skeletal traction require x rays prior to application. If skeletal traction is
required, standard pre-op surgical tests are conducted, such as blood and urine studies.
X rays may be repeated over the course of treatment to insure that alignment remains
correct, and that healing is proceeding.

NORMAL RESULTS
There have been few scientific studies on the effects of traction. Criteria (such as

randomized controlled trials and monitored compliance) do exist, but an outcome study

incorporating all of them has not yet been done. Some randomized controlled trials

emphasize that traction does not significantly influence long-term outcomes of neck

pain or lower back pain.

TYPES OF TRACTION

DUNLOP TRACTION
The main use of Dunlop's traction is in the maintenance of reduction in supracondyar
fractures of the humerus in children.
Dunlop Traction

 Supracondyar fractures in children

 Allows swollen elbow to settle
 Contraindicated in open fractures and skin defects Skin traction is placed on the
forearm and A special frame used on the side of the bed. 
 Traction is placed along the axis of the forearm as well as at right angles to the
humerus by means of a broad sling placed around the upper arm. Bed blocks are
required on the lateral side (fracture side up) of the bed.
 if a supracondyar fracture cannot be reduced to over 90 degrees elbow flexion,
this method of traction is an alternative to invasive methods such as a percutaneous
K-wires. It allows swelling to subside. Do not rely on this method to reduce a supra
condylar fracture, a manipulation will still be required!

(Please refer to appendix figure 1.3)

RUSSELL TRACTION

 In this form of skin traction, a system of suspension and traction pull is used.

Adhesive strips are applied as in Buck's extension, and the knee is suspended in a

sling. A rope is attached to the sling's spreader bar. This rope passes over a pulley

which is attached to an overhead bar and is then directed to a system of three pulleys at

the foot of the bed: first to a pulley on the bed's foot bar, next to a pulley attached to the
foot spreader bar, and then back to a second pulley on the bed's foot bar. There is an

upward pull from the sling pulley and a forward pull from the pulleys at the foot of the

bed. In Russell traction, the angle between the thigh and the bed is approximately 20°

and there is always slight flexion of both the hip and the knee. The advantage of

Russell traction is that some movement in bed is permissible. The patient can turn

slightly toward the side in traction for back care, bedpan placement, or linen change.

 Check the popliteal space for signs of pressure from the sling such as

redness, indentations, abrasions, or pain. Check all the tape and wrappings as in

Buck's traction. Keep the patient from sliding down the bed. The foot of the bed may

be elevated to help prevent this.

(Please refer to appendix figure 1.4)

CERVICAL TRACTION

What is Cervical Traction

Cervical traction is a simple chiropractic procedure used to correct the alignment of the
entire spinal column.  It is considered a conservative therapeutic method of chiropractic
medicine.  The advantage of this kind of procedure is that it can be done at home,
without direct supervision of a health practitioner.

Indications and Contraindications of Cervical Traction

Cervical traction is indicated for the diseases of cervical disc, osteoarthritis, and for
accelerated extension damages as long as there are no post-traumatic lesions.  

For cervical disc disorders, traction can be used with or without root inflammations.  For
back bone disorders without extensive neurological effects, this procedure should be
applied conservatively.  It is also indicated for most neck injuries that resulted from
traumatic motions.  

The procedure of cervical traction is generally safe, and there are no reported major
hazards concerning the use of traction devices.  However, it is contraindicated for cases
wherein patients have not undergone thorough orthopedic, neurological, and radiological
examinations.  

Cervical traction is not recommended for neo-plastic disorders, cervical spine injuries
having serious post-traumatic lesions, or for patients experiencing serious
cervicobrachial discomforts mostly associated with gross neurological deficit.

(Please refer to appendix figure 1.5)

BALANCED SKELETAL TRACTION

 The combination of skeletal traction and balanced suspension is widely used

for the treatment of fractures of the femoral shaft (see figure 1-16). This method of

treatment provides considerable freedom of body movement while maintaining efficient

traction on the injured limb. The Thomas leg splint and Pearson attachment are used to
achieve this balanced suspension traction.

 The Thomas splint (half ring) is applied in various ways: with the ring fitted

posteriorly against the ischium or anteriorly in the groin. The thigh rests in a canvas or
 bandage-strip sling with the popliteal space left free. The leather ring should not be

wrapped or padded. If kept smooth, dry, and polished, the leather of the ring is

designed to rest against the skin and resist moisture.

 The Pearson attachment is attached by clamps to the Thomas splint at knee

level. A canvas or bandage-strip sling supports the lower leg and provides the desired

degree of knee flexion. A footplate is attached to the distal end of the Pearson

attachment to support the foot in a neutral position. The heel should be left free.

 The traction is in line with the long axis of the femoral shaft and is maintained

by the rope, pulley, and weights attached to the skeletal tractor, which is fitted onto the

wire or pin. Counter traction and balanced suspension are provided by the ropes,

pulleys, and weights attached to the Pearson attachment. When all is operational, the

thigh and Thomas splint will be suspended at about a 45° angle with the bed and the

lower leg and Pearson attachment will be suspended horizontal to the mattress. The

patient may sit up, turn toward the traction side, and raise his hips above the bed by

means of the trapeze and still maintain the line of traction

(Please refer to appendix figure 1.6)

GALLOW TRACTION

This is used in infants and children with femoral fractures.

Indications Gallows Traction
 Child must weigh less than 12 kg
 Femoral fractures
 Skin must be intact

Both the fractured and the well femur are placed in skin traction and the infant is
suspended by these from a special frame. Vascular compromise is the biggest danger.
Check the circulation twice daily. The buttocks should be just off the bed.

(Please refer to appendix figure 1.7)

PELVIC SLING TRACTION

 The pelvic traction sling is used in the treatment of pelvic fracture.The patient is
placed in a cavas sling or hammock that is suspended by a tension spring to an
overlead frame bar.The pelvis is suspended so that it is just off the matters.
 Padding may be placed along the sling edges or as needed to receive pressure on
the coccyx.Keep the sling,the pedding and the skin clean and dry.

(Please refer to appendix figure 1.8)

CALCANEAL TRACTION

 Temporary traction for tibial shaft fx or calcaneal fx

 Insert about 1.5 inches inferior and posterior to medial malleolus
 Do not skewer subtalar joint or NV bundle
 Maintain slight elevation leg

 Calcaneus traction with a Steinmann-pin or K-wire inserted into the dorsal aspect of
the calcaneus is a common temporary procedure in fractures of the lower leg when
internal fixation has to be delayed. Infection due to this simple manoeuvre is rare, but
is a very serious complication. In 1991, a so-called pinless external fixator was
introduced in clinical trials, based on the idea of external fixation without transosseus
 pins, thus preserving local blood supply and lowering the risk of pin track infection.
This pinless clamp also represents a handy tool for calcaneus traction. We have
used this pinless clamp for calcaneus traction in 39 patients without any major
problems or complications. Of these, 29 patients were scheduled for delayed internal
fixation, and in 10 patients this clamp was used intraoperatively in closed tibial nailing
for traction on the fracture table. Tips and tricks for the use of this pinless clamp, and
its advantages and disadvantages are discussed.

(Please refer to appendix figure 1.9)

APPENDIX

Figure 1.1

Figure 1.2
For tibial traction, a pin is surgically placed in the lower leg (A). The pin is attached to a
stirrup (B), and weighted (C). In cervical traction, an incision is made into the head (D).
Holes are drilled into the skull, and a halo or tongs are applied (E). Weights are added to
pull the spine into place (F).

Figure 1.3
Figure 1.4

Figure 1.5
Figure 1.6

Figure 1.7
Figure 1.8

Figure 1.9