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Balance Skeletal Traction
Balance Skeletal Traction
Traction is the act of pulling and drawing which is associated with counter traction. Indications: For the affection of the hip, femur, tibia and supracondylar of the humerus
Purposes: To provide immobilization To prevent or correct deformity To reduce pain and muscle spasm To reduce fracture To maintain good body alignment For support
APPLICATION OF TRACTION
1. Verify/ check doctors order to know the patient, the site of affection, and to
patients anxiety and to elicit cooperation. 3. Preparation a. Identify the different parts of the orthopedic bed Balkan Frame: 4 vertical bars 2 horizontal bars 1 diagonal bar 2 straight or cross bar 1 curved bar
Thomas splint Pearsons attachment Rest splint 3 cord/ropes/sashes 5 slings 5 safety pins/ paper clips 3 pulleys Weights
4. Assemble the Thomas splint and Pearsons attachment Estimate/ measure the length of the thigh to ensure that the screws of the Pearsons is in line with the knee The Pearsons attachment must be under the Thomas splint
5. Mount the Thomas & Pearsons on the rest splint. 6. Apply the slings. Start from the medial side to the lateral side, secure both ends together, fan fold nicely on the lateral aspect and secure with a pin or clip. Observe the Principles In Sling Application:
b. One (1) inch distance in between the slings to promote aeration or ventilation. c. Popliteal area and heel portion should be free from any slings d. Smooth and right side should come in contact with the patients skin to avoid friction and irritation. e. Two (2) longer and wider slings for the thigh portion (Thomas) and the three (3) for the leg area (Pearson)
7. Tie the thigh rope (shortest) on the medial upright of the Thomas with a
slipknot and secure the other end of the rope at the screw of the Pearson 8. Insertion of the apparatus under the affected extremity. Three manpower needed:
1st person insert the whole apparatus under the affected extremity 2nd person to perform manual traction to be released after the attachment of the traction weight on the third pulley 3rd person to support lift the affected extremity
Instruction to the patient: Hold on to the trapezes, flex the unaffected leg and at the count of three (simultaneous with the insertion of the apparatus) will lift the buttock of the affected side
9. Check if the principles of sling application are followed; check the alignment; and make the necessary adjustments. 10.
Application of the traction weight. One end of the traction rope (longer rope) is attached to the Steinman pin holder with a slipknot; the other end is to run along the third (3rd) pulley. Attach the prescribed weight.
The loose end of the thigh rope is attached to the lateral aspect of the ischial ring with a slipknot. Attach suspension rope (longest) at the mid-part of the thigh rope with a slipknot. Insert the end of the suspension rope to the 1st pulley Insert the suspension weight and hang it on the first pulley Insert the suspension rope to the second pulley then pass it under the rest splint, outside the traction rope, and tie it to the Thomas splint with a clove hitch knot and tie it again to the Pearsons attachment with another clove hitch knot. Consume the remaining rope.
12.
13. Apply foot board ( using ribbon knot) to prevent foot drop
14. Check the efficiency of the traction by swinging the patient to and fro, side to side. (Give the patient the same instructions during the insertion of the apparatus).
15. Check the Principles of Traction:
Patient should be in dorsal recumbent position Line of pull should be in line with the deformitu
o o o
1st pulley should be in line with thigh 2nd pulley should be in line with the knee 3rd pulley should be in line with the 1st and 2nd pulley
Traction should always be continuous importance of manual traction should be emphasized Avoid friction:
o Rope should be running along the groove of the pulley o Knots should be away from the pulley o Weight should be hanging freely o Observe for wear and tear of rope and bags Provide counter traction patients body weight will serve as th counter traction.
REMOVAL OF TRACTION
3. Completely remove the suspension rope. 4. Loosen the thigh rope on the lateral aspect of the ischial ring and secure the loose end of the screw 5. Apply manual traction on the Steinman pin holder 6. Remove the traction weight
7. Remove the traction rope from the third pulley and secure the loose end on
the rest splint with a clove hitch knot; another knot on the Thomas and the Pearson attachment
2. Provision of general comfort: a. Skin care - head to toe, focus on sponging of the affected extremity
- PNEUMONIA : Provide bronchial tapping and teach - good perineal care, proper skincare, turning/ buttocks once in a while
deep breathing
b. Bedsore
lifting
c. Urinary & kidney problem - good perineal care, increase fluid intake d. Bowel complication perineal care
e. Pin site infection
- fear of apparatus, no privacy, lack of fluids, - observe for S/S of infection: loosening coming out, foul smelling drainage/ pin site, fever
f. Deformity
4. Provision of exercise: a. ROM exercise with the use of trapeze b. Deep breathing exercise c. Static quadriceps exercise quadriceps - alternate contraction and relaxation of muscles d. Toes pedal exercises 5. Nutritional status Depending on the status of patient o Encourage patient to increase intake of foods rich in fiber, protein, vitamin C & and calcium; increase fluid intake 6. Psychological aspect
Fear of unknown, fear of death, fear of the apparatus, fear of losing job, financial fear
7. Provision of supportive therapy Offer book to read; discover interest; encourage listening to radio or TV
8. Spiritual aspect Know his religion, encourage relatives to read him verses from the Bible
9. Diversional activities
1. Verify/ check the doctors order 2. Inform the patient about the procedure and purpose of traction 3. Identify/ gather the mat needed 4. Assemble the Thomas splint & Peason attachment 5. Mount the TS & PA on the rest splint 6. Apply the slings 7. Tie the tie rope on the medial aspect upright of the TA with slipknot and secure the other of the rope at the screw of the PA 8. Insertion of apparatus under the unaffected extremity 9. Check the principle of sling application are followed, check alignment and make necessary adjustment 10. 11. 12. Application of traction weight Application of suspension weight Remove the rest splint
14.