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Traction

Purpose
1.
2.
3.
4.

To minimize spasm
Reduce align-immobilize fractures
To reduce deformity
To increase space between opposing surface

Principles
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Countertraction traction
Traction must be continues
Fractures that reduce effective pull must be eliminated
o Body alignment
o Ropes
o Weights
o Knots on ropes and footpath

Class of traction
1. Manual traction
a. Chiropractor
2. Skin traction
a. Pelvic traction
b. Cervical traction
3. Skeletal traction
a. Balance suspension traction
i. Steinman’s pins
ii. Thomas splint
iii. Pearson’s attachment
iv. Stirrups
 Balkan frame
 Four vertical bars
 Minimum of two horizontal bars
 One diagonal bar
 Over head trapeze
 Firm mattress
 Minimum of three pullies
 Fracture board
Maintaining position
-

Semi fowler
Prevent skin break down
o Four staging of bed soar
 Stage one: non-blanching Redness
 Stage two: blister formation
 Stage three: open wound
 Stage four: leathery formation
 Fascia


Bones
Muscle

Monitor neuron vascular status
-

-

Report
o Changes in sensation
o Changes in movement
o Discomfort
Neurovascular assessment
o Check the 6 Pls
 Pain
 Pulse
 Pallor
 Paresthesia
 Paralysis
 Poikilothermia/Polar

Most common complication under traction
-

Deep vein thrombosis
o Homan’s sign
- Provide pin site care
- To reduce infection
o

Osteomyelitis
 Only cleaned by the surgeon

Exercise
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Range of motion
o Active
o Isometric

Ambulation
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Manner of walking
o Heel – toe (w/hand swing)
o Posture (erect)
Functional optional

Iliopsoas
-

Ilacus
Psoas
o Femur
 Both connected to femur iliac crest/pelvic
 Lower vertebrae
 Weight bearing

Goal: promote imdependence

1. Crutches: good sense of balance and one good leg.
2. Walker: one weak leg but still can bear weight.
3. Wheelchair: hemiplegia, paraplegia, quadriplegia
Equipment
Gait belt – used assisting in ambulation transferring
-

Walk I’m unison

Anti-slip sole
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Rubber soled

Cane
-

Cane
Opposite
Affected
Leg

Crutch
-

-

Measure
o Axilla to heel
 Supine + 1 in
 Standing – 1 in
Crutch stand
Types
o
o
o
o
o
o

of gait
4 point
3 point
2 point
Swing to
Swing through
Good leg goes to heaven bad leg goes to hell

Clients and environment
-

General conditions/vs (baseline)/pain(cooperate)
o Pain meds 30 mins
o Activities
Family/caregiver

Cast
Purposes
1.
2.
3.
4.
-

Immobilize and reduce fracture
Correct deformity
Apply uniform pressure to underlying soft tissue
Support and stabilize weakened joints
Provides maximal comfort and alleviation of complicated
Cleanse addicted area and dry before cast application

-

Handle the cast with care
Use palms to mold the cast
Appearance of dry plaster cast
o White and shiny
o Resonant to percussion
o Odorless
o Firm
Contraindications

-

Pregnant woman
o Increases weight; possible circulation cut
Skin infections
o Skin infection
Materials

1.
2.
3.

4.

Plaster of paris
Fiberglass
Wading sheet
Stockinette
Cast application
Check the doctors order
Inform and prepare the patient for the procedure
Explain to the patient and his relative the need for placing the affected part
of the body in a cast cleanse and dry the affected body part; wound dressing
application if needed
Prepare the materials and drape the clients.
Don’t forget
1. Assess clients general health prior to cast application
a. Presenting signs and symptoms emotional status
b. Understanding of the need for cast
c. Competition of the affected body part
2. Support the affected body part during cast application and during
hardening
a. Maintain proper alignment for bone healing
b. Minimalize movement
c. 2-3 wraps around affected area
3. Trim and reshape the edges
a. Smoother edges
b. Allow full ROM of adjacent joints
The 6 P’s

CAST CARE
-

Clean and dry always
Assess neurovascular status (6 p’s)
Shiny, hard , and resonant
Too tight – BIVALVING

-

Carry newly castes extremity with palms/pillow
Assess by windowing
Recheck for complications
Elevate casted extremity

Potential complications
1. Compartment syndrome
a. Increase in tissue size
b. Remove cast and treat before recasting
c. Treatment fasciotomy procedure
2. Pressure ulcers
3. Disuse syndrome