Traction

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 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.

Specialized forms of skin traction have been developed to address specific problems. Dunlop's traction is used on
children with certain fractures of the upper arm, when the arm must be kept in a flexed position to prevent
problems with the circulation and nerves around the elbow. Pelvic traction is applied to the lower spine, with a
belt around the waist. Buck's skin traction is used to treat knee injuries other than fractures. The purpose of this
traction is to stabilize the knee and reduce muscle spasm.

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.

Specialized forms of skeletal traction include cervical traction used for fractures of the neck vertebrae; over-head
arm traction used for certain types of upper arm fractures; and tibia pin traction used for some fractures of the
femur, hip, or pelvis.

Preparation

X rays are done prior to the application of both forms of traction, and may be repeated during treatment to assure
that the affected parts are staying in alignment and healing properly. Since the insertion of the anchoring devices
in skeletal traction is a surgical procedure, standard preoperative blood and urine testing are done, and the patient
may meet with an anesthesiologist to discuss any health conditions that might affect the administration of
anesthesia.
Aftercare

Aftercare for skin traction involves making sure the limb stays aligned, and caring for the skin so that it does not
become sore and irritated. The patient should also be alert to any swelling or tingling in the limb that would
suggest that the limb has been wrapped too tightly.

Aftercare for skeletal traction is more complex. The patient is likely to be immobile for an extended period. Deep
breathing exercises are taught so that respiratory function is maintained during this time of little activity. Patients
are also encouraged to do range-of motion exercises with the unaffected parts of the body. The patient is taught
how to use a trapeze (an overhead support bar) to shift on and off a bedpan, since it is not possible to get up to use
the toilet. In serious injuries, traction may be continued for several months until healing is complete.

Risks

The main risks associated with skin traction are that the traction will be applied incorrectly and cause harm, or
that the skin will become irritated. There are more risks associated with skeletal traction. Bone inflammation may
occur in response to the introduction of foreign material into the body. Infection can occur at the pin sites. If
caught early, infection can be treated with antibiotics, but if severe, it may require removal of the pin.

Both types of traction have complications associated with long periods of immobility. These include the
development of bed sores, reduced respiratory function, urinary problems, and circulatory problems

Different Types Of Skeletal Traction

Balanced Suspension Traction

Balanced suspension traction is used to stabilize fractures of the femur. It can be the skin or skeletal type. If it is
skeletal, a pin or wire is surgically placed through the distal end of the femur. If it is skin traction, tape and
wrapping or a traction boot of the kind described under Buck’s traction is used.

The patient is in the supine position, with the head of the bed elevated fro comfort. As the name suggests, the
affected leg is suspended by ropes, pulleys, and weights in such a way that traction remains constant, even when
the patient moves the upper body.

Two important components of balanced suspension traction are the Thomas splint and the Pearson attachment.
The Thomas splint consists of a ring, often lined with foam, that circles and supports the thigh. Two parallel rods
are attached to the splint and extend beyond the foot. A Pearson attachment consists of a canvas sling that
supports the calf.

Parallel rods lead from the pin sites on the distal and of the attachment for the rope. Traction to the femur is
applied through a series of ropes, pulleys, and weights. These weights hang freely at the foot off the bed.

The skin should be inspected frequently to identify problems early. The ring of the Thomas splint can excoriate
the skin of the groin. Special padding may have to be used. Again, the foot should always be at a right angle on
the footrest to prevent footdrop. If pins are used for fixation, aseptic technique must be used around pin sites until
they have healed. From then on, clean technique can be used. The pin sites are cleansed carefully with soap and
water and rinsed thoroughly, unless this varies from policy. An antiseptic, such as povidone-iodine ointment, may
then be applied. Dressings are usually not required. You should, however, constantly assess for infection at the
pin sites. Indications include redness, heat, drainage, pain, or fever. Review your facility’s policy on pin care.

Skull Tongs Traction

Skull tongs are used to immobilize the cervical spine in the treatment of unstable fractures or dislocation of the
cervical spine. Although Crutchfield tongs were used almost exclusively in the past, Gardner-Wells skull tongs
are in wide use. Some think these are less likely to pull out than the Crutchfield tongs. The patient is prepared for
either type with a local anesthetic to the scalp. The tongs are surgically inserted into the bony cranium, and a
connector half-halo bar is attached to a hook from which traction can be applied.

The patient is supine and is usually on a special frame instead of the regular hospital bed. If a hospital bed is used,
two or more people are required to assist the patient with any turning movements. The head of the bed may be
elevated to provide counter traction.

Because patients remain in this type of traction for an extended period, observe the precautions taken for the
patient in other types of skeletal traction. Difficulties with the performance of activities of daily living, infection
at the tong sites, and restlessness and boredom are common. It is useful to teach the patient range-of-motion
exercises, provide good nutrition and suggest recreational or occupational activities.

Halo Traction

Halo traction provides stabilization and support for fractured cervical vertebrae. The surgeon inserts pins into the
skull. A half circle of metal frame connects the pins around the front of the head. Vertical frame pieces extend
from a halo section to a frame brace that rests on the patient’s shoulders. The halo traction allows the patient to be
out of bed and mobile while stabilizing the cervical vertebrae could injure the spinal cord.

Lumbar Traction Device

Lumbar traction is widely used to treat low back pain, often in conjunction with other treatment modalities. The
traction may be applied intermittently, using any of several methods to treat conditions of the spine, in either an
outpatient setting or in a home setting. Typically, these modalities are used short term but can also be use in long
term. Various techniques have been reported to widen or decompress disc spaces, unload the vertebrae, decrease
disc protrusion or muscle spasm, separate the vertebra, or lengthen and stabilize the spine. The duration of the
exerted force applied may be intermittent or continuous throughout a treatment session. Traction therapy is
consider to be a safe and effective treatment for back pain, especially with radiculopathy. Commonly used home
lumbar traction devices employ a free weight and pulley system capable of holding approximately 20 pounds of
sand or water as a traction force. A harness is attached around the pelvis (to deliver a caudal pull), and the upper
body is stabilized with a chest harness or voluntary arm force (for the cephalad pull). In some cases, 70–150
pounds of pull are required to distract lumbar vertebrae.

Several available home lumbar traction devices that are not pulley and weight systems may apply traction forces
greater than 20 pounds. This type of device may be indicated when use of a standard home pulley traction device
has been unsuccessful. Some of the home lumbar traction devices we carry can apply up to 200 pounds of home
traction force. Manufacturers propose that the device mimics the traction offered in a clinical setting by providing
a friction-free split surface that actively moves, enabling vertebral separation by inducing a pulling force. It is
suggested that, when using these devices, the patient can be positioned so that the lumbar curve is in any degree
of flexion, neutral or in extension. Each of these devices has both a patient-controlled pressure valve that limits
the amount of force transmitted to the user and a hand-held pump for immediate release of pressure.

Lumbar traction can relieve pressure on compressed nerves, help muscles relax and reduce muscle spasms.
Traction increases the space between vertebrae - reducing pressure on intervertebral discs and nerve root. The
vertebral separation is temporary, but may last long enough to allow some patients to exercise without
aggravating sciatica.

The therapist must decide the optimum amount of force to use and the length of time the force is sustained.
Enough force must be used to cause vertebral separation. Though relatively safe, excessive force could increase
pain or injury. Force is increased slowly to avoid overstretching or triggering muscle spasms. Traction should not
cause pain although mild soreness is often felt the next day.

Cervical Traction Device

Cervical traction has been utilized for many years for relief of pain associated with neck muscle spasms or nerve
root compression. Traction is a medical technique in which opposite forces are applied to separate parts of the
body to stretch soft tissues, and/or separate bony structures. Cervical traction focuses on stretching the head away
from the rest of the body to release tension and pressure on neck structures. It generally requires 2 minutes of
sustained traction before the intervertebral spaces begin to widen. Forces between 20 and 50 pounds are
frequently used to achieve intervertebral separation. Duration of cervical traction can range from a few minutes to
20 to 30 min, once or twice weekly to multiple times per day.

A variety of cervical traction devices are available for use in the home. The most commonly used device uses an
"over the door" design, in which a patient wears a chin strap harness attached to a counterweight that is suspended
over the door using a pulley system. The weight pulls the chin harness upwards, relieving tension on the neck.
Other variations of this device include frames which attach to a headboard or freestanding units. "Over the door"
units are designed to deliver no more than 20 pounds of tension. Pneumatic devices are also available that push up
the head while pushing down on the shoulders. Pneumatic Traction device, which consists of a soft foam cushion
that extends from the patient's shoulders to the back of the head (occiput) and is secured with a head strap. A
patient-controlled bellows then inflates the cushions, thus applying up to 20 pounds of tension. Some pneumatic
traction device can deliver up to 50 pounds of tension.

Pneumatic cervical traction devices were developed to deliver cervical traction in the home comparable to forces
applied by physical therapists in the outpatient setting. The patient is instructed in home traction to relieve
symptoms, an exercise routine to relieve spasm and discomfort, and to report any weaknesses, eye symptoms, and
bladder or bowel incontinence immediately.

Cervical traction is administered by various techniques ranging from supine mechanical motorized cervical
traction to seated cervical traction using an over-the-door pulley support with attached weights. Duration of
cervical traction can range from a few minutes to 20 to 30 min, once or twice weekly to several times per day.
Anecdotal evidence suggests efficacy and safety, but there is no documentation of efficacy of cervical traction
beyond short-term pain reduction. Because of a clinical impression that a simplified, inexpensive, over-the-door
home cervical traction method of treatment requiring 5 min of cervical traction twice daily was efficacious for
both cervical pain and radiculopathic syndromes, we undertook a retrospective study of 58 outpatients treated
between 1994 and 1996. Age range was 29 to 84 (mean, 56) yr. Twenty-three males and 35 females were
classified as Grade 1 to Grade 3 according to the Quebec Task Force of Whiplash-Associated Disorders Cohort
Study. Outcomes were as follows: Grade 1 (mild)--4 of 4 (100%) patients improved; Grade 2 (moderate)--34 of
44 (77%) patients improved (P < 0.01), 5 were unchanged, and 5 felt their symptoms were aggravated by cervical
traction; Grade 3 (patients with radiculopathy)--9 of 10 (90%) patients improved (P < 0.01). In a retrospective
study, a brief (3-5 min), over-the-door home cervical traction modality provided symptomatic relief in 85% of the
patients with mild to moderately severe (Grade 3) cervical spondylosis syndromes. Prospective, randomized
assessment of cervical traction for this and other methods is needed.

LUMBAR TRACTION DEVICES

Back pain is one of the most common afflictions of all. From something as simple as too much lifting, or a case of
the flu, to much deeper causes, most people experience back pain - especially lower back pain - during their lives.

As with neck pain, back pain may be the result of poor posture, physical stress, computer work, driving long
distances, sitting down for too long, improper sleeping habits, even muscle tension associated with emotional
stress. But other possible reasons include diseases of the organs in the chest, muscle strain, traumatic injury of the
back, rheumatism, arthritis, hyperplastic spondylosis, disk herniation, spinal compression.... Medical advice is
important. For instance, if caused by diseases of internal organs, back pain is merely a symptom and not the
condition needing treatment. If due to stress, strain, bad posture, correcting those will help. Look at some of our
products to enhance relaxation, de-stressing and general health.

Bryant's Traction

Bryant's traction is mainly used in young children who have fractures of the femur or congenital abnormalities of
the hip.[1] Both the patient's limbs are suspended in the air vertically at a ninety degree angle from the hips and
knees slightly flexed. Over a period of days, the legs hips are gradually moved outward from the body using a
pulley system. The patient's body provides the countertraction.