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TRACTION

The act of pulling and drawing associated with counter traction.


MANUAL TRACTION
1. A pulling force applied by the hands of the operator.
TYPES OF TRACTION:
I. Skeletal Traction
 A pulling force applied directly to the bones using wires, pins and tongs

KIRSCHNER’S WIRE HOLDER STEIMANN’S PIN HOLDER CRUTCHFIELD TONG


Affection of the radius ulna Affection of the humerus, femur, Affection of the upper dorsal
Thinner than the steimann’s pin tibia and fibula cervical spine
Inserted at the parietal area

BALANCED SKELETAL TRACTION OVERHEAD TRACTION NINETY-NINETY DEGREES


Affection of the hips and or femur Supracondylar fracture of the TRANTION
humerus Subtrochanteric and proximal 3rd
fracture of femur

HALO – PELVIC TRACTION HALO – FEMORAL TRACTION


For C type scoliosis For S – Type Scoliosis

II. Skin Traction


 Pulling force is applied to the skin, transmitted to the muscle, then to the bones
Types:
A. ADHESIVE
 Use of adhesive tape, elastic bandage, wooden spreader and wadding sheet.

DUNLOP TRACTION ZERO DEGREES TRACTION BUCK’S EXTENSION TRACTION


Affection of supracondylar of the Affection of the surgical neck of Affection of the hip and the
humerus the humerus and the shoulder femur
joint
BRYANT TRACTION BOOT CAST TRACTION MODIFIED BUCK’S EXTENSION TRACTION

Affection of the hip and femur for For post poliomyelitis with use of foam instead of plaster.
children below 3 years old residual paralysis of the hip and For post poliomyelitis with
knee residual paralysis of the hip and
knee

B. NON-ADHESIVE
 Use of canvass, slings, leathers, straps with buckles, laces and ribbons.

HEAD HALTER TRACTION PELVIC GIRDLE TRACTION COTREL TRACTION


For cervical spine affection For lumbo-sacral spine affection For scoliosis
For herniated nucleus pulposus A combination of head halter and
pelvic girdle traction

HAMMOCK SUSPENSION TRACTION BOHLER BRAUN SPLINT


For affection of the pelvis Supports the lower leg
For malgained fracture (double For fracture of Proximal 3rd and
fracture of the pelvic ring causing Middle 3rd of tibia-fibula
instability of the pelvis)

THE BALANCED SKELETAL TRACTION

Traction is the act of pulling and drawing in an opposite direction which is associated with counter
traction.

INDICATIONS:
1. To lessen muscle spasm
2. To reduce fracture
3. To provide immobilization
4. To maintain alignment
5. To correct or prevent deformities in the case of arthritis patient with flexion contraction
6. To help lessen the curvature of the spine before correction surgery
PREPARATION:
1. Check/verify the doctor’s order to know the patient, the site of affection, and to check the
weights to be used.
2. Inform the patient about the need and purpose of the procedure to allay patient’s 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 bars
 1 curved bar
-FIRM MATTRESS
-FRACTURE BOARD
b. Gather equipment needed for BST:
 Thomas splint
 Pearson’s attachment
 Rest splint
 3 cord/ropes/sashes
 5 slings
 5 safety pins/paper clips
 3 pulleys
 Weights
-Traction weight-10% of patient’s weight
-Suspension weight-50% of traction weight
 Steinman’s pin holder
 Foot board
 Overhead trapeze
4. Assemble the Thomas splint and Pearson’s attachment
 Estimate/measure the length of the thigh to ensure that the screw of the Pearson’s is in
line with knee.
 The Pearson’s attachment must be under the Thomas splint.
5. Mount the Thomas & Pearson’s 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:
a. Not too tight and not too loose
b. One 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 patient’s skin to avoid
friction and irritation.
e. Two longer and wider slings for the thigh portion (Thomas) and the three 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 to 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.
This is to be done simultaneously at the count of three.
Instruction to the patient:
Hold on to the trapeze, flex the unaffected leg and at the count of three (simultaneously 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 (3 rd) pulley. Attach the prescribed
weight.
11. Application of suspension 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 1 st 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 Pearson’s attachment with another clove hitch knot.
 Consume the remaining rope.
12. Remove the rest splint.
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 instruction during the insertion of the apparatus)
15. C heck the Principles of Traction:
 Patient should be in dorsal recumbent position.
 Line of pull should be in line with the deformity
o 1st pulley must be in line with the deformity
o 2nd pulley must be in line with the knee
o 3rd pulley must in line with the 1st & 2nd pulley
 Traction should always be continuous- importance of manual traction should be
emphasized.
 Avoid friction: (you have to W O R K)
W-weight should be hanging freely
O-observe for wear and tear of rope and bags
R-rope should be running along the groove of the pulley
K-knots should be away from the pulley
 Provide counter traction-patient’s body weight will serve as the counter traction.

REMOVAL OF TRACTION
1. Apply the rest splint
2. Hang suspension weight on the 1st pulley
3. Completely remove the suspension rope
4. Loosen the thigh rope on the lateral aspect of the ischial ring and secure the loose end on 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 Pearson attachment.

NURSING CARE OF PATIE NTS WITH TRACTION


1. Assessment-assess the patient as to level of understanding, consciousness
2. Provision of general comfort:
a. Skin care-head to toe, focus on sponging of the affected extremity
b. Changing of linen, slings
c. Provide bedpan as needed
d. Perineal care
3. Assess for potential complication
a. Upper respiratory- PNEUMONIA- Provide bronchial tapping and teach deep breathing
b. Bedsore-good perineal care, proper skin care, turning/lifting buttocks once in a while
c. Urinary and kidney problem-good perineal care, increase fluid intake
d. Bowel complication-fear of apparatus, no privacy, lack of fluids, perineal care
e. Pin site infection-observe for S/S of infection-loosening pin tract, pus coming out, foul
smelling drainage/pin site, fever
f. Deformity-contracted knee, atrophy of muscles, foot drop, joint contractures
4. Provision of exercises:
a. ROM exercises with the use of trapeze
b. Deep Breathing Exercises
c. Static quadriceps exercises- alternate contraction and relaxation of quadriceps muscles
d. Toes pedal exercises
5. Nutritional status-depending on the status of patient- 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 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- logic games/crossword puzzles
CAST
A temporary immobilization device made of gypsum sulphate rendered anhydrous which when mixed
with water, swells and form into hard cement.

MOLD
Used for splinting the affected part of the body wherein there is an open wound, inflammation, abrasion,
swelling, or infection.

FUNCTIONS OF CAST
1. Promote healing and early weight – bearing
2. Immobilization
3. Correct or prevent deformity
4. To obtain a mold of a limb to serve as a model in making an artificial limb
5. Support, maintain and protect realigned bone

PRINCIPLES IN APPLICATION OF CAST


1. Apply padding first before applying cast
2. Apply cast by including the joint above and the joint below the affection
3. Apply cast in circular motion and smoothen with the palm
4. Support with the palm

CONTRAINDICATIONS
1. pregnancy
2. skin disease

NEUROVACULAR ASSESSMENT OF PATIEN T WITH CAST (MC NEWS)

M- movement
C- color

N- numbness
E- edema
W- warmth
S- sensation

SIGNS OF CAST SYNDROME


1. Inability to take a deep breath
2. Nausea
3. Abdominal pressure
4. Feeling of tightness and bloating

MATERIALS/ INSTRUMENTS IN CAST APPLICATION/ REMOVAL

1. Stockinet Directly in contact with the skin


2. Wadding sheet and gauze bandage Serve as padding
3. Plaster of Paris/ fiber glass Casting material
4. Trimming knife Smoothen the edges of cast
5. Cast spreader To widen a bivalve cast
6. Stryker cast cutter Used in windowing
7. Bandage scissor To cut wadding sheet and stockinet
CAST TECHNIQUES

1. windowing Putting a hole on a cast on the site of an open wound of the casted extremity
for the purpose of visualization, inspection, dressing, as well as application of
medications
2. bivalving Cutting the cast into halves from the upper portion to the bottom part for the
purpose of relieving possible cast tightness, X-ray and inspection of the casted
extremity
3. reinforcing reapplication of Plaster for the purpose of regaining its strength in case of
wetting the cast which resulted to its instability
I. CAST IN THE TRUNK AREA

COLLAR CAST BODY CAST MINERVA CAST


– cervical cast affection lower thoracic and lower lumbar upper dorsal; cervical spine

RIZZER’S CAST SHOULDER SPICA CAST SUGAR TONG


For scoliosis fracture of the upper portion of the fracture of the upper portion of the humerus
humerus and the shoulder joint and shoulder joint with open wound swelling
and infection
II. CAST OF THE UPPER EXTREMITIES

SHORT ARM CIRCULAR CAST SHORT ARM POSTERIOR MOLD MUNSTER/FUENSTER CAST
Fracture of the wrist and finger fracture of the wrist and finger with open fracture of radius and ulna with callus
wound, swelling and infection formation

LONGARM CIRCULAR CAST LONGARM POSTERIOR MOLD HANGING CAST


fracture of radius and ulna fracture of the radius and ulna with fracture of the shaft of the
open wound swelling and infection humerus

FUNCTIONAL CAST ABDUCTION SPLINT/AIRPLANE CAST THUMB SPICA CAST


fracture of the shaft of the humerus fracture of the neck of the humerus / – fracture of the first metacarpal
with callus formation recurrent shoulder dislocation bone
III. CAST IN THE LOWER EXTREMITIES

SHORT LEG CIRCULAR CAST LONG LEG CIRCULAR CAST SHORT LEG POSTERIOR MOLD
ankles, tarsals and metatarsals tibia and fibula affection ankles, tarsals and metatarsals affections with
open wound, swelling and infection
affection

LONG LEG POSTERIOR MOLD PATELLAR TENDON BEARING CAST DELVIT CAST
tibia-fibula affections with open tibia fibula with callus formation fracture of the distal third of tibia and
wound, swelling and infection fibula with callus formation

CYLINDER CAST CYLINDER MOLD QUADRILATERAL/ISCHIAL WEIGHT BEARING CAST

for patellar affection – fracture of the patellar with open wound, fracture of the shaft of femur with callus formation
swelling and infection

BASKET CAST CAST BRACE


severe/massive bone injury – fracture of the distal third of femur with callus formation

SINGLE HIP SPICA CAST 1 ½ HIP SPICA CAST DOUBLE HIP SPICA CAST
hip and femur affections hip and femur affections – hip and femur affection
PANTALON CAST FROG CAST INTERNAL ROTATOR BOARD
pelvic affection for congenital hip dislocation hip surgery (partial and total hip
surgery

NIGHT SPLINT
Post polio

BRACE
A mechanical support for weakened muscles, joints and bones in rehabilitation
I. FUNCTIONS
1. For immobilization
2. Permit patients to walk without fatigue
3. Maintain body alignment
4. To control involuntary movements
5. Prevent and correct deformity
6. For support

SHANTZ COLLAR BRACE PHILADELPHIA COLLAR BRACE FOUR POSTER BRACE


For cervical spine affection For cervical spine affection For cervical spine and upper
thoracic spine affection

SOMI BRACE FORESTER BRACE


STERNO-OCCIPITO-MANDIBULAR IMMOBILIZER Cervico-thoracic-lumbar spine
affection
KNIGHT TAYLOR BRACE CHAIR BACK BRACE JEWETTE BRACE
Affection of the upper thoracic For lumbo-sacral spine affection For dorso lumbar and upper
spine lumbar spine affection

MILWAUKEE BRACE YAMAMOTO BRACE SCOTTISH RITE


For scoliosis For scoliosis For Coxa Plana or Legg Calve
Affection of T9 and below Affection of T9 and above Perthe’s Disease

COCK –UP SPLINT BANJO SPLINT OPPEN HEIMER


For wrist drop For peripheral nerve injury For radial nerve injury

UNILATERAL LONG LEG BRACE BILATERAL LONG LEG BRACE SHORT LEG BRACE
For post poliomyelitis with For post poliomyelitis with residual For clubfoot
residual paralysis paralysis

DENNIS BROWNE SHOE


For congenital clubfoot (Talipes Equino Varus)
ORTHOPEDIC HARDWARE

TOWERS EXTERNAL FIXATOR ROGER ANDERSON EXTERNAL FIXATOR MINIROGER ANDERSON EXTERNAL
For fracture of the mandible For comminuted fracture of the long FIXATOR
bone; RAEF FOR LOWER EXTREMITIES For comminuted fracture of the
long bone of upper extremities
(radius – ulna/humerus)MINIRAEF

DELTA FRAME EXTERNAL FIXATOR HYBRID EXTERNAL FIXATOR ELIZAROV EXTERNAL FIXATOR
rd
For fracture of Proximal 3 and Distal For periarticular fracture of the For comminuted fracture,
3rd tibia-fibula ankle or knee joint non-union, mal union and
bone lengthening

SPANNING EXTERNAL FIXATOR HOFFMAN’S EXTERNAL FIXATOR


For fracture of femur extended to tibia For pelvic affection or hip dislocation

CERCLAGE WIRE INTRAMEDULLARY NAIL


For fracture of the patella Fracture of middle 3rd of femur/long bone
Used in tension bond wiring
COMPRESSION HIP SCREW FIXATOR BUTTRESS PLATE/T PLATE
Intertrochanteric fracture of the femur Fracture of Proximal 3rd of tibia

Y BONE PLATE INTRAMEDULLARY NAIL EXTRACTOR ANTIBIOTIC BEADS


For supracondylar fracture of the For removal of IM nail Therapeutic effect for
humerus Osteomyelitis
X BONE PLATE – for fracture of the Prophylactic effect in plating, IMN
medial 3rd of radius - ulna and all types of internal and
external fixators

OSTEOTOME (CHISEL) GIGLI SAW SPACER ANTIBIOTIC


Used for obtaining bone chips for For amputation Replacement of infected hip
spinal fusion prosthesis
Used for scraping dead or
necrotic bone tissue

BIPOLAR HIP PROSTHESIS AUSTIN MOORE HIP PROSTHESIS KNEE PROSTHESIS


Replacement of femoral head, neck Replacement of femoral head and For fracture of the patella
and acetabulum neck With femoral and tibial
For total hip replacement For partial hip replacement component
arthroplasty arthroplasty For osteoarthritis of knee