ROMERO, DEINIELLE INGRID M.

BSN 3-2

TRACTIONS

Traction is used for: (i) reduction of fractures and dislocations, and their maintenance; (ii) for
immobilising a painful, inflamed joint; (iii) for the prevention of deformity, by counteracting the
muscle spasms associated with painful joint conditions; and (iv) for the correction of soft tissue
contractures by stretching them out.

TYPES OF TRACTION

I. DIFFERENT TYPES OF TRACTION

 SKELETAL TRACTION
o Balanced suspension traction:  is used when a patient breaks a femur bone.
The femur is also known as the thigh bone. With balanced suspension traction,
pins are inserted through this large bone. This is a surgical procedure. Usually,
one large pin is placed through the center of the bone, while two smaller pins
are inserted on either side of the bone. The pins are used to hold the bone in
place.
o Skeletal Traction: It may be used as a means of reducing or maintaining the
reduction of a fracture. It should be reserved for those cases in which skin
traction is contraindicated
o Steinmann Pin Rigid stainless steel pins of varying lengths 4 – 6 mm in
diameter. Bohler stirrup is attached to steinmann pin which allows the
direction of the traction to be varied without turning the pin in the bone
o Steinmann Pin: Rigid stainless steel pins of varying lengths 4 – 6 mm in
diameter. Bohler stirrup is attached to steinmann pin which allows the
direction of the traction to be varied without turning the pin in the bone.
o Denham Pin: Identical to stienmann pin except for a short threaded length in
the center . This threaded portion engages the bony cortex and reduce the risk
of the pin sliding. Used in cancellous bone like calcaneum and osteoporitic
bones.
o Kirschner wire:They are easy to insert and minimize the chance of soft tissue
damage and infections, It easily cuts out of the bone if a heavy traction weight
is applied, Most commonly used in upper limb e.g. Olecranon traction.
Specific Tractions
 - Head Halter traction: Simple type cervical traction. Management of neck
pain. Weight should not exceed 2.3 kg. Can only be used a few hours at a
time.
o Perkin’s traction: Treatment of fractures of tibia and of the femur from the
subtrochantric region distally. Basis of management is the use of skeletal
traction coupled with active movements of the injured limb.
o Upper Femoral Traction: Lateral traction for fractures with medial or
anterior force. Stretched capsule and ligamentum teres may reduce acetabular
fragments.
o Ninety-Ninety Traction: Useful for subtrochantric and proximal 3rd femur
fracture. Especially in young children. Matches flexion of proximal fragment.
Can cause flexion contracture in adult.
Modern Techniques

o Traction procedures are largely replaced now by more modern techniques, but
certain approaches are still used today: Milwaukee brace/ Bryant's traction.

 SKIN TRACTION – is attached directly to patient’s skin to immobilize a body part

continuously or intermittently over a short or extended period.

o Buck’s Traction or Extension - used in temporary management of fractures of:

 Femoral neck
 Femoral shaft in older children
 Undisplaced fractures of the acetabulum
 After reduction of a hip dislocation
 To correct minor flexed deformities of the hip or knee
 In place of pelvic traction in management of low back pain
 Can use tape or pre- made boot
 Not more than 4.5 kgs
 Not used to obtain or hold reduction

o Hamilton Russel Traction

 Buck’s with sling
 May be used in more distal femur fracture in children
 Can be modifies to hip and knee exerciser

o Bryant’s Traction
 Useful for treatment of femoral shaft fracture in infant or small child
 Combines Gallows traction and Buck’s traction
 Raise mattress for counter traction
  Rarely used currently

o Forearm Skin Traction

 Adhesive strip with Ace wrap
 Useful for elevation in any injury can treat difficult clavicle fractures with
excellent cosmetic result
 Risk in skin loss

o Double Skin Traction

 Used for greater tuberosity or proximal humeral shaft fracture
 Arm abducted 30 degrees
 Elbow flexed 90 degrees
 Risk of ischemia at antecubital fossa

o Finger traps
 Used for distal forearm reductions
 Changing fingers imparts radial/ulnar angulation
 Can get skin loss/necrosis
 Recommend no more than 20 minutes
 Head Halter traction

o Head Halter Traction

 Simple type cervical traction
 Management of neck pain
 Weight should not exceed 2.3 kg
 Can only be used a few hours at a time

o Dunlop’s Traction
 Used for supracondylar and transcondylar fractures in children
 Used when closed reduction difficult or traumatic
 Forearm skin traction with weight on upper arm
 Elbow flexed at 45 degrees

METHODS OF APPLYING TRACTION

There are two methods of applying traction – skin

and skeletal
• Skin traction: An adhesive strap is applied on the skin and traction applied. The traction force
is transmitted from the skin through the deep fascia and intermuscular septae to the bone. These
days, readymade foam traction kits are available for this purpose.

Skin traction is far less invasive than skeletal traction. It involves applying splints, bandages, or
adhesive tapes to the skin directly below the fracture. Once the material has been applied,
weights are fastened to it. The affected body part is then pulled into the right position using a
pulley system attached to the hospital bed.

Skin traction is used when the soft tissues, such as the muscles and tendons, need to be repaired.
Less force is applied during skin traction to avoid irritating or damaging the skin and other soft
tissues. Skin traction is rarely the only treatment needed. Instead, it’s usually used as a temporary
way to stabilize a broken bone until the definitive surgery is performed.

Skeletal traction involves placing a pin, wire, or screw in the fractured bone. After one of these
devices has been inserted, weights are attached to it so the bone can be pulled into the correct
position. This type of surgery may be done using a general, spinal, or local anesthetic to keep
you from feeling pain during the procedure.

The amount of time needed to perform skeletal traction will depend on whether it’s a preparation
for a more definitive procedure or the only surgery that’ll be done to allow the bone to heal.

Skeletal traction is most commonly used to treat fractures of the femur, or thighbone. It’s also the
preferred method when greater force needs to be applied to the affected area. The force is
directly applied to the bone, which means more weight can be added with less risk of damaging
the surrounding soft tissues.

• Skeletal traction: The traction is applied directly on the bone by inserting a K-wire or
Steinmann pin through the bone.
Gallows traction (overhead Bryant skin traction) is useful for children younger than 2 years who
weigh 10-12 kg for Fracture shaft of femur.

The traction should be enough to just lift the buttocks of the child off the bed.
Careful examination of the neurovascular status of the extremity is mandatory in the early period
after application of traction.
Russell traction is a type of skin traction used to stabilize and align the lower

extremities. The patient's leg is suspended in a sling and attached to pulleys, strings and weights,

which serve to gently draw the bones into alignment.

Buck's traction is a type of skin traction that is widely used for femoral, hip, and acetabular
fractures, which are fractures in the socket portion of the "ball-and-socket" hip joint.
 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!
Pelvic traction for Backache
In sciatica and other backaches relief from pain can be obtained by means of pelvic traction.
Traction is applied to a pelvic harness with weights over the end of the bed.

An alternative in Sciatica is the 90-90 position. By means of cushions under the knees, the hips
are flexed near 90 degrees, as well as the knees. This shortens the sciatic nerve and relieves
pain.

Acetabular Traction
In conservative treatment of acetabular fractures longitudinal traction in the long axis of the
limb is often used. In addition the head of the femur can be disimpacted from the acetetabulum
( central fracture dislocations) by means of manipulation under anesthesia. The reduction is
maintained by means of lateral traction from pins paced in intertrochanteric region.
Gallows traction

Gallows traction is used in very young children to treat a fractured shaft of femur, or may be
used to stretch the soft tissues pre-operatively in the treatment of developmental dysplasia of the
hip (DDH). Gallows traction is limited to children under 12 months (and not walking) or
weighing 10 to 16kgs. Compartment syndrome is considered a low risk complication,
neurovascular monitoring should take place according to local guidelines.

Kendrick Traction Device

A Kendrick Traction Device (KTD) can be applied to all age groups and is light weight, compact
(stored in a pouch), and quick and easy to apply. Variation in the way this modality is applied
may exist in clinical practice; however, it is unlikely to cause additional pressure or pain. It can
be used to immobilise a suspected fracture of the mid shaft of the femur plus eliminates the need
to roll the patient or raise the leg during application. The KTD will be in situ on the patient and
will not need to be applied on the ward. The KTD will then be removed in theatre prior to
surgery.The application of Kendrick Traction Device should be carried out by at least two health
care practitioners who are trained in the procedure.

DAILY CARE OF A PATIENT IN TRACTION

A patient in traction can develop serious complications and needs the following care:

a) The traction should be as comfortable as possible.

b) Proper functioning of the traction unit must be ensured. Traction weights should not be
touching the ground. See that the ropes are in the grooves of the pulleys. The foot of the patient
or the end of the traction device should not be touching the pulley, as it makes traction
ineffective.

c) One must see that terminal part of the limb in traction (hand or foot) is warm and of normal
colour. Sensations over toes and fingers should be normal. Any numbness or tingling may point
to a traction palsy of a nerve.

d) Any swelling over the fingers or toes may point to a tight bandage or slipped skin traction.

e) A pin tract infection in skeletal traction can be detected early by eliciting pain on gentle
tapping at the site of the pin insertion.

f) The proper position of the fracture should be ensured by taking check X-rays in traction.

g) Physiotherapy of the limb in traction should be continued to minimise muscle wasting.

h) A watch must be kept on general complications of recumbency, i.e., bed sores, chest
congestion, UTI, constipation etc.

i) Diversion therapy is important for any patient confined to bed for a long period of time. This
may be done by suggesting the patient to do things he likes – such as reading, craft,
games,watching television, net surfing, etc

Most fractures can be immobilised by one of the following non-operative methods:

Strapping: The fractured part is strapped to an adjacent part of the body e.g., a phalanx fracture
where one finger is strapped to the adjacent normal finger

Sling: A fracture of the upper extremity is immobilised in a sling. This is mostly to relieve pain
in cases where strict immobilisation is not necessary e.g., triangular sling used for a fracture of
the clavicle.

Cast immobilisation: This is the most common method of immobilisation. Plaster-of-Paris casts
have been in use for a long time. Lately, fibreglass casting tapes have become popular. The latter
provide durable, light-weight, radiolucent casts.

Plaster of Paris (Gypsum salt) is CaSO4. ½H2O in dry form, which becomes CaSO4.2H2O on
wetting. This conversion is an exothermicreaction and is irreversible. The plaster sets in the
given shape on drying. The setting time of a plaster varies with its quality, and temperature of the
water. Names of some of the plaster casts commonly used are given in Table–3.2
 Types of casts
 Plaster cast. This is made from gauze and plaster strips soaked in water. These are
wrapped around the injured body part over a stockinette and cotton padding. As they dry, the
strips harden. The cast takes 24 to 48 hours to harden fully.
 Synthetic cast. This is made from fiberglass or plastic strips. These are wrapped around
the injury over a stockinette and cotton padding. Synthetic casts can be different colors. A
synthetic cast is lighter than plaster. It dries in a few minutes, but may take a few hours to harden
fully. Synthetic stockinettes and padding are also available. These can get wet for bathing or
swimming.
 Cast brace. This is made of hard plastic. Soft pads inside the brace push against
(compress) the injury. The brace is held in place with Velcro strips and can be removed. A cast
brace may be used right after the injury occurs. Or, it may be used toward the end of healing,
after another cast has been removed.
 Splint (also called a half cast). This is made from slabs of plaster or fiberglass that hold
the injury still. A bandage is wrapped around the injury to hold the plaster slabs in place. Splints
are often used when swelling is present, or you have a risk of swelling. In most cases, the splint
is eventually replaced with another type of cast.
 Contact your healthcare provider right away if you have any of these symptoms after you have a
cast or splint put on:

 Increased pain or tightness from the cast or splint

 Numbness, tingling, or burning below a cast or splint

 Excessive swelling above or below a cast or splint

 Loss of active movement of fingers or toes below a cast

Cast aids

Cast aids help you get around safely and comfortably. If you need any of these aids, your
healthcare provider will teach you how to use them:
 Sling. This keeps your injured arm still and helps carry your cast.
 Cane. This helps you balance and put less weight on an injured leg.
 Walking cast. This is a cast you can walk on. You may wear a cast shoe over your cast
to keep it clean and protected.
 Walker. This helps you balance and keep weight off an injured leg. Some walkers have
wheels and can be pushed as you walk. Others are lifted and placed down as you step.
 Crutches. These help you balance and keep weight off an injured leg. When using
crutches, be sure they are sized correctly. Remember to support yourself with your hands and
upper arms. Don't rest crutches in your armpits. (Doing so could damage the nerves leading to
your arms and hands.)