TRACTION - Assess back of the knee for pressure
- The act of pulling associated with sores
counterpull
PURPOSES
1. Reduce/immobilize fractures
2. Relieve muscle pain/spasm
3. Relieve pain
4. Prevent/correct deformities
TYPES OF TRACTION
A. Skin traction – uses elastic bandages and
adhesives
– is used to control muscle spasms and to
immobilize an area before surgery
- Is accomplished by using a weight to pull
on traction tape or on a foam boot
attached to the skin
- The amount of weight applied must not
exceed the tolerance of the skin
1. Buck’s Traction
- to temporary immobilize the leg in
patient with a fractured hip
- shock blocks at the foot of the bed to
produce counter traction and to prevent the
patient from sliding down in bed
- turn towards unaffected side, with 2
pillows in between legs
- check for pressure sore at the heel of
the feet and signs and symptoms of
thrombophlebitis
2. Russell’s Traction
- Knee is suspended in a sling attached
to a rope and pulley on a Balkan frame,
creating upward pull from the knee
- Weights are attached to the foot of
the bed creating horizontal traction
- Used to treat fracture of the femur
- Allows patient to move about in bed
more freely and permits bending of the knee
joint
- Hip should be flexed at 20 degrees;
foot of bed usually elevated by shock blocks
to provide countertraction
- Check for signs and symptoms of
thrombophlebitis
3. Bryant Traction
- Both legs raised at 90 degree angle to
bed because the weight of the child is not
adequate to provide countertraction
- Used for children under 2 years and
30 pounds to treat fractures of the femur and
hip dislocation
- Buttocks must be slightly off the
mattress to enhance efficacy of the weight as
countertraction
- Knees slightly flexed to prevent
hyperextension deformity
4. Cervical Traction
- Cervical head halter attached to
weights that hang over head of bed
- Used for soft tissue damage or
degenerative disc disease of cervical spine to
reduce muscle spasm and maintain
alignment
- Usually intermittent traction, elevate
head of bed to provide countertraction
- Do not shave beard for better
anchorage of halter
5. Pelvic Traction
- Pelvic girdle with extension straps
attached to ropes and weights used for low
back to reduce muscle spasm and maintain
alignment
- Usually intermittent, patient in semi-
Fowler’s position with knee gatched 20-30
degrees angle, secure pelvic girdle around
iliac crests
- Encourage to use overhead trapeze
-
B. SKELETAL TRACTION
1. Balanced Suspension Traction
- Produced by a counterforce other
than the patient’s weight
 - Extremity floats or balances in the
traction apparatus
- Patient may change position without
disturbing the line of traction
2. Thomas Splint with Pearson attachment
- Used with skeletal traction in
fractures of the femur, hip should be flexed
at 20˚
- Use footplate to prevent footdrop
TYPES:
- Check pressure at the inguinal area
1. Nonplaster (synthetic)
(groin)
- Because upward traction is required,
an overbed frame is used
3. Dunlop traction - horizontal traction to
align fractures of the humerus; vertical
traction maintains the forearm in proper
alignment
4. 90® – 90® Traction – for femoral fractures
in children
NOTE: Only skeletal traction has pin site care to
avoid development of osteomyelitis.
PRINCIPLES IN THE CARE OF THE CLIENT WITH
TRACTION
1. Traction must be continuous to be effective
in reducing and immobilizing fractures.
2. Skeletal traction is never interrupted.
3. Weights are not removed unless intermittent
traction is prescribed.
4. Any factor that might reduce the effective
pull or alter in resultant line of pull must be
eliminated:
a. The patient must be in good body
alignment in the center of the bed when
traction is applied.
b. Ropes must be unobstructed.
c. Weights must hang free and not rest on
the bed or floor.
d. Knots in the rope or the footplate must
not touch the pulley or the foot of the
bed.
5. Turn the client as indicated.
6. Avoid friction.
7. Pin site care for skeletal traction:
- Cleanse and apply antibiotic ointment.
- Do neurovascular check.
- Prevent complications of immobility.
CASTING MATERIALS
- Generally referred to as fiberglass casts
which have the versatility of plaster but
are lighter in weight, stronger, water-
resistant and durable
- Reach full rigid strength in minutes
- Are porous and therefore diminish skin
problems
- Do not soften when wet which allows the
use of hydrotherapy
- When wet, dry with a hair drier on a cool
setting; dry thoroughly to prevent skin
breakdown
- Indication: used for nondisplaced
fractures with minimal swelling and for
long-term wear
2. Plaster
- Rolls of plaster bandage wet in cool water
applied smoothly to the body
- A crystallizing reaction can occur and heat
is given off which can be uncomfortable,
therefore, nurse should inform patient
about the sensation of increasing warmth
so patient does not become alarmed
- Cast needs to be exposed to allow
maximum dissipation of the heat and that
most casts cool after about 15 minutes
- It does not have its full strength until dry
- When wet, cast can be dented, therefore,
it must be handled with the palms of the
hand and not allowed to rest on hard
surfaces or sharp edges
 - Requires 24 to 72 hours to dry completely
- Freshly applied cast should be exposed to
circulating air to dry and should not be
covered with clothing or bed linens
- Wet plaster cast: appears dull and gray,
sounds dull on percussion, feels damp,
and smells musty
- Dry plaster cast: white and shiny,
resonant, odorless, and firm
CARE OF THE CLIENT WITH CAST
1. Carry with palms of the hand, not the fingers
to prevent indentation and pressure.
2. Do not insert anything into the cast.
3. Use blower to relieve itchiness inside the
cast.
4. Elevate with pillow support for the first 24-48
hours to prevent edema.
5. Expose to air to dry.
6. Keep clean and dry.
7. Observe “hot spots” & musty odor. These
are signs and symptoms of infection.
8. Maintain skin integrity – “petalling”
9. Do isometric exercises on the affected
extremity and active ROM on unaffected
extremity.
10. Do neurovascular checks:
 Skin color: Check the extremity and the
nail beds distal to the site of the fracture
for color. Pallor, discoloration, and
coldness indicate circulatory impairment
 Skin temperature: “hot spots” (areas
warm to touch) or any elevation of
temperature must be noted, documented
and reported
 Sensation: Check for any diminished or
absent sensation or for numbness or
tingling
 Mobility: Check hand function by having
the patient try to hyperextend the thumb
or wrist, oppose the thumb and little
finger, and adduct all fingers. Check
function of the foot by having the patient
try to dorsiflex (peroneal nerve =
damage causes footdrop) and plantarflex
(tibial nerve) the ankles and flex and
extend the toes.
 Pulse: If an upper extremity is involved,
brachial, radial, ulnar, and digital pulses
should be checked. If a lower extremity is
involved, femoral, popliteal, posterior
tibial, and dorsalis pedis pulses should be
monitored.
 Pain: Any sign of pain should be noted
and the exact area determined
11. Windowing – to facilitate observation under
the cast if infected
12. . Bivalving – done for casts that are too tight
to prevent compartment syndrome.
HIP REPLACEMENT
AVOIDING HIP DISLOCATION AFTER
REPLACEMENT SURGERY
needed until 4 months after surgery
1. Maintain abduction of the affected leg at all
times with abductor splint or 2 pillows
between legs.
2. Prevent external rotation by placing
trochanter rolls along hip.
3. Use abductor splint or 2 pillows when turning
or lying on side.
4. Keep the knees apart at all times.
 5. Put a pillow between the legs when sleeping.
6. Never cross the legs when seated. The knees
should be lower than the hip.
7. Avoid bending forward when seated in a
chair. Hip should not bend more than 90˚
8. Do not elevate the head of the bed more
than 60°.
9. Avoid bending forward to pick up an object
on the floor.
10. Use a high-seated chair and a raised toilet
seat.
11. Do not flex the hip to put on clothing such as
pants, stockings, socks, or shoes.
12. For use of the fracture bedpan, flex the
unaffected hip and use the trapeze to lift the
pelvis onto the bed pan. Never flex the
affected hip.
13. Do not sleep on the affected extremity.
14. Affected leg should not cross the center of
the body.
15. Affected leg should not turn inward while
lying down.
F If prosthesis becomes dislocated,
immediately notify the surgeon to reduce
and stabilize hip promptly to prevent
circulatory and nerve damage.
SIGNS OF DISLOCATION OF
PROSTHESIS
1. Popping sensation of the hip.
2. Pain and swelling at the groin.
3. Shortening of the affected leg.
4. Loss of function of the affected leg.
5. Abnormal internal or external rotation of the
affected leg.
Care for Clients after Limb Amputation
1. Evaluate for phantom limb sensation and
pain; explain sensation and pain to the client,
and medicate the client as prescribed.
 Providing activity to the client decreases
phantom limb pain
 Stump desensitization by kneading massage
brings relief
2. If prescribed, during the first 24 hours,
elevate the foot of the bed to reduce edema;
then keep the bed flat to prevent hip flexion
contractures
3. Do not elevate the stump itself but raise the
entire foot of the bed because elevation can
cause flexion contracture of the hip joint.
4. After 24 and 48 hours postoperatively,
position the client prone for 20-30 minutes 2-
3x/day if prescribed, to stretch the muscles
and prevent flexion contractures of hip
5. In the prone position, place a pillow under
the abdomen and stump and keep the legs
close together to prevent abduction
6. Maintain application of an Ace wrap or elastic
stump shrinker
 Wrap from distal to proximal
 If it falls off, nurse must immediately wrap
the residual limb to prevent severe edema
7. Wash the stump with mild soap and water
and apply lanolin to the skin if prescribed
8. Massage the skin toward the suture line to
increase circulation
9. Encourage the client to look at the stump
10. Encourage verbalization regarding loss of the
body part
Above the Knee Amputation
1. prevent edema – ace wrap
2. do not allow the stump to hang over the
edge of the bed – prevent flexion
contractures
3. do not allow the client to sit for long periods
of time, to prevent contractures
Below the Knee Amputation
1. Prevent internal or external rotation of the
limb
 2. Place a sandbag or rolled towel along the
outside of the thigh to prevent rotation

Note: A large tourniquet in plain sight at bedside

must be on hand for hemorrhage