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PHILIPPINE ORTHOPEDIC CENTER

NURSING TRAINING AND RESEARCH DEPARTMENT

BALANCE SKELETAL TRACTION

Traction – is the act of pulling and drawing which is associated with counter traction.
Indications:
For the affection of the hip and femur
Purposes:
S – support
P – prevent or correct deformity
I – immobilization
R – reduce fracture
R – reduce muscle pain and spasm
M – maintain good body alignment

APPLICATION OF TRACTION
1. Verify/check 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 bar
 1 curved bar
 Firm mattress
 Fracture board
b) Gather equipment’s needed for BST:
 Thomas splint
 Pearson’s attachment
 Rest splint
 3 cord/ropes/sashes

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 5 slings
 5 safety pins/paper clips
 3 pulleys
 Weights
 Traction weight – 10% of patient’s body weight
 Suspension weight – 50% of the 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 screws of
the Pearson’s is in line with the knee
 The Pearson’s attachment must be under the Thomas splint
5. Mount the Thomas and 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 (1) 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 (2) longer and wider slings for the thigh portion (Thomas)
and the three (3) 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 is secured
 3rd person to support and lift the affected extremity
This is to be done simultaneously at the count of three (3).
Instruction to patient:
Hold on to the trapeze, flex the unaffected leg and at the count of three
(simultaneous with the insertion of the apparatus) will lift the
buttocks of the affected side

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9. Check if the principles of sling application are followed; check the alignment;
and make necessary adjustments. Adjust also the Pearson’s’ attachment if
not aligned with the patients’ knee.
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 (3rd) 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 1st 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 instructions during the insertion of the
apparatus).
15. Check the Principles of Traction:
1) Patient should be in dorsal recumbent position
2) Provide counter traction – patient’s body weight will serve as the
counter traction
3) The line of pull should be in line with the deformity
 1st pulley should be in line with the thigh
 2nd pulley should be in line with the knee
 3rd pulley should be in line with the 1st and 2nd pulleys
4) Traction should always be continuous – importance of manual
traction should be emphasized
5) Avoid friction
 Rope should be running along the groove/canal of the pulley
 Knots should be away from the pulley
 Weight should be hanging freely
 Observe for wear and tear of the ropes and bags

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REMOVAL OF TRACTION
1. Check the doctor’s order
2. Explain the procedure to the patient
3. Apply the rest splint
4. Hang the suspension weight on the 1st pulley
5. Completely remove the suspension rope
6. Loosen the thigh rope on the lateral aspect of the ischial ring and secure the
loose end on the screw of the Pearson’s
7. Apply manual traction on the Steinman pin holder
8. Remove the traction weight
9. 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 the
Pearson attachment

NURSING CARE OF PATIENTS’ 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 exercises
b) Bedsore – good perineal care, proper skin care, turning or positioning/lifting
of 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 exercise:
a) ROM exercises with the use of the trapeze
b) Deep breathing exercises
c) Static quadriceps exercises – alternate contraction and relaxation of
quadriceps muscles
d) Toes pedal exercises

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5. Nutritional status – depending on the status of the 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 the apparatus, fear of
losing job, financial fear
7. Provision of supportive therapy – offer books to read; discover interest; encourage
listening to radio or watching movies/televisions if available
8. Spiritual aspect – know his religion, encourage relatives to read him verses from the
Bible
9. Diversional activities – logic games/crossword puzzles

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