BALANCED SKELETAL TRACTION

SETUP (1ST PHASE) STATUS

NOT
STEPS: DONE
DONE
Verify/check the Doctor's Order to determine the following:
Patient's demographic
The site of the affection
Prescribed/initial weight to be used
Inform the patient about the need and purpose of the procedure to allay patient's anxiety and to elicit
cooperation
Prepare necessary personnel and materials for facilitation of BST application:
Identify the different parts of the Orthopedic Bed
BALKAN FRAME (1); Determine parts
Vertical Bar (4)
Horizontal Bar (2/3)
Straight/Curved Bar (1)
Pulleys (3)
Overhead Trapeze (1) or (2)
FIRM MATTRESS
Gather equipment's needed for BST:
ROPES (3); Determine appropriate use and placement
SHORT: Padded Ring (PR)
LONG: Traction Weight (TW)
LONGEST: Suspension Weight (SW)
THOMAS SPLINT (1); Determine appropriate size
Adult
Pedia
PEARSONS ATTACHMENT (1); Determine appropriate size
Adult
Pedia
TRACTION WEIGHT (TW) (1); Determine appropriate weight
Prescribed or 10% of patient's body weight
SUSPENSION WEIGHT (SW) (1); Determine appropriate weight
50% of traction weight
SLINGS (5); Determine appropriate size for attachment
Thigh (2)
Leg (3)
BINDER CLIP (5)
FOOT BOARD/REST (1)
STEINMANN PIN HOLDER
REST SPLINT (1) (unavailable)
POINT PERSONS (3); Determine important roles
1st person (MAIN): Facilitate application of the APPARATUS
2nd person: Facilitate application of MANUAL TRACTION
3rd person: Facilitate support and lifting AFFECTED LIMB

SETUP (2ND PHASE) STATUS

NOT
STEPS: DONE
DONE
Using SHORT ROPE, measure from the GREATER TROCHANTER up to the KNEE
After determining, measure using SHORT ROPE to the THOMAS SPLINT
 Attach the PEARSONS ATTACHMENT to the THOMAS SPLINT (combined: "apparatus"), screws should be
facing upward and is aligned with the knee
Attach the REST SPLINT to the apparatus (unavailable)
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:
Not too tight and not too loose
One (1) inch distance in between the slings to promote aeration or ventilation
Popliteal area and heel portion should be free from any slings
Smooth and right side should come in contact with the patient’s skin to avoid friction and irritation
Two (2) longer and wider slings for the thigh portion (Thomas) and the three (3) for the leg area
(Pearson)
Tie the SHORT ROPE to the PADDED RING (PR) aligned to the inside bar of THOMAS SPLINT, using SLIP
KNOT
Secure the other of the rope to the screw of PEARSONS ATTACHMENT
Align Pulleys (3):
1st Pulley: Align to the INGUINAL AREA in favor of the affected limb
2nd Puley: Align to the KNEE of the affected limb
3rd Pulley: Align to the 1ST and 2ND Pulley

APPLICATION (2ND PHASE) STATUS

NOT
STEPS: DONE
DONE
SUPPORT and PREPARE the affected limb for application of the APPARATUS
Using STEINMANN PIN HOLDER, apply MANUAL TRACTION to the affected extremity
Instruct the patient to elicit cooperation
Hold on the trapeze
Flex the unaffected leg
Lift the hip with the count of three
Apply the APPARATUS under the affected limb SIMULTANEOUSLY AND SAFELY with other POINT PERSON
at the count of 3
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.
Application of TRACTION WEIGHT (TW):
While still applying MANUAL TRACTION, apply the appropriate TRACTION WEIGHT to the STEINMANN
PIN HOLDER using the SLIPKNOT with LONG ROPE and then seated to the 3rd pulley; Clean up excess
rope
Using SLIPKNOT, tie to the STEINMANN PIN HOLDER
The other end is to run along the 3rd pulley
Attach the prescribed/initial weight and consume excess rope
Application of SUSPENSION WEIGHT (TW):
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 1st pulley
Insert the suspension rope to the 2nd pulley then pass it under the rest splint (unavailable), 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
Remove the rest splint
Apply foot board (using ribbon knot) to prevent foot drop
Check the efficiency of the traction by swinging the patient to and from, side to side. (Give the patient the same
instructions during the insertion of the apparatus).
Check the Principles of Traction:
Patient should be in dorsal recumbent position
Provide counter traction – patient’s body weight will serve as the counter traction
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
Traction should always be continuous – importance of manual traction should be emphasized
Avoid friction
Knots should be away from the pulley
Weight should be hanging freely
Observe for wear and tear of the ropes and bags