TRACTION

In orthopedic medicine, traction reIers to the set oI mechanisms Ior straightening broken
bones or relieving pressure on the spine and skeletal system.
Purpose
Traction is usually applied to the arms and legs, the neck, the backbone, or the pelvis. It
is used to treat Iractures, dislocations, and long-duration muscle spasms, and to prevent or
correct deIormities. Traction can either be short-term, as at an accident scene, or long-term, when
it is used in a hospital setting.
Traction serves several purposes:
O it aligns the ends oI a Iracture by pulling the limb into a straight position
O it ends muscle spasm
O it relieves pain
O it takes the pressure oII the bone ends by relaxing the muscle
Categories of traction

1. Straight or running traction
The pulling Iorce is applied in a straight line to the injured body part resting on the
bed.

The length oI the limb remains constant
There is continuous diminution oI traction Iorce, as the tone in the muscles
diminishes and no Iurther stimuli results in activation oI the muscle stretch reIlex
Pull is exerted against a Iixed point, e.g. tapes are tied to the cross piece oI a Thomas
splint and the leg pulled down until the root oI the limb abuts against the ring oI the
splint
Pins in plaster is a Iorm oI Iixed traction



2. Balanced suspension traction
It involves more than one Iorce oI pull. Several Iorces work in unison to raise and
support the client`s injured extremity oII the bed and pull it in a straight Iashion away
Irom the body.



3. Combined Traction
May be used in conjunction with Iixed traction, where the weight takes up any slack in
the tapes or cords, while the splint maintains a reduction
This combination Iacilitates less Irequent checks and adjustment oI the apparatus

4. Sliding Traction
First introduced by Pugh by applying traction tapes to the limb and Iastening them to
the raised Ioot oI the bed which was then inclined head down
He utilised this traction in the treatment oI conditions such as Perthes, where only
one limb was Iastened to the end oI the bed enabling the pelvis on the opposite side
to slide down the bed more; thus creating traction and abduction
The extent to which the patient slides down on the bed is limited by the Iriction oI
the body against the mattress
The traction was subsequently modiIied by Hendry using a mattress on a sliding
Irame, which resulted in the same amount oI traction with an inclination oI 10
o
,
as on a normal mattress at 30 - 40
o
inclination
This is also really a Iorm oI balance traction, where the amount oI weight is
determined by the inclination oI the bed









Two main types of traction:
1. SKIN TRACTION
Skin traction uses Iive- to seven-pound weights attached to the skin to indirectly
apply the necessary pulling Iorce on the bone. II traction is temporary, or iI only a
light or discontinuous Iorce is needed, then skin traction is the preIerred treatment.
Because the procedure is not invasive, it is usually perIormed in a hospital bed.
Weights are attached either through adhesive or non-adhesive tape, or with straps,
boots, or cuIIs. Care must be taken to keep the straps or tape loose enough to prevent
swelling and allow good circulation to the part oI the limb beyond the spot where the
traction is applied. The amount oI weight that can be applied through skin traction is
limited because excessive weight will irritate the skin and cause it to slough oII.
Specialized Iorms oI skin traction have been developed to address speciIic problems.
Dunlop's traction is used on children with certain Iractures oI the upper arm, when the
arm must be kept in a Ilexed position to prevent problems with the circulation and
nerves around the elbow. Pelvic traction is applied to the lower spine, with a belt
around the waist. Buck's skin traction is used to treat knee injuries other than
Iractures. The purpose oI this traction is to stabilize the knee and reduce muscle
spasm.
TYPES OF SKIN TRACTION

1.1 Buck Traction
O Buck introduced simple horizontal traction in 1861
O Traction is analogous to Pugh's traction only the inclination oI the bed is
replaced by the application oI weights over a pulley



1.2 Bryant's traction
O Vertical extension traction was described by Bryant in 1873 and applied to the
management oI Iemoral Iractures
O The development oI ischemia oI the lower leg through reduced perIusion
resulted in limitation oI its application to the short term management oI a
Iractured Iemur
O A modiIication oI his traction has been shown to reduce the risk oI limb
ischemia and may be applicable where prolonged traction is required in an
inIant.









1.3 Thomas Splint Traction
O Hugh Owen Thomas introduced his splint which he called "The Knee
Appliance" in 1875
O The method oI Hugh Owen Thomas uses Iixed traction with the counter
traction being applied against the perineum by the ring oI the splint
O This is in contrast to other methods using weight traction which is countered
by the weight oI the body
O Backward angulation oI the distal Iragment can never be corrected by traction
in the axis oI the Iemur which only results in elongation with persistence oI
the deIormity
O A Thomas splint and Iixed traction is only capable oI maintaining a reduction
previously achieved by manipulation
O The use oI supports enables correction oI angulation caused by muscle tension
O Placement oI a large pad behind the lower Iragment acts as a Iulcrum over
which backward angulation is then corrected by the traction Iorce
O The pad should be 6" in width, 9" long and 2" thick, applied transversely
across the splint under the distal Iragment and popliteal Iossa
O It is the splint which controls alignment and not the traction
O The tension in the apparatus should only be that suIIicient to balance resting
muscle tone
O Suspension oI the splint using an overhead beam enables the splint to move
easily with the patient when they move in bed. Its use in combination with a
Pearson Knee-Ilexion piece enables mobilization oI the knee, while
maintaining traction, alignment and splinting oI the Iracture.





1.4 Hamilton Russell Traction
O Robert Hamilton Russell wrote "Fracture oI the Iemur: A clinical study" in
which he described his traction in 1924
O Sling under the distal 1/3 oI the thigh provides upward liIt, as well as
longitudinal traction in the line oI the tibia
O The sling under the distal Iragment controls posterior angulation and the
liIting Iorce is related to the main traction Iorce through the medium oI pullies
O No rigid splinting is used in this method
O Combines a means oI suspending the lower extremity and a means oI applying
traction in the axis oI the Iemur
O Many other varieties oI both skeletal and skin traction result in a similar eIIect





2. SKELETAL TRACTION
Skeletal traction is perIormed when more pulling Iorce is needed than can be
withstood by skin traction; or when the part oI the body needing traction is positioned
so that skin traction is impossible. Skeletal traction uses weights oI 25-40 pounds.
First achieved by the use oI tongs
The application oI traction applied by a pin transIixing bone was introduced by Fritz
Steinmann
Now a threaded Denham pin is preIerred to prevent early loosening oI the device
The threaded portion oI the Denham pin is oIIset, closer to the end oI the pin held in
the drill chuck and should engage only the proximal cortex oI the recipient long bone.

















Nursing consideration for the Client with Traction

4 Monitor Ior complications oI Iracture reduction
InIection
Nerve compression syndrome
Kidney stones
Pulmonary emboli
Circulatory impairment
Fat embolism (pulmonary embolism)
4 Monitor bowel sounds
4 Assess Ior abdominal distention
4 Provide optimal nutrition Ior bone healing, growth, and development
4 Neurovascular assessment every 1 to 2 hours aIter application oI device
4 Assessment oI strength oI pulse distal
to the site
4 Assessment oI capillary reIill
4 Assessment oI Iive P`s
4 Reposition every 2 hours; encourage mobility within the conIines oI traction or cast
4 Prevent skin breakdown
4 Maintain hydration
4 Encourage or provide range oI motion exercises as appropriate Ior traction
4 Maintain the line oI pull:
Center the client on the bed.
Ensure that weights hang Ireely and do not touch the Iloor.
4 Assist in repositioning.
The area oI the Iracture must be stabilized when the client is repositioned.