CARE OF PATIENTS

IN TRACTION

Traction means that a pulling force is

applied to a part of the body or an
extremity while a countertraction pulls in
the opposite direction. In straight or
running traction countertraction is
supplied by the patients body with the
bed in one of the following positions.

Basic types of tractions

Skin traction- is the application of a pulling force to the skin
from where it is transmitted to the muscles and then to the
bones by the use of:
Adhesive type material
Example: Bryant
Dunlop
Bucks Extension

Non-adhesive type materials like: canvas, slings leathers and

straps with buckles and laces

Examples: Head halter traction
Hammock suspension traction
Pelvic traction
Anklet traction

Skeletal traction the pulling force is applied

directly to the bone using pins and wires such
as Kirshners wire. Steinmans pin, vinkes
skull retractor and crutch field tongs.
Manual traction the pulling force is applied
by the hands of the operator. It is a temporary
measure sometimes employed in handling
neck injury when a cervical spine is fractured.
It is also used to apply the necessary pull to
an extremity when cast is being applied.

Purposes of traction

1. Traction is often used in the treatment of fractured extremities.

To lessen muscle spasm

To reduce fracture
To provide immobilization
To maintain alignment thus prove
2. Traction is also used to correct, lessen or prevent deformities as in
the case of arthritis patient with flexion contraction or a child who
has scoliosis and is placed in traction to help lessen the curvature of
the spice before correction surgery is carried out to insert a
Harlington rod.
3. Prior to total hip replacement, surgeons may apply skeletal traction,
in an attempt to stretch muscles and obtain more working space
within the joints.
4. It lessens muscles spasm in back pain and in resting a diseased joint
as in tuberculosis.

Principles of traction

Have an opposite pull or countertraction

Be free from any friction
Follow an established line of pull that is
the line of pull must be in line with the
deformity
Be continuous
Be applied to a patient in a supine
position

Nursing implication in various

tractions application

Physicians vary in their methods of applying traction

according to the way they have been taught, what
they have practiced and what they have found to be
effective and efficient. This contributes to making
difference in traction application regional as well as
personal. In addition hospitals vary in the types of
equipment they use.
All of these means that the nurse must be
knowledgeable about principles first of all, before
she can understand the traction routines of the
hospitals and staff physicians. The nurse must
understands the basic care of a patient in traction.

Observations to be made in
caring for Patient in Traction
1. Patient is free from the following:
Impaired circulation of the extremities
Respiratory distress
Condition of the skin with emphasis on
the ischial, sacral, popliteal, achilles
tendon, dorsum of foot, heel.
Deformity like footdrop contracture of
joint.
Signs of infection

2. Bone alignment and position of

extremities which the purpose of traction
is being accomplished.
3. Patients comfort traction should never
be a source of undue discomfort of the
patient. Care of skin, mouth, hair, nails
and toes, genitalia must be included in
the plan of daily care.

4. Provisions of exercises
ROM exercise of all unaffected joints
Static quadriceps exercises
Deep breathing and coughing exercises
Flexion and extension of the toes,
fingers in traction

5. Provision of supportive therapy

6. Checks the nutritional status of the
patient
7. Every complaint of the patients in
traction should be investigated

8. Check the traction set-up for the following

Check the apparatus if it is accomplishing each purpose

of traction and that the equipments are safe as possible.
Sash, cords and pulleys should be unobstructed.
Examine knots, clamps and weights to be certain they
are tightened.
Do not bumps the bed and traction causing the weight to
swing.
Always check the traction apparatus after a patient has
moved to make certain that the patient is correctly
repositioned

9. Provide care to specific type of traction

a. Bryant traction

Applied for fractures of the femur, injuries to the hip

among children below 3 years old.
Specific observation- care
Positions level bed two legs suspended vertically, hips

flexed at right angle buttocks not resting against

mattress.
Check for presence of pimples, blisters and purulent
discharges on tracted legs.
Check for signs of impaired circulation of toes
Skin traction snug and in place
Proper application of diaper
Provide toys for children to play on.

b. Bucks extension traction

Indication: affections of femur and hip
Specific observations
Position- bed in trendelenburgh with the legs in

traction supported by a Braun splint or pillow.

Check toes for signs of impaired circulation
Check for signs of irritation and discharge on tracted
legs
Pressure around malleali and pepliteal region and
heel.
Skin traction snug and in place.

c. Russel Indication: affections of femur and hip

Specific observations
Position level bed pillows to support the legs with

the hip in 20 angle from the bed.

Checks for signs of impaired circulation of toes
Signs of irritation or discharges on the ischial
tuberosity, popliteal region, melleoli and heel
Patient allowed to sit, turn and move wall while in
traction

d. Dunlop traction:
indication: supracondylar fracture, humerus
specific observations
position level bed, tilted laterally
checks sign of impaired circulation
check radial pulse of fingers
check signs of irritation blisters and purulent

discharges on tracted arms

e. Head Halter Traction

indication: Cervical spine affections
Specific observations
Position-semi fowlers
Check for signs of respiratory distress
Check for signs of irritation on the chin, jaw, face,

and ear and on the posterior portion of the head

Check sensation of the extremities
Check for urinary and bowel disturbances

f. Pelvic traction
Indication: affections of the lumbar spine
such as H.N.P, low back syndrome
Specific Observations
Position level bed in slight trendelenburgh
Check for signs of irritation along the lumbo-

sacral region
Pelvic strap must not be applied directly to the
skin, provide padding material before applying
strap
Check for free movement of the lower extremity

g. Hammock Suspension Traction

Indication: affection of the pelvis region affection
Specific observations
Position- level bed, buttocks not resting on the mattress
Place padding material first before applying the

hammock suspension
It is applied including the lumbar spine and mid-thigh
Check for signs of intraabdominal injury, urinary and
bowel disturbance
Check for irritations on edges of the hammock
suspension

h.Skeletal traction

Skeletal traction is achieved by insertion of a Steinmann pin,

Kirshners wire, Crutchfield tong or similar devices into the bone,
enabling direct longitudinal pull to be applied directly to the bone.
When wires or pins are used, the traction force itself is applied to
a traction bow (spreads stirrups or calliper) which is attached to
the wire or pin. These attachment can withstand the stress of 15
to 40 lbs. of weight for external periods of time and are therefore
effective means of providing traction when a strong steady force
is indicated.
Sites most commonly used on the extremities are the distal end
of the femur, the proximal end of the tibia, the calcareus and the
proximal ulna. Skeletal traction of the toe or finger is also
employed although rarely. Tongs are used in the skull for traction
and immobilization of the cervical spine fractures.

Indications:
for immobilization
to prevent and correct deformity
to maintain good body alignment
to support
to reduce pain and muscle spasm
to reduce fracture and dislocation

Nursing Care
check the efficiency of traction by applying the

principle of traction
giving diversional therapy
increase caloric diet, increase protein intake
encourage immobilization
encourage fluid intake to prevent urinary
complication
personal hygiene
maintain stability of traction
avoid infection
deep breathing and coughing exercise
observe for circulatory impairments

Examples of skeletal traction and

their corresponding indications
1. Skeletal traction using Kirschners wire
and Steinmans pin
indications affections of femur, hip,
tibia, supracondylar humerus
it can be used either for a fixed or a
balance traction (discussion will follow)

STEINMANN PINN WITH HOLDER

2. Crutchfield tong or Vinkes skull calliper

Indications: affections of the upper dorsal and

cervical spine
Position: semi-Fowler position
Bed preparation: bed with fracture board, firm
mattress, variables sizes of pillows for the nape,
for the back, for the legs and foot support and 2
sandbags.
Bed with: 2 vertical bars, 1 curve bar, 1 pulley, 1
sash cord, and 2 clamps

Crutchfield tongs

Vinkes skull caliper

Crutchfield Traction

CRUTCHFIELD TONG AND VINKES

SKULL CALIPER FOR CERVICAL
AFFECTION

Specific Observation
Observe signs of respiratory distress
Observe alignment of traction
Regular check-up for signs of loosening of the

screws of the tong

Weights must be hanging freely

Precautions:
Head halter traction must be ready at the bedside
Traction must not be released at anytime
Turning the patient as unit by the turning team

3 . Halo femoral
Halo pelvic traction
indication scoliosis, kyphosis

Halo-pelvic traction

4.Skeletal balance traction of the lower

extremity (in a Thomas Splint with
Pearson Attachment)

APPLICATION OF
TRACTION
1. Verify Doctor s order discuss the
importance of the procedure
2. Inform the patient about the need and
purpose of the procedure

3. Preparation
Identify the different parts of the orthopaedic bed
Assemble the needed equipments:
Thomas splint & Pearson Attachment
Lateral side
Upper potion
Medial side (lower portion)
Medial upright

-know the affected extremity

* Where to stand the demo side- look for the last

pulley and stand on that side
4. Mount the Thomas & Pearson on the rest splint:

5 PRINCIPLES IN THE APPLICATION OF

SLINGS TO EMPHASIZE
Not too tight not too loose
One (1) inch distance in between the
slings to promote aeration or ventilation
Popliteal and heel portion should be free
from any sling
Two (2) longer and wider slings for the
thigh portion and three (3) for the leg area

How to apply sling?

Start from the medial side to the lateral side,
secure both ends together, fan hold nicely on
the lateral aspect and secure with a pin or
clip. Observe the principle of not too loose
and avoid hitting the patients extremely a pin.
The thigh rope should be attached on the
medial upright of the Thomas splint and
secure temporarily to the Pearson screw
attachment.

5. Insertion of the apparatus under the affected

extremity
Three (3) manpower needed:
To insert whole apparatus under the affected extremity
Manual traction to be released after the completion of

traction weight on the third (3rd) pulley

To lift the affected extremity
-Simultaneous at the count of three

* Instruction to the patient:

- Hold the trapeze, flex unaffected leg at the count of
three (3), the three (3) manpower to do their work
simultaneously

6. Application of Traction Weight

Rope to be attached to the Steinman pin
holder to run along the third (3rd) pulley
and attached the prescribed weight
Check the principle of sling application,
and make the necessary adjustments,
also check the alignment.

7. Apply suspension traction

One (1) end of the thigh rope to be attached to the

lateral aspect of the ischial ring with a slip knot

Attach suspension rope on the mid part of the
thigh rope, to the first (1st) pulley insert suspension
weight, hang it on the first (1st) pulley pass it on the
second (2nd) pulley under the rest splint club hitch
knot on the Thomas spin tang another club hitch
on the Pearson, close it with a knot to secure it.
Be sure to maintain the traction rope inside, and
the suspension weight should be outside.

8. Remove the rest splint

9. Apply the support
10. Check the Principles of Traction.
Emphasizing the five (5) Principles of
Traction and Discuss the Nursing Care

Swing the patients to and form, side-to-side to check

the efficiency of traction.
a. Patient should be on dorsal recumbent position
b. Line of pull should be in line with the deformity. Positioning
the diagonal bar and positioning of a pulley. First (1st) pulley
should be in line with the thigh, second (2nd) pulley should be
in line with the knee or screw. Third (3rd) pulley should be in
line with the first (1st) and second (2nd) pulley.
c. Should always be continuous; emphasize the importance of
manual traction.
d. Avoid friction- rope should be running along the groove of
the pulley, knots should be away from the pulley. Weight
bags should be hanging freely. Observe for wear and tear of
the rope and bags.

e. Provide counter traction- patients body weight will

serve as a counter traction.

REMOVAL OF TRACTION
1.Apply rest splint
2.Hang suspension weight on the first (1st) pulley
3.Complete removal of suspension weightremove the knot on the Pearson and Thomas
4.Manual traction on the Steinman pin holder,
remove the traction weight on the third (3rd)
pulley, secure the traction rope on the rest
splint another on the Thomas and Pearson
attachment.

Various Types of Traction and

their Corresponding Indication

Halo- femoral traction

Skin
Indication severe scoliosis

Head Halter Traction

Skin
Use: severe cervical sprains, cervical

strains, torticollis, mild servical spine

Cruthfield Tong Traction and Halotraction

Skeletal
Cervical fracture, subluxation

Side Arm Traction (90-90 upper

extremity traction)
Skin or Skeletal
Use: Supracondylar fracture humerus,

shoulder

Dunlop Traction
Skin
Use: supracondylar Fracture humerus

Pelvic traction
Skin (non-adhesive type)
Use: low back pain

Cotrel
Skin (combination of head halter & Pelvic

Traction)
Use: scoliosis

Head halter + Pelvic girdle for

Scoliosis

Bryant Traction
Skin (adhesive type)
Use: Femur Fracture, congenital hp

dislocation in infants less than 3 years old,

less than 3 lbs.

Bucks Extension
Skin (adhesive type)
Use : Injuries to the hip and femur knee

Russell Traction
Skin (adhesive Type)
Use: injuries to the hip and femur knee

90-90 lower extremity traction

Skin or skeletal
Use: Displaced femoral Fracture

90-90 lower extremity traction

Skin or skeletal
Use: Displaced femoral Fracture

Adjunct to traction: Balance suspension

with Thomas splint and Pearsons
attachment
Device that support the extremity and

overcomes the force of gravity thus allowing

the patient to move in bed while in traction
Use: used in skin or skeletal traction for
femur fractures to allow for exercise, to
maintain elevation, to support a dependent
part and correct alignment.

Boot

leg traction
fracture of hip and or
femur
Post poliomyelitis with
residual paralysis

Boot leg traction

Stove in chest
For multiple rib fracture

Stove in chest

HAMMOCK SUSPENSION
pelvic affection

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.

TRACTIONS AND
INDICATIONS

Head Halter cervical spine affection

Pelvic Girdle Lumbo sacral affection,
Herniated Nucleus Pulposus
Overhead Skeletal fracture of humerus
Bucks Extension femoral fractures,
hipo injuries among kids below 3 years
old
Boot Cast hip and femoral affection,
post polio, knee contracture

Tractions and indications

Halo Pelvic scoliosis

Halo Femoral severe scoliosis
Ninety Degrees subtrochonteric
fracture of femur
Stove-in-Chest severe chest injury
with multiple rib fracture
Dunlops Skin Traction supracondylar
fracture of the humerus
Hammock Suspension- pelvic affection

Parts of an Orthopedic bed:

Firm mattress
Fracture board
Bed elevator or shock
block

Balkan frame:
4 vertical bars
2 horizontal bars
1 diagonal bar
1 straight bar or cross bar

Pulleys

(3)
Clamps to hold bars in
place
Overhead trapeze

Traction equipments:
Thomas splint with Pearson attachment
Rest splint
Cord sash (3)
Short-thigh
Long-traction
Longest suspension

 Safety

pins

Clips
Foot

rest
Slings (2 sizes)
Weights and bags- Suspension
weight is lighter than the
weight of the traction

THANK YOU
MELCHOR FELIPE Q. SALVOSA, R.N., M.A.N.