TRACTION
Presented to: PRESENTED BY:
Mrs. Sherin Sussan Thomas RADHIKA KUMARI SAH
Asst. prof. Medical surgical nursing
SJCON M.SC. 1ST YEAR
SJCON
DEFINITION
• TRACTION IS THE APPLICATION OF A PULLING FORCE TO A
PART OF THE BODY.
• TRACTION IS A FORCE APPLIED MANUALLY OR
MECHANICALLY GENERATED BY WEIGHS OR FORCE ,
USED TO REDUCE FRACTURES/DISLOCATIONS OR TO
ACHIEVE RELATIVE IMMOBILIZATION.
PRINCIPLES
• TRACTION MUST CONTINUOUS TO BE EFFECTIVE IN
REDUCING AND IMMOBILIZING FRACTURE.
• SKELETAL TRACTION IS NEVER INTERRUPTED.
• WEIGHTS ARE NOT REMOVED UNLESS INTERMITTENT
TREACTION IS PRESCRIBED.
• ANY FACTOR THAT MIGHT REDUCE THE EFFECTIVE PULL
OR ALTER ITS RESULATANT LINE OF PULL MUST BE
ELIMINATED.
• THE PATIENT MUST BE IN GOOD BODY ALIGNMENT IN THE
CENTER OF THE BED WHEN TRACTION IS APPLIED.
• ROPE MUST BE UNOBSTRUCTED.
• WEIGHTS MUST HAVE FREELY AND NOT REST ON THE BED
OR FLOOR.
• KNOTS IN THE ROPE OR THE FOOT PLATE MUST NOT
TOUCH THE PULLEY OR THE FOOT OF THE BED.
PURPOSE
• TO REGAIN THE NORMAL LENGTH AND ALIGNMENT OF
INVOLVED BONE.
• TO REDUCE AND IMMBOLIZE A FRACTURE BONE.
• TO RELIEVE OR ELIMINATE MUSCLE SPASM.
• TO RELIEVE PRESSURE ON NERVES.
• TO PREVENT OR REDUCE SKELETAL DEFORMITIES OR
MUSCLE CONTRACTURES.
Types
Skin Skeletal
traction traction
SKIN TRACTION
• SKIN TRACTION INVOLES THE APPLICATION OF A PULLING
FORCE DIRECTLY TO THE SKIN THROUGH THE USE OF
SKIN STRIPS, BOOTS, OR FOAM SPLINTS.
TYPES
1. BUCK’S EXTENSION SKIN TRACTION: A FOAM BOOT IS
APPLIED TO THE CLIENT’S AFFECTED EXTREMITY AND
ATTACHED TO A WEIGHT THAT IS SUSPENDED OFF THE FLOOR
OF THE BED.
USED FOR THE CLIENT WITH A HIP FRACTURE WHO IS
UNABLE TO UNDERGO SURGICAL REPAIR UNTIL
DETERMINED TO BE MEDICALLY SATBLE.
2. DUNLOP’S TRACTION: USED IN THE UPPER LIMBS AND IS
INDICATED FOR SUPRACONDYLAR FRACTURES, INNER
CONDYLAR FRACTURES OF HUMERUS WHERE ELBOW
FLEXION CAUSES CIRCULATORY EMBARRASSMENT.
3. GALLOW’S TRACTION OR BRAYNT’S TRACTION: USED
FOR FRACTURE SHAFT FEMUR IN CHILDREN LESS THAN 2
YEARS .
IF USED IN CHILDREN ABOVE 2 YEARS IT CAUSE VASCULAR
COMPLICATIONS.
4) PELVIC TRACTION:
SPECIAL CANVAS HARNESS IS
BUCKLED AROUND THE PATIENT’S
PELVIS.
LONG CORDS ATTACH THE HARNESS
TO THE FOOT OF THE BED.
FOOT END OF THE BED RAISED
PROVIDES SLIDING TRACTION.
USED IN CONSERVATIVE
MANAGEMENT OF IVDP. TO ENSURE
THAT PATIENT LIES QUIETLY IN BED
RATHER THAN TO DISTINCT THE
VERTEBRAL BODIES.
MECAHNISM OF SKIN TRACTION.
• TRACTION FORCE IS APPLIED OVER A LARGE AREA LOAD IS
SPREAD AND IS MORE COMFORTABLE AND EFFICIENT.
• FORCE IS APPLIED IS TRANSMITTED FROM SKIN TO THE BONES
VIA THE SUPERFICIAL FASCIA AND INETERAMUSCULAR SEPTA.
• FOR BETTER EFFICIENCY , THE TRACTION FORCE IS APPLIED
ONLY TO THE LIMBS DISTAL TO THE FRACTURE.
CONTRAINDICATION
• ABRASION
• LACERATIONS
• IMPAIRED CIRCULATION
• DERMATITIS
• SKELETAL TRACTION INVOLVES PASSING A METAL PIN OR WIRE
(KIRSCHNER WIRE, STEINMAN’S PIN) THROUGH THE BONE (E.G.
PROXIMAL TIBIA OR DISTAL FEMUR) UNDER LOCAL ANESTHESIA,
AVOIDING NERVES, BLOOD VESSELS, MUSCLES, TENDON AND
JOINTS.
• USES PIN TO APPLY FORCE TO THE BONE.
• IS USED WHEN CONTINUOUS TRACTION IS DESIRED TO IMMOBILIZE
POSITION, AND ALIGN A FRACTURE OF THE FEMUR, TIBIA AND
CERVICAL SPINE.
• IT IS USED WHEN SKIN TRACTION IS NOT POSSIBLE, GREATER
WEIGHT (11 TO 18 KNG) (25 TO 40 LB) IS NEEDED TO ACHIEVE THE
THERAPEUTIC EFFECT.
SITES
APPLICATION
• USE GA OR LA.
• PAINT THE SKIN WITH IODINE AND SPIRIT.
• MOUNT THE PIN/WIRE ON THE HAND DRILL.
• HOLD THE LIMB IN SAME DEGREE OF LATERAL ROTATION.
• IDENTIFY THE SITE OF INSERTION AND MAKE A SWAB
WOUND.
• HOLD THE PIN HORIZONTALLY AT RIGHT ANGLES TO THE LONG
AXIS OF LIMBS.
• APPLY SMALL COTTON WOOLEN PADS SOAKED IN TINCTURE
AROUND THE PINS TO SEAL THE WOUND.
• THE PIN SHOULD PASS ONLY THOROUGH SKIN SUBCUTANEOUS
TISSUE AND BONE AVOIDING MUSCLES AND TENDONS.
COMPLICATION
• AT THE TIME OF APPLICATION
ANESTHETIC PROBLEMS
VASOVAGAL SHOCK
VERY RARELY DEATH DUE TO VASOVAGAL SHOCK
• DURING APPLICATION
INJURY TO THE NERVES
INJURY TO THE EPIPHYSIS
PAIN
• WHEN PIN IS INSITU
INFECTION
MIGRATION
BREAKAGE
LOOSENING
DISTRACTION OF FRACTURE FRAGMENTS
• LATE EFFECTS
PIN TRACT INFECTION
CHRONIC OSTEOMYELITIS WITH RING SEQUESTRA AT THE SITE
DEPRESSED SCAR
NURSING DIAGNOSIS
• ACUTE PAIN RELATED TO MUSCULOSKELETAL DISORDER AS
EVIDENCED BY FACING GRIMACING DISTRACTING BEHAVIOURS.
• DEFICIENT KNOWLEDGE RELATED TO THE TREATMENT
REGIMENAS EVIDENCED BY FREQUENT QUESTIONING.
• ANXIETY RELATED TO HEALTH STATUS AND THE TRACTION
DEVICE.
• SELF CARE DEFICIT:FEEDING, BATHING HYGIENE AND/OR
TOILETING RELATED TO TRACTION AS EVIDENCED BY
DEPENDENT ON OTHER.
• IMPAIRED PHYSICAL ACTIVITY MOBILITY RELATED TO
MUSCULOSKELETAL DISORDER AND TRACTION AS EVIDENCED
BY RESTRICTED MOVEMENTS.
• IMPAIRED SKIN INTEGRITY RELATED TO TRACTION.
