Académique Documents
Professionnel Documents
Culture Documents
DEFINITION OF TERMS:
1. . Counter traction
- pulling force equal and opposite the traction weights. Usually the patient’s body weight and
bed position adjustment.
2. Fixator
- metallic plate or screw placed on the bone to provide support. It fixes the origin of prime
movers so that the muscle acts in an exerted at the insertion
3. Traction
- is the application of a pulling force, used to stretch soft tissue and to separate join surfaces on
bone fragments . It involves applying as a force of sufficient magnitude and duration while
simultaneous resisting movement of the body
4. Trapeze
- an overhead patient helping device to promote mobility in bed. A triangular device hung from
the ceiling or from a bar over the bed which can be adjusted to the patients reach. Patient
should be assisted upon changing positions or sitting.
PURPOSE:
used primarily as a short term intervention until other modalities such as external or
internal fixator are possible reducing the risk of disuse syndrome
to relieve pain
reduce, align and immobilize fractures, to reduce deformities and to increase space
between opposing surfaces
to maintain proper alignment until bone develops
INDICATIONS:
to reduce fractures – the application of traction overcomes the injured limbs tendency
to shorten ( due to muscle spasm) and holds the limb constantly in a position of
corrective extension with the ends of the fractured bone aligned
immobilization of an area before surgery
control and relieve of painful muscle spasm
stretching adhesions
treatment of painful arthritis, sore muscles and ligaments, dislocations, degenerated or
ruptured intervertebral disks and spinal cord compression
degenerative joint disease
nerve root syndromes and herniated discs
relief from general, vague back pain
CONTRAINDICATIONS:
Patients with structural diseases secondary to tumor or infection, rheumatoid arthritis
and severe vascular compromise.
Acute strains, sprains and inflammation conditions
Malignancy
aneurysm
APPLICATION OF TRACTION:
1. SKIN TRACTION
- in skin traction, the pull is applied to the client's skin which transmitted the pull to the
musculoskeletal structures. A belt, head halter, foam rubber wrapped with an elastic bandage,
or a foam boot is applied to the client's skin before the appendage is attached to traction.
Ensure that pelvic girdle fits snugly over iliac crests and pelvis
Inspect skin areas over iliac crests for pressure points q4h
Maintain sling placement beneath lower back with buttocks elevated from mattress. Replace
soiled sling.
Lift and turn patient’s use of trapeze if it alters compressive forces on pelvis
Change bed linen from head to foot rather than from side to side
Ensure skin integrity by avoiding pressure on heel, dorsum or foot, fibular head, or malleolus
downward pull, as in Buck's traction, may be applied to the leg, but an additional
overhead pulley system is incorporated into the traction apparatus with the leg
supported by a sling. The pull is up (toward the ceiling) and toward the foot of the bed.
Assure skin integrity by avoiding pressure on heel, dorsum of foot, fibular head, or malleolus
d. Bryant's Traction
is used to immobilize a fracture of the femur in children who weigh less than 40 pounds
(18.2 kg. ). This skin traction is a simple running traction in which the legs are raised at
90 degree angle to the body. Both legs are held in traction for comport and balance even
though only one leg is affected.
Observe bandages carefully for slippage and bunching over heel cords
Check feet for color, pulses, warmth, and sensation q2h to q4h
Apply bilaterally with hips with hips flexed 45 degrees and legs in extension
Ensure skin integrity with nonadhesive straps and wraps that do not impair
neurovascular status
Ensure buttocks are elevated 1 to 2in. from mattress
Utilize jacket or vest restraint to prevent child from rotating in the bed
for neck pain, neck strain and whiplash, traction can be applied to the cervical spine by
means of a head halter. The pull of cervical skin traction should be felt as an upward pull
on the back of the neck. A slight change in the level of the head of the bed is often the
key to correct application of this type of traction. Because this is a form of skin traction,
it cannot be used for prolonged periods.
this type of traction is often used by client at home with the client sitting in a chair.It can
be used to alleviate painful muscle spasm of the neck, to create alignment, or to prevent
deformities.
Apply manual traction if pin loosens or penetration occurs. Notify physician immediately.
2.SKELETAL TRACTION
-is a applied directly to the bone with wires or pins that are inserted during surgery.
this form of skeletal traction is accomplished by inserting a points of a skull tong device
(such as Vinke or Crutchfield tongs) into the skull bone. It is used reduced a fracture of
the cervical vertebrae. This type traction is often used only temporarily until a halo
device can be placed.
Redness
Swelling
Discharge
Odor
Bleeding
- is a pulled in one direction against the long axis of the body or bone. With this
type of traction, the body must be aligned with the pulling force to be effective
TYPES OF FIXATOR
EXTERNAL FIXATOR
-is the device is used to manage complex fractures that associated with soft tissue damage or
with open wounds in the fractures area. A physician inserts multiple pins that protrude through
the clients of skin into the bone fragments. The external fixation device is a metal frame that, on
the outside of the body, holds the pins in place and maintains immobilization. The picture
shown is an example of external fixator being used in the treatment of a fractured radius bone.
INTERNAL FIXATOR
Internal fixation is done through open reduction, the surgeon places a pin, wire, screw, plate,
nail or rod into or onto the bone to keep it reduced (properly aligned), immobilized, or both.
This procedure is called open reduction, internal fixation (ORIF) and is the treatment of choice
for certain fractures in which casting is generally impossible (hip fracture).
Internal fixation can be performed using various devices. It is most frequently with fractures of
the legs long bones, in which case the spike is called intermedullary nail
2. Microbiology
- patients who have traction are of great risk for skin infection because the skin integrity
is being altered. The nurse observes the pin sites at least every 8 hours for drainage,
color and severe redness which indicate inflammation and possible infection. To prevent
infection to happen the nurse must observe this principle.
3. Physics
- the nurse should observe on the friction between traction part and the bed. Also the
nurse should know the mechanical devices such as ropes, pulleys, and weights supply is
used properly for the part to be traction to prevent further injury.
4. Psychology
-the nurse should observe on the safety of the patient to prevent aggravation on the
injured part. This is also to prevent fall of the patient that may cause further injury.
- during the initial assessment, the nurse identifies sensitive, fragile skin
(common in older adults)
- the nurse closely monitors the status of the skin in contact with tape or
foam to ensure that shearing forces are avoided
- the nurse performs the following procedures to monitor and prevent skin
breakdown:
removes the foam boots to inspect the skin, the ankle and
the Achilles tendon three times a day
the nurse is needed to support the extremity during the
inspection of akin care
palpates the area of the traction tapes daily to detect
underlying tenderness
provide back care at least every 2 hours to prevent
pressure ulcers. The patient must remain in a supine
position to prevent the increased risk of the development
of pressure ulcers
uses a special mattress overlays (e.g filled, high-foam) to
prevent pressure ulcers.
2. NERVE DAMAGE – skin traction can place pressure on peripheral nerves. When traction is
applied to the lower extremity, care must be taken to avoid pressure on the peroneal nerve at
the point at which it passes around the neck of fibula just below the knee. Pressure at this point
can cause foot drop. Weakness of dorsiflexion or foot movement and inversion of the foot
indicate pressure on the common peroneal nerve. Plantar flexion demonstrates function of the
tibial nerve.
The following are important points to keep in mind when caring for patient in traction:
Encourage a diet high in fiber and fluids may stimulate gastric motility
If constipation develops – Therapeutic measures may include: stool softeners
To improve patient’s appetite, the nurse identifies and includes the patient’s food
preferences, as appropriate, within the prescribed therapeutic diet.
The nurse teaches the patient to perform ankle and foot exercises within the limits of
the traction therapy every 1-2 hours when awake to prevent DVT.
The patient is encouraged to drink fluids to prevent dehydration and associated
hemoconcentration, which contributes to stasis.
The nurse monitors the patient for signs of DVT including unilateral calf tenderness,
warmth, redness and swelling (increased calf circumference)
The nurse promptly reports finding to the physician for definitive evaluation and
therapy.
6. PRESSURE ULCERS
The nurse examines the patient’s skin frequently for evidence of pressure or friction,
paying special attention to bony prominences.
It is helpful to reposition the patient frequently and to use protective devices (e.g elbow
protectors) to relieve pressure.
The nurse consult with the physician and the woundostomy- continence nurse.
The nurse monitors the fluid intake and character of the urine.
The nurse teaches the patient to consume adequate amounts of fluid and to void every
3-4 hours
If the patient exhibits signs or symptoms of urinary tract infection ,the nurse notifies the
physician
7.1.1 Circulation
- check the skin color, joint motion, complaints of numbness, coldness or swelling
over the extremity. Avoid pressure in the popliteal space.
- check the skin areas over Achille’s tendon, dorsum of the foot, heel, and sacral
region.
- have measures been provided to prevent foot drop, hip flexion and
contracture? Is the backrest lowered several times daily to provide for complete extension of
the hip joints?
7.1.5 Countertraction
- is countertraction sufficient or does the foot plate frequently rest against the
foot of the bed.
7.1.6 Slipping
- is there slipping of the traction tapes and does outer bandage need
rewrapping?
7.1.7 Pressure
- is there pressure on the lateral aspect of the leg over the head of the fibula?
Pressure in this area may result in a palsy of the peroneal nerve.
- traction should never be a source of undue discomfort for the patient. Listen
carefully and heed complaints of discomfort.
7.1.9 Complication
- because of the prolonged bed rest and minimal activity, hypostatic pneumonia
is a constant threat, particularly to the elderly patient. Encourage coughing and deep breathing.
- inspect traction apparatus frequently to ensure the ropes are running straight and through the
middle of the pulleys; the weights are hanging free; that bed clothes, the bed or the frame or
bars of the bed are not impinging on any part of the traction apparatus
- check ropes frequently to be sure they are not frayed.
- Avoid releasing weights from or altering the line of pull of the traction.
- Avoid adding weight to the traction
- Check the position of the Thomas splint frequently; if the ring is away from the groin, readjust
the splint to its proper position without releasing the traction.
- Avoid bumping into the bed or traction equipment
- Be sure that weights are securely fastened to their ropes
- Avoid manipulation of pins
- encourage the patient to turn slightly from side to side and to lift hip up on the trapeze to
relieve pressure on the skin on the sacrum and scapulae
- avoid padding the ring of the Thomas splint- since this will create dampness next to the skin.
Bathe the skin beneath the ring, dry it thoroughly, and powder the skin lightly.
- inspect skin frequently to be sure that it is not being rubbed, macerated by traction
equipment; readjust splint or the extremity in the splint to free the skin from pressure
- keep skin areas around the pin sites clean and dry
7.4. TURNING
- Do not remove traction or increase or decrease the amount of the weight without specific
orders
- Always tell the patient when you’re going to remove or re-apply the tension
- Never drop a weight when reapplying traction but gradually lower the weight so the patient
does not undergo sudden extreme stress
- a patient who may have the head rest up and down should be positioned completely flat at
least half the time to prevent hip flexion contractures.
- When traction is applied to the leg a foot plate may be applied to prevent foot drop
- Turning to any position is generally permitted as long as the integrity of the traction is not
compromised and the patient is comfortable.
- prevent rotation of the leg and splint. The heel should not rest on the bed or pressure necrosis
will develop
- If pillows are used they should be firmed so they will provide adequate support and will
maintain alignment of the limb of the traction apparatus.
5. TOILETING
- use a fracture pan with blanket roll or padding as support under the back
- protect the Thomas ring splint with water proof material when female patients are using the
bed pan.