TRACTION

THE ACT OF PULLING AND DRAWING ASSOCIATED WITH COUNTER TRACTION.

MANUAL TRACTION
1. PULLING FORCE APPLIED BY TE HANDS OF THE OPERATOR.

TYPES OF TRACTION:
I. SKELETAL TRACTION
A PULLING FORCE APPLIED DIRECTLY TO THE BONES USING WIRES,
PINS AND TONGS.

KIRSCHNER’S WIRE STEIMANN’S PIN CRUTCHFIELD TONG

HOLDER HOLDER Affection of the upper
Affection of the radius ulna Affection of the dorsal cervical spine
Thinner than the humerus, femur, tibia Inserted at the parietal
and fibula area

BALANCED SKELETAL OVERHEAD

TRACTION HALO – FEMORAL
TRACTION TRACTION
Affection of the hips and Supracondylar fracture
or femur For S – Type Scoliosis
of the humerus

HALO – PELVIC NINETY-NINETY

TRACTION DEGREES TRANTION
For C type scoliosis Subtrochanteric and
proximal 3rd
fracture of femur
 II. SKIN TRACTION
PULLINF FORCE IS APPLIED TO THE SKIN, TRANSMITTED TO THE
MUSCLE, THEN TO THE BONE TYPES:

a. ADHESIVE
USE OF ADHESIVE TAPE, ELASTIC BANDAGE, WOODEN SPREADER
AND WADDING SHEET.

DUNLOP TRACTION ZERO DEGREES BUCK’S EXTENSION

Affection of supracondylar TRACTION TRACTION
of the humerus Affection of the surgical Affection of the hip and the
neck of the humerus and femur
the shoulder joint

BRYANT TRACTION BOOT CAST TRACTION MODIFIED BUCK’S

Affection of the hip and For post poliomyelitis with EXTENSION TRACTION
femur for children below 3 residual paralysis of the use of foam instead of
years old hip and knee plaster. For post
poliomyelitis with residual
paralysis of the hip and
knee
b. NON-ADHESIVE
USE OF CANVAS, LINGS, LEATHERS, STRAPS WITH BUCKLES, LACES AND RIBBONS.

HEAD HALTER PELVIC GIRDLE COTREL TRACTION

TRACTION TRACTION For scoliosis
For cervical spine affection For lumbo-sacral spine A combination of head
affection for herniated halter and
nucleus pulposus pelvic girdle traction
 HAMMOCK SUSPENSION BOHLER BRAUN SPLINT
TRACTION Supports the lower leg
For affection of the pelvis For fracture of Proximal 3rd
For maligned fracture (double and Middle 3rd of tibia-fibula
fracture of the pelvic ring
causing instability of the
pelvis)

THE BALANCED SKELETAL TRACTION

Traction is the act of pulling and drawing in an opposite direction which is

associated with counter traction.

INDICATION:
FOR THE AFFECTION OF THE HIP AND FEMUR
PURPOSES:
S – SUPPORT
P – PREVENT OR CONNECT DEFORMITY
I – IMMOBILIZATION
R – REDUCE FRACTURE
R – REDUCE MUSCLE PAIN AND SPASM
M – MAINTAIN GOOD BODY ALLIGNMENT

PREPARATION:
1. Check/verify the doctor’s order to know the patient, the site of
affection, and to check the weights to be used.
2. Inform the patient about the need and purpose of the
procedure to allay patient’s anxiety and to elicit cooperation.
3. Preparation:
a. Identify the different parts of the Orthopedic bed
BALKAN FRAME:
4 vertical bars
2 horizontal bars
1 diagonal bar
2 straight or cross bars
1 curved bar
FIRM MATTRESS
FRACTURE BOARD

b. Gather equipment needed for BST:

 Thomas splint
 Pearson’s attachment
 Rest splint
 3 cord/ropes/sashes
 5 slings
 5 safety pins/paper clips
 3 pulleys
 Weights
 Traction weight-10% of patient’s weight
 Suspension weight-50% of traction weight
 Steinman’s pin holder
 Foot board
 Overhead trapeze

4. Assemble the Thomas splint and Pearson’s attachment

 Estimate/measure the length of the thigh to ensure that the screw
of the Pearson’s is in line with knee.
 The Pearson’s attachment must be under the Thomas splint.
5.Mount the Thomas & Pearson’s on the rest splint.
6.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:

a. Not too tight and not too loose
b. One inch distance in between the slings to promote aeration or
ventilation.
c. Popliteal area and heel portion should be free from any slings
d. Smooth and right side should come in contact with the patient’s skin
to avoid friction and irritation.
e. Two longer and wider slings for the thigh portion (Thomas) and the
three for the leg area (Pearson).

7. Tie the thigh rope (shortest) on the medial upright of the Thomas
with a slipknot and secure the other end of the rope at the screw of the
Pearson.
8. Insertion of the apparatus under the affected extremity. Three
manpower needed:
1st person to insert the whole apparatus under the affected
extremity.
2nd person to perform manual traction to be released after the
attachment of the traction weight on the third pulley.
3rd person to support/lift the affected extremity.
This is to be done simultaneously at the count of three.
Instruction to the patient:
Hold on to the trapeze, flex the unaffected leg and at the count of three
(simultaneously with the insertion of the apparatus) will lift the buttock of
the affected side.
9. Check if the principles of sling application are followed; check the
alignment; and make the necessary adjustments.
10. Application of the traction weight.
One end of the traction rope (longer rope) is attached to the
Steinman pin holder with a slipknot; the other end is to run along
the third (3rd) pulley. Attach the prescribed weight.
11. Application of suspension weight.
  The loose end of the thigh rope is attached to the lateral aspect of
the ischial ring with a slipknot
 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 first pulley

 Insert the suspension rope to the second pulley then pass it under
the rest splint, 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.
12. Remove the rest splint.
13. Apply foot board (using ribbon knot) to prevent foot drop.
14. Check the efficiency of the traction by swinging the patient to and
from side to side. (Give the patient the same instruction during the
insertion of the apparatus)
15. C heck the Principles of Traction:
 Patient should be in dorsal recumbent position.
 Line of pull should be in line with the deformity
1st pulley must be in line with the deformity
2nd pulley must be in line with the knee
3rd pulley must in line with the 1st & 2nd pulley
 Traction should always be continuous- importance of manual
traction should be emphasized.
 Avoid friction: (you have to W O R K)
W – weight should be hanging freely
O – observe for wear and tear of rope and bags
R – rope should be running along the groove of the pulley
K – knots should be away from the pulley
 Provide counter traction-patient’s body weight will serve as the
counter traction.

REMOVAL OF TRACTION
1. Apply the rest splint
2. Hang suspension weight on the 1st pulley
3. Completely remove the suspension rope
4. Loosen the thigh rope on the lateral aspect of the ischial ring and
secure the loose end on the screw.
5. Apply manual traction on the Steinman pin holder.
6. Remove the traction weight
7. Remove the traction rope from the third pulley and secure the loose
end on the rest splint with a clove hitch knot; another knot on the
Thomas and Pearson attachment.

NURSING CARE OF PATIE NTS WITH TRACTION

1. Assessment-assess the patient as to level of understanding,
consciousness
2. Provision of general comfort:
a) Skin care-head to toe, focus on sponging of the affected extremity
b) Changing of linen, slings
c) Provide bedpan as needed
d) Perineal care
3. Assess for potential complication
a) Upper respiratory- PNEUMONIA- Provide bronchial tapping and teach
deep breathing
b) Bedsore-good perineal care, proper skin care, turning/lifting
buttocks once in a while
c) Urinary and kidney problem-good perineal care, increase fluid intake
d) Bowel complication-fear of apparatus, no privacy, lack of fluids,
perineal care
e) Pin site infection-observe for S/S of infection-loosening pin tract, pus
coming out, foul smelling drainage/pin site, fever
f) Deformity-contracted knee, atrophy of muscles, foot drop, joint
contractures
4. Provision of exercises:
a) ROM exercises with the use of trapeze
b) Deep Breathing Exercises
c) Static quadriceps exercises- alternate contraction and relaxation of
quadriceps muscles
d) Toes pedal exercises

5. Nutritional status-depending on the status of patient- encourage

patient to increase intake of foods rich in fiber, protein, vitamin C and
calcium; increase fluid intake
6. Psychological aspect- fear of unknown, fear of death, fear of apparatus,
fear of losing job, financial fear
7. Provision of supportive therapy- offer book to read; discover interest;
encourage listening to radio or TV
8. Spiritual aspect- know his religion, encourage relatives to read him
verses from the Bible
9. Diversional activities- logic games/crossword puzzles
 CAST
A temporary immobilization device made of gypsum sulphate rendered
anhydrous which when mixed with water, swells and form into hard
cement.

MOLD
Used for splinting the affected part of the body wherein there is an open
wound, inflammation, abrasion, swelling, or infection.

FUNCTIONS OF CAST
1. Promote healing and early weight – bearing
2. Immobilization
3. Correct or prevent deformity
4. To obtain a mold of a limb to serve as a model in making an artificial
limb
5. Support, maintain and protect realigned bone

PRINCIPLES IN APPLICATION OF CAST

1. Apply padding first before applying cast
2. Apply cast by including the joint above and the joint below the
affection
3. Apply cast in circular motion and smoothen with the palm
4. Support with the palm

CONTRAINDICATIONS
1. pregnancy
2. skin disease

NEUROVACULAR ASSESSMENT OF PATIEN T WITH CAST (MC

NEWS)

M – movement
C – color
N – Numbness
E – edema
W – warmth
S – sensation

SIGNS OF CAST SYNDROM

1. Inability to take a deep breath
2. Nausea
3. Abdominal pressure
4. Feeling of tightness and bloating

MATERIALS/ INSTRUMENTS IN CAST APPLICATION/ REMOVAL

STOCKINET Directly in contact with the skin

WADDING SHEET AND GAUZE BANDAGE Serve as padding
PLASTER OF PARIS/ FIBER GLASS Casting material
TRIMMING KNIFE Smoothen the edges of cast
CAST SPREADER To widen a bivalve cast
STRYKER CAST CUTTER Used in windowing
BANDAGE SCISSOR To cut wadding sheet and stockinet

CAST TECHNIQUES:
WINDOWING – Putting a hole on a cast on the site of an open wound of
the casted extremity for the purpose of visualization, inspection, dressing,
as well as application of
Medications.
BIVALVING – Cutting the cast into halves from the upper portion to the
bottom part for the purpose of relieving possible cast tightness, X-ray and
inspection of the casted
Extremity.
REINFORCING – reapplication of Plaster for the purpose of regaining its
strength in case of
wetting the cast which resulted to its instability.
I. CAST IN THE TRUNK AREA

COLLAR CAST BODY CAST

Cervical cast affection Lower thoracic and lower MINERVA CAST
lumbar Upper; cervical spine

SUGAR TONG
RIZER’S CAST SHOULDER SPICA CAST fracture of the upper portion
For scoliosis Fracture of the upper of the humerus and
portion of the humerus and shoulder joint with open
shoulder joint wound swelling
and infection

II. CAST ON THE UPPER EXTREMITIES

SHORT ARM CIRCULAR SHORT ARM MUNSTER/FUENSTER

CAST POSTERIOR MOLD CAST
Fracture of the wrist and fracture of the wrist and fracture of radius and
finger finger with open wound, ulna with callus
swelling and infection formation
 LONGARM POSTERIOR HANGING CAST
LONGARM CIRCULAR MOLD fracture of the shaft of the
CAST fracture of the radius and humerus
fracture of radius and ulna ulna with open wound
swelling and infection

ABDUCTION THUMB SPICA CAST

FUNCTIONAL CAST SPLINT/AIRPLANE CAST
Fracture of the shaft of the Fracture of the first
Fracture of the neck of the metacarpal
humerus with callus humerus / recurrent shoulder
formation bone
dislocation

III. CAST IN THE LOWER EXTREMITIES

SHORT LEG CIRCULAR LONG LEG CIRCULAR SHORT LEG POSTERIOR

CAST CAST MOLD
ankles, tarsals and tibia and fibula affection ankles, tarsals and
metatarsals metatarsals affections with
affection open wound, swelling and
infection

LONG LEG POSTERIOR PATELLAR TENDON DELVIT CAST

MOLD BEARING CAST fracture of the distal third
tibia-fibula affections with tibia fibula with callus of tibia and fibula with
 CYLINDER CAST CYLINDER MOLD QUADRILATERAL/
for patellar affection fracture of the patellar with ISCHIAL WEIGHT
open wound, swelling and BEARING CAST
infection fracture of the shaft of
femur with callus formation

BASKET CAST CAST BRACE

severe/massive FROG CAST
fracture of the distal
bone injury for congenital hip
third of femur with
dislocation
callus formation

SINGLE HIP SPICA 1 ½ HIP SPICA DOUBLE HIP SPICA

CAST CAST CAST
hip and femur hip and femur hip and femur
affections affections affection

NIGHT SPLINT
Post polio
INTERNAL ROTATOR
PANTALON CAST BOARD
pelvic affection hip surgery (partial and
 BRACE

A mechanical support for weakened muscles, joints and bones in

rehabilitation.

FUNCTIONS
For immobilization For immobilization
Permit patients to walk without Permit patients to walk without
fatigue fatigue
Maintain body alignment Maintain body alignment

SHANTZ COLLAR PHILADELPHIA FOUR POSTER

BRACE COLLAR BRACE BRACE
For cervical spine For cervical spine For cervical spine
affection affection and upper thoracic
spine affection

SOMI BRACE STERNO- FORESTER BRACE

OCCIPITO-MANDIBULAR Cervico-thoracic-
IMMOBILIZER lumbar spine
affection

KNIGHT TAYLOR CHAIR BACK JEWETTE BRACE

BRACE BRACE For dorso lumbar and
Affection of the For lumbo-sacral upper lumbar spine
 MILWAUKEE YAMAMOTO SCOTTISH RITE
BRACE BRACE For Coxa Plana or
For scoliosis For scoliosis Legg Calve Perthe’s
Affection of T9 and Affection of T9 and Disease
below above

COCK –UP SPLINT BANJO SPLINT OPPEN HEIMER

For wrist drop For peripheral nerve For radial nerve
injury injury

UNILATERAL LONG BILATERAL LONG SHORT LEG BRACE

LEG BRACE LEG BRACE For clubfoot
For post For post
poliomyelitis with poliomyelitis with