BAYERO UNIVERSITY KANO
FACULTY OF ALLIED HEALTH SCIENCE
DEPARTMENT OF NURSING SCIENCE
TOPIC: TRACTION (SKIN AND SKELATAL TRACTION)
GROUP TWO, MEDICAL SURGICAL NURSING PRACTICAL PRESENTATION
COURSE TUTOR: MALLAMA BINTA
TIJANI NAFISA AHS/17/NUR/00068
HUSSEIN HUSSEINAT KEHINDE AHS/17/NUR/00030
AMAD KHADIJA AHS/17/NUR/00016
BABATUDE NAOMI TINUOLA AHS/17/NUR/00022
SA’ADATU UMAR DAUDA AHS/17/NUR/00109
SHARON LUKA BALA AHS/16/NUR/00452
FATIMA AWAISA AHS/16/NUR/00421
ZAINAB YUSUF RABIU AHS/17/NUR/00128
SANI AMINU AHS/17/NUR/00020
SYLVIA DADAH AHS/16/NUR/00429
ABDULRAHMAN YUNUSA AHS/17/NUR/00127
AISHA RABIU MUZAKKAR AHS/17/NUR/00119
SUBERU ONIPE MATHEW AHS/15/NUR/00349
SAKINA SALISU AHMAD AHS/17/NUR/00018
SHARFADDEN AUWULA SANI AHS/16/NUR/00451
SAMSOM BAMIDELE GABRIEL AHS/17/NUR/00028
AMINU MUSA AHS/15/NUR/00250
DAVID MICAH AHS/17/NUR/00027
HARIS HUSSEINI AHS/17/NUR/00029
BELLO ABDULBASITH ONIMISI AHS/16/NUR/00425
Introduction
Traction is a technique for realigning a broken bone or dislocated part of the body using
weights, pulleys, and ropes to gently apply pressure and pull the bone or injured body part back
into position. After a fracture, traction can restore the position of a bone during the early stage of
healing or temporarily ease the pain while you are waiting for further corrective surgery.
Traction is based on simple mechanical principles and is a well-established treatment in
orthopedic settings. To pull (or apply) traction effectively, there must be something to pull
against, which is endeavoring to pull or thrust in the opposite direction. These two forces are
called traction and counter traction respectively.Counter traction is the force acting in the
opposite direction to the applied traction. It is usually achieved by a patient’s body weight and
bed adjustment, sometimes with the use of additional weights.
The pulling force overcomes muscle spasm and shortening. It can also, in some
circumstances, control movement of the injured part so enabling bone and soft tissue to 4sed to
help stabilize fractures in the neck.
The use of apparatus to apply traction to injured limbs has played an important role in the
treatment of patients with fractures since the time of the Ancient Greek physician, Hippocrates.
The texts he gathered contained discussions on diagnosis and treatment of fractures, including
carefully prescribed methods of traction for fractures of the long bones. Through the following
centuries, physicians recorded a variety of techniques and refinements to the way traction was
used to deal with lower limb fractures and manage spinal conditions.
Definition of traction
Traction employ technique of pulling and counter pulling to immobilize a fracture bone,a strain
or sprain. It functions to realigning a broken bone or dislocated part of the body using weights,
pulleys, and ropes to gently apply pressure and pull the bone or injured body part back into
position. After a fracture, traction can restore the position of a bone during the early stage of
healing or temporarily ease the pain while you are waiting for further corrective surgery.
Types of traction
The kind of traction used will depend on the location and severity of the broken bone or injury
and the amount of force needed.
There are two main types are; skin and skeletal
A third kind, cervical traction, is used to help stabilize fractures in the neck.
Skin traction: It apply directly to the skin by mechanical means. I.e indirectly to bone.
Skin traction is less invasive than skeletal traction and uses splints, bandages, and adhesive tapes
positioned on the limb near the fracture and is applied directly to the skin. Weights and pulleys
are attached, and pressure is applied. When a bone breaks, the muscles and tendons can pull the
extremity into a shortened or bent position. The traction can hold the fractured bone or dislocated
joint in place. This can cause painful movement at the fracture site and muscle cramping. Buck's
traction is a type of skin traction that is widely used for femoral, hip, and acetabular fractures,
which are fractures in the socket portion of the "ball-and-socket" hip joint.
Skeletal Traction: skeletal traction is directly applied to the bone, is used for fractures of the
femur (thighbone), pelvis, hip, and certain upper arm fractures. It involves inserting a pin or wire
directly into the bone, then attaching weights through pulleys or ropes to it that control the
amount of pressure applied. Skeletal traction is used for fractures that require a high amount of
force applied directly to the bone, as it allows more weight to be added with less risk of
damaging the surrounding soft tissues. If you need skeletal traction, it will be done while an
anesthetic so you don't experience too much pain.
Principle
The grip or hold on the patient’s body must be adequate and secure.
Provision for counter traction must be made.
There must be minimal friction on the cords and pulleys.
The line and magnitude of the pull, once correctly established, must be maintained.
There must be frequent checks of the apparatus and of the patient to ensure that:
the traction set-up is functioning as planned.
the patient is not suffering any injury as a result of the traction treatment.5
The grip or hold on the body is achieved via
1. Skin
2. Bone
Precautions
Poorly applied traction can cause considerable discomfort to the patient, and may
delay rehabilitation. It is important, therefore, that staff responsible for setting up and
maintaining traction are thoroughly familiar with the principles of traction, so that the
mechanics of each type of traction set-up are well understood.5
Indication
Bone fractures such as arm or legs to stabilize and realign bone.
To relief pain of fracture before surgery.
correct stiff and constricted muscles, joints, tendons, or skin
stretch the neck and prevent painful muscle spams.
Treat bone deformities caused by certain conditions, such as scoliosis
Skin traction
The principles of skin traction are the basis for both Gallows traction and Thomas splint traction.
When using basic skin traction, traction tapes are applied to the lateral and medial aspects of the
skin on the lower limb, and with the attached weight hung freely over the bed a generating
pulling force is achieved. It is used to create a traction force over a large area of skin which is
then transmitted via the soft tissues to the bone.6The application of skin traction should be
carried out by at least two health care practitioners (HCPs) who are trained in the procedure.6
Requirements for traction
1. Patient
2. Screen
3. Orthopaedic/orthopedic bed
4. Fracture board for non orthopedic bed
5. Then trolley containing the followings:
Requirements on a Trolley (Top and Bottom Shelf)
Top shelf: Bottom shelf:
in a tray. M. Bowl of warm water
A. Bowl with cotton wool swab N. Soap in a soap dish
B. Galipot for lotion O. Flannel
C. Covered reciever with a pairs of dressing P. Towel
forceps.
Q. Salvage bowl
Shaving tray:
R. Weighs and weighs carriers
D. Covered galipot with cotton wool swabs
S. Bed elevator
E. Reciever with shaving stick or surgical
razor. T. Extension frame by the bed side
F. Galipot with savlon lotion or soap U. 1 pillow
G. Markintoch
Tray containing:
H. Extension kit, strapping spreader care,
crepe babdange and safety pin
I. Scissors
J. Tape measure
K. Orthoban
L. Bottle of ether and Tincture of benzoic
compound (TBC).
Procedure:
a. Two nurse are required. One to apply traction to the limb and support, the other applies the
extension strapping
b. Inform patient, gain consent and reassure
c. Set trolley and wheel to patient's bed side
d. Provide privacy, use screen
e. Expose the area for application of traction
f. Protect the bedclothes from getting soiled, apply markintoch
g. Using soap and water wash affected limb and pat dry with towel.
h. Shave the affected limb if hairy and dry with ether
i. Pour out some TBC in one of the galipot
j. Using the medical and lateral aspect of the affected limb where the exteo kits is to be
applied.
k. Apply the extension strapping evenly without wrinkles starting from above the malleoli
l. Apply a layer of orthoban on either side
m. Apply crepe bandage using figure of eight or spiral to hold firm not too tight.
n. Support the limb on a pillow placed longitudinally.
o. The card of the foot is passed through the pulley which is already fixed to extension frame at
the foot of the bed
p. Mount weight on to weight Carrier and tie the card to weight Carrier gently let the weight
hand down while the assistant also gradually lower the limb.
q. The foot of the bed is now elevated to allow counter balance.
r. Patient maybe given a pillow for the head pending on the reasons for traction.
s. Check curculi of the foot and see if patient can fully dorsiflexion the foot.
t. Clear up used equipment and make patient comfortable.
Skeletal traction
It involves the insertion of kirschmer wire or steiman's pin through the bone for attachment to the
weight. E.g at tibial tuberosity or upper end of the tibia. The insertion of steiman's pin is s sterile
procedure which is nearly always carried out in the operating theater but occaao done in ward
under local anesthesia.
Requirements on Trolley
Basic dressing trolley
1. Sterile gloves
2. Local anesthesia (lidocaine)
3. Syringe & needles
4. Bottle of TBC in lotion tray
5. Stirrup
6. Cord
7. Weight and weighs carriers
8. Tray for shaving extension frame
9. Bed elevator by the bed side
Procedure
a. This is done by the doctor, the nurse sets the trolley and assist the doctor
b. Inform patient, gain consent and reassure
c. Screen the bed, give patient urinal if need be
d. Inform the doctor
e. It important the nurse participate and watch carefully during insertion because when the pin
is due for removal the nurse can be requested to remove it.
f. After the pin has been inserted, the nurse will apply a tincture of TBC on both ends of the
steiman's pin.
g. Fix the stirrup and tie the cord to the stirrup
h. Fix the extension frame to the root of the bed
i. Put the prescribed weight for the weight bearer
j. Pass the cord through the pulley which is already on the extension cord tied to the weight
bearer down.
k. Elevate foot of the bed
l. Make your patients comfortable and remove the screen
m. Remove trolley and wash instruments used.
Complications of traction
Muscle weakness and difficulty in walking
Excessive bleeding
An infection of the pin site
Damage to the surrounding tissue
Nerve injury or vascular injury from too much weight being applied
Nursing management and responsibility
Skin traction
Always ensure the weights are connected securely and the traction cord and weights are
checked at least daily, but usually as often as the patient is checked
Assess that the weight on the traction given is suitable. If the patient is moving either up
Or down the bed constantly, then either the weight is wrong or the amount of elevation.
Inform the senior nurse and doctor about this and record the information in the patient’s
notes
Lower the bed for the patient to use a bedpan or urinal (bottle) and then put the counter
traction straight back on.9
Check the extensions for wrinkles and adhesion and change only if necessary
check the patient’s limb for any neurovascular change or calf pain, and report this to
the charge nurse or doctor.10
Do not remove the extensions unless there are clinical indications i.e severe pain at the site
of application, cyanosis of limb or change in skin colouration.
Nurse need to take extra care with what they give younger children to eat and
drink as there is a risk of choking – extra pillows will help.
fluids need to be encouraged as they are at risk of renal calculi due to prolonged immobilization.
Skeletal traction.
Check vitals signs of patients, particular the temperature
Observe site of steiman's pin for any discharge which indicate infection. If any, take abswab
specimen and send for culture and sensitivity test, inform the doctor
Daily dressing of the site if infection is confirmed.
Ensure that the stirrup is not pressing on the skin which increase risk for pressure ulcer.
No pillow is allowed for 6 weeks to allow counter balance in the traction.
Reference.
1.Anderson GH, Harper WM, Connolly CD, Badham J, Goodwich N, Gregg PG (1993)
Preoperative skin traction for fractures of the proximal femur, Journal of Bone and Joint
Surgery, 75- B: 794 -796.
2.Braden B and Bergstrom N (1988) The Braden Scale: for predicting pressure sore risk.
Available at: www.in.gov/health/files/Braden_Scale.pdf (accessed 15 July 2021).10
3.Draper P and Scott F (1998) Using traction, Nursing Times, 94 (12): 31-32.10
4. www.healthline. com
