Traction

 is the use of a pulling force to treat muscle and

skeleton disorders.

Traction is usually applied to the arms and legs, the neck, the backbone, or the pelvis. It is used to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities. Traction can either be short-term, as at an accident scene, or long-term, when it is used in a hospital setting.

Purpose

Traction serves several purposes: it aligns the ends of a fracture by pulling the limb into a straight position

it ends muscle spasm it relieves pain it takes the pressure off the bone ends by relaxing the muscle

There are two main types of traction:

skin traction and

skeletal traction.

Within these types, many specialized

forms of traction have been developed to

address problems in particular parts of the

body. The application of traction is an exacting

technique that requires training and

experience, since incorrectly applied traction

can cause harm.

Positioning the extremity so that the angle of pull brings the ends of the fracture together is essential. Elaborate methods of weights, counterweights, and pulleys have been developed to provide the appropriate force while keeping the bones aligned and preventing muscle spasm.

The patient's age, weight, and medical condition are all taken into account when deciding on the type and degree of traction.

 

Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis, hip, or femur; and overhead arm traction, used in certain upper arm fractures. Cervical traction is used when the neck vertebrae are fractured.

For tibial traction, a pin is surgically placed in the lower leg (A). The pin is attached to a stirrup (B), and weighted (C). In cervical traction, an incision is made into the head (D). Holes are drilled into the skull, and a halo or tongs are applied (E). Weights are added to pull the spine into place (F). (

People who are suffering from skin disorders or who are allergic to tape should not undergo skin traction, because the application of traction will aggravate their condition. Likewise, circulatory disorders or varicose veins can be aggravated by skin traction. People with an inflammation of the bone (osteomyelitis) should not undergo skeletal traction.

Precautions

Skin traction uses five- to seven-pound weights attached to the skin to indirectly apply the necessary pulling force on the bone. If traction is temporary, or if only a light or discontinuous force is needed, then skin traction is the preferred treatment. Because the procedure is not invasive, it is usually performed in a hospital bed.

Skin traction

Weights are attached either through adhesive or non-adhesive tape, or with straps, boots, or cuffs. Care must be taken to keep the straps or tape loose enough to prevent swelling and allow good circulation to the part of the limb beyond the spot where the traction is applied. The amount of weight that can be applied through skin traction is limited because excessive weight will irritate the skin and cause it to slough off.

Specialized forms of skin traction have been developed to address specific problems. Dunlop's traction is used on children with certain fractures of the upper arm, when the arm must be kept in a flexed position to prevent problems with the circulation and nerves around the elbow. Pelvic traction is applied to the lower spine, with a belt around the waist. Buck's skin traction is used to treat knee injuries other than fractures. The purpose of this traction is to stabilize the knee and reduce muscle spasm.

Skeletal traction is performed when more pulling force is needed than can be withstood by skin traction; or when the part of the body needing traction is positioned so that skin traction is impossible. Skeletal traction uses weights of 25-40 pounds.

Skeletal traction requires the placement of tongs, pins, or screws into the bone so that the weight is applied directly to the bone. This is an invasive procedure that is done in an operating room under general, regional, or local anesthesia.

Skeletal traction

Correct placement of the pins is essential to the success of the traction. The pin can be kept in place several months, and must be kept clean to prevent infection. Once the hardware is in place, pulleys and weights are attached to wires to provide the proper pull and alignment on the affected part.

Specialized forms of skeletal traction include cervical traction used for fractures of the neck vertebrae; over-head arm traction used for certain types of upper arm fractures; and tibia pin traction used for some fractures of the femur, hip, or pelvis.

X-rays are done prior to the application of both forms of traction, and may be repeated during treatment to assure that the affected parts are staying in alignment and healing properly.

 

 Preparation

Since the insertion of the anchoring devices in skeletal traction is a surgical procedure, standard preoperative blood and urine testing are done, and the patient may meet with an anesthesiologist to discuss any health conditions that might affect the administration of anesthesia.

Traction refers to the usage of a pulling force and special devices, such as a cast or splint, to treat muscle and skeletal disorders. It is used to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities. The illustration above features several commonly used forms of traction. (Illustration by Electronic Illustrators Group.)

Aftercare for skin traction involves making sure the limb stays aligned, and caring for the skin so that it does not become sore and irritated. The patient should also be alert to any swelling or tingling in the limb that would suggest that the limb has been wrapped too tightly.

Aftercare

Aftercare for skeletal traction is more complex. The patient is likely to be immobile for an extended period. Deep breathing exercises are taught so that respiratory function is maintained during this time of little activity. Patients are also encouraged to do range-of motion exercises with the unaffected parts of the body. The patient is taught how to use a trapeze (an overhead support bar) to shift on and off a bedpan, since it is not possible to get up to use the toilet. In serious injuries, traction may be continued for several months until healing is complete.

The main risks associated with skin traction are that the traction will be applied incorrectly and cause harm, or that the skin will become irritated. There are more risks associated with skeletal traction. Bone inflammation may occur in response to the introduction of foreign material into the body.Infection can occur at the pin sites. If caught early, infection can be treated with antibiotics, but if severe, it may require removal of the pin.

Risks

Both types of traction have complications associated with long periods of immobility. These include the development of bed sores, reduced respiratory function, urinary problems, and circulatory problems. Occasionally, fractures fail to heal. Being confined to traction for a long period can take a an emotional toll on the patient, also.

When correctly applied, traction generally produces very good, if slow, results.

 

Normal results

1.)Balanced suspension traction

is used to stabilize fractures of the femur. It can be the skin or skeletal type. If it is skeletal, a pin or wire is surgically placed through the distal end of the femur. If it is skin traction, tape and wrapping or a traction boot of the kind described under Buck’s traction is used.

Different Types Of Skeletal Traction 

The patient is in the supine position, with the head of the bed elevated fro comfort. As the name suggests, the affected leg is suspended by ropes, pulleys, and weights in such a way that traction remains constant, even when the patient moves the upper body.

Two important components of balanced suspension traction are the Thomas splint and the Pearson attachment. The Thomas splint consists of a ring, often lined with foam, that circles and supports the thigh. Two parallel rods are attached to the splint and extend beyond the foot. A Pearson attachment consists of a canvas sling that supports the calf.

Parallel rods lead from the pin sites on the distal and of the attachment for the rope. Traction to the femur is applied through a series of ropes, pulleys, and weights. These weights hang freely at the foot off the bed.

The skin should be inspected frequently to identify problems early. The ring of the Thomas splint can excoriate the skin of the groin. Special padding may have to be used. Again, the foot should always be at a right angle on the footrest to prevent footdrop. If pins are used for fixation, aseptic technique must be used around pin sites until they have healed. From then on, clean technique can be used. The pin sites are cleansed carefully with soap and water and rinsed thoroughly, unless this varies from policy. An antiseptic, such as povidone-iodine ointment, may then be applied. Dressings are usually not required. You should, however, constantly assess for infection at the pin sites. Indications include redness, heat, drainage, pain, or fever. Review your facility’s policy on pin care.

2.) Skull Tongs Traction

are used to immobilize the cervical spine in the treatment of unstable fractures or dislocation of the cervical spine. Although Crutchfield tongs were used almost exclusively in the past, Gardner-Wells skull tongs are in wide use. Some think these are less likely to pull out than the Crutchfield tongs. The patient is prepared for either type with a local anesthetic to the scalp. The tongs are surgically inserted into the bony cranium, and a connector half-halo bar is attached to a hook from which traction can be applied.

The patient is supine and is usually on a special frame instead of the regular hospital bed. If a hospital bed is used, two or more people are required to assist the patient with any turning movements. The head of the bed may be elevated to provide counter traction.

Because patients remain in this type of traction for an extended period, observe the precautions taken for the patient in other types of skeletal traction. Difficulties with the performance of activities of daily living, infection at the tong sites, and restlessness and boredom are common. It is useful to teach the patient range-of-motion exercises, provide good nutrition and suggest recreational or occupational activities.

3.)Halo Tractionprovides stabilization and support for

fractured cervical vertebrae. The surgeon inserts pins into the skull. A half circle of metal frame connects the pins around the front of the head. Vertical frame pieces extend from a halo section to a frame brace that rests on the patient’s shoulders. The halo traction allows the patient to be out of bed and mobile while stabilizing the cervical vertebrae could injure the spinal cord.

1.)Thomas Splint TractionHugh Owen Thomas introduced his splint

which he called "The Knee Appliance" in 1875

The method of Hugh Owen Thomas uses fixed traction with the counter traction being applied against the perineum by the ring of the splint

This is in contrast to other methods using weight traction which is countered by the weight of the body

Specific Types of Traction

2.)Hamilton Russell TractionRobert Hamilton Russell wrote "Fracture of the

femur: A clinical study" in which he described his traction in 1924

Sling under the distal 1/3 of the thigh provides upward lift, as well as longitudinal traction in the line of the tibia

The sling under the distal fragment controls posterior angulation and the lifting force is related to the main traction force through the medium of pullies

No rigid splinting is used in this methodCombines a means of suspending the lower

extremity and a means of applying traction in the axis of the femur

Many other varieties of both skeletal and skin traction result in a similar effect

3.)Buck TractionBuck introduced simple horizontal traction in 1861

Traction is analogous to Pugh's traction only the inclination of the bed is replaced by the application of weights over a pulley

4.)Bryant's tractionVertical extension traction was described

by Bryant in 1873 and applied to the management of femoral fractures

The development of ischemia of the lower leg through reduced perfusion resulted in limitation of its application to the short term management of a fractured femur

A modification of his traction has been shown to reduce the risk of limb ischemia and may be applicable where prolonged traction is required in an infant

5.)Braun FrameThis is merely a cradle for the limbDisadvantage is that the position of the pulleys cannot be altered and the size of the splint often does not fit the limb as might be wished

Lateral bowing is common as the splint and the distal fragment are fixed to the frame, while the patient and the proximal fragment can move sideways leaving the frame behind

6.)Perkins TractionHere no splinting is used at all

The posterior angulation of the thigh is controlled by a pillow 

The alignment and fixation depend entirely on the action of continuous traction

7.)Fisk TractionHinged version of a Thomas splint is arranged to allow 90o of knee movement

It is particularly attractive as it allows active extension of the knee joint

Fixation and alignment is dependent entirely on the weight traction and the splint merely applies the motive power for assisted knee movement

8.)90 - 90 TractionThe thigh is suspended in the vertical plane by weight traction pulling vertically upwards

The ill effect of gravity as the cause of backward angulation of the fragments is thus eliminated

9.)CharnleyStrongly recommends the use of a BK POP incorporating

the Steinmann or Denham pin in the upper end, in order to reduce pressure on the soft structures around the knee

Benefits of POP/Traction unit (Charnley) : Foot supported at right angles to the tibia Common peroneal nerve and calf muscles protected from

pressure against the slings of the splint and the splint itself The tibia is suspended from the skeletal pin inside the POP, so

that an air space develops under the tibia as the calf muscles loose their bulk

External rotation of the foot and distal fragments is controlled The tendo achilles is protected from pressure sores Comfort; The patient is unaware of the traction when applied

through the medium of a nail

10.)Upper LimbA number of skin traction methods have been

described and a number more utilised without documentation in the literature

Ingerbrightsen's overhead skin traction (A); Dunlop's side arm skin traction (B); and Graham's extension skin traction (C) are but a few

Skeletal pin traction can also be utilised : Overhead (A) Overhead with secondary distal forearm

traction directed cephalad (B) Side arm pin traction (C)

THE END