NURSING CARE MANAGEMENT 102

ORTHOPEDIC NURSING
BALANCED SUSPENSION SKELETAL TRACTION

 Balanced suspension traction is used to stabilize fractures of the femur and requires an invasive procedure in which
pins, screws or wires are surgically installed.

 Weights used in skeletal traction generally range from 25-40lbs (11-18kg)

Purpose:
 To maintain the anatomical position of the fractured bone.

Materials needed:
1. Thomas splint – placement of the thigh 7. Rest splint
2. Pearson attachment – placement of the leg 8. 3 ropes:
3. Steinman’s holder a. Thigh rope – the shortest
4. Steinman’s pin b. Suspension rope – the longest
5. Traction weight c. Traction rope
a. 10% of the body weight 9. Slings and pins
b. Inside of the suspension rope 10. Foot board
6. Suspension weight
a. 50% of the traction weight

Thomas Splint

Pearson Attachment

Rest Splint Steinman Holder

Steinman Pin

Steps in the application of traction: 1. Verify doctor’s order

2. Inform patient about the need and purpose of the
procedure
3. Preparation:
a. Identify the different types of orthopedic bed
b. assemble the needed equipments
 Thomas Splint
 Pearson attachment
c. Know the affected extremity
d. Where to stand – look for the last pulley and
stand on the side
4. Mount the Thomas and Pearson on the rest splint.
5 Principles in the application of slings
 Not too tight not too close
 1 inch distance between the slings to
promote aeration or ventilation
 Popliteal and heel portion should be from
sling
 Smooth and right side should come in
contact with the patient’s skin
 (2) longer and wider slings for thigh
portion and (3) for the leg area
How to apply sling?
 Start from the medial side to the lateral side
 Secure both ends together
 Fan fold nicely on the lateral aspect and
secure with pin or clip
 Observe the principle of not too tight and
not too loose and avoiding hitting the
patient’s extremity with the pin
 The thigh rope should be attached on the
medial aspect to the lateral aspect.
5. Insertion of the apparatus under the affected
extremity
Three Manpower needed
a. To insert the whole apparatus under the
affected extremity
b. Manual traction to be released after the
completion of traction weight in the 3rd pulley
c. To lift the affected extremity
 Simultaneously at the count of three
 Instruction to the patient:
o Hold on the trapeze
o Flexed the unaffected leg at the count
of 3
 The three manpower must do their work
simultaneously
6. Application of traction weight
a. Rope attached to the Steinman pin holder to
run along the 3rd pulley and attached the
prescribed weight.
b. Check the principles of sling application and
make the necessary adjustment and also
check the correct alignment.
7. Apply suspension traction
a. One end of the thigh rope to be attached to
the lateral aspect of the ischial ring with a
slip knot.
b. Attach suspension rope on the mid part of the
thigh rope, to the 1st pulley
c. Insert the suspension weight
d. Hang it on the 1st pulley
e. Then pass it on the 2nd pulley under the rest
splint and clobe it with hitch knot on the
Thomas splint
f. And another clobe hitch knot on the Pearson,
and finally close it with a knot to secure it.
8. Remove the rest splint
9. Apply foot support
10. Check the principle of traction emphasizing the 5
Principles of traction and discuss the nursing
care.
Swing the patient to and from side to side to check the
efficiency of traction
1. Patient should be on a dorsal recumbent position.
2. Line of pull should be in line with the deformity
positioning of a diamond bar positioning of a
pulley.
a. 1st pulley should be in line with the thigh
b. 2nd pulley should be in line with the knee or
screw
c. 3rd pulley should be in line with the (1st) and
(2nd) pulley.
3. Should always be continuous; emphasize the
importance of manual traction.
4. Avoid friction
5. Provide counter traction – patient’s body weight
will serve as counter traction.
Removal of Traction
1. Apply rest splint.
2. Hang suspension weight on the 1st pulley.
3. Remove the knot on the Pearson attachment and
Thomas splint. – to completely remove
suspension weight.
4. Apply manual traction on the Steinman pin
holder.
5. Remove the traction weight on the 3rd pulley;
secure the traction rope on the rest splint another
on the Thomas and Pearson attachment.
 Suspension Rope

Traction Rope

Steinman Holder
Thigh rope

Steinman Pin

Thomas Splint

Rest Splint
Pearson Attachment

1st Pulley
2nd Pulley

1st Pulley
Suspension
Rope

Traction Rope
Suspension Weight Trapeze

Vertical Bar Horizontal Bar

 Diagonal Bar

Vertical Bar

Traction Weight

 The Thomas Splint (half ring) is applied in various ways: with the ring fitted posteriorly against the ischium or
anteriorly in the groin. The thigh rest in the canvas or bandage strip sling with the popliteal space left free. The
leather ring should not be wrapped or padded. If kept smooth, dry and polished, the leather of the ring is being
designed to rest against the skin and resist moisture.

 The Pearson Attachment is attached by clamps to the Thomas Splint at the knee level. A canvas or bandage-strip
sling supports the lower leg and provides the desired degree of knee flexion. A footplate is attached to the distal
end of the Pearson Attachment to support the foot in a neutral position. The heel should be left free.

 The traction should be in line with the long axis of the femoral shaft and is maintained by the rope, pulley and
weights attached to the skeletal tractor, which is fitted onto the wire or pin. Counter traction and balanced
suspension are provided by the ropes, pulleys and weights attached to the Pearson attachment. When all is
operational the thigh and Thomas splint will be suspended at about 45 degree angle with the bed and the lower
leg and Pearson attachment will be suspended horizontally to the mattress.

 The patient may sit up, turn toward the traction side and raise his hips above the bed by means of the trapeze and
still maintain the line of traction.