BALANCE SKELETAL TRACTION

Traction is the act of pulling and drawing which is associated with counter traction.

Indications:

• For the affection of the hip, femur, tibia and supracondylar of the humerus

Purposes:

• To provide immobilization

• To prevent or correct deformity

• To reduce pain and muscle spasm

• To reduce fracture

• To maintain good body alignment

• For support

APPLICATION OF TRACTION

1. Verify/ check 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 bar

• 1 curved bar

• Firm mattress

• Fracture board
 b. Gather equipments 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 screws of
the Pearson’s is in line with the 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 to loose

 b. One (1) 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 (2) longer and wider slings for the thigh portion (Thomas) and
the three (3) 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 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 (3)

Instruction to the patient:

Hold on to the trapezes, flex the unaffected leg and at the count of three
(simultaneous 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 fro,
side to side. (Give the patient the same instructions during the insertion of
the apparatus).

15. Check the Principles of Traction:

• Patient should be in dorsal recumbent position

• Line of pull should be in line with the deformitu

o 1st pulley should be in line with thigh

o 2nd pulley should be in line with the knee

o 3rd pulley should be in line with the 1st and 2nd pulley

• Traction should always be continuous – importance of manual traction

should be emphasized

• Avoid friction:
 o Rope should be running along the groove of the pulley

o Knots should be away from the pulley

o Weight should be hanging freely

o Observe for wear and tear of rope and bags

• Provide counter traction – patient’s body weight will serve as th 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 of 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 the
Pearson attachment

NURSING CARE OF PATIENTS 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 skincare, turning/

lifting

buttocks once in a while

c. Urinary & 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 exercise:

a. ROM exercise with the use of trapeze

b. Deep breathing exercise

c. Static quadriceps exercise - alternate contraction and relaxation of

quadriceps

muscles

d. Toes pedal exercises

5. Nutritional status

• Depending on the status of patient

o 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 the 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

1. Verify/ check the doctor’s order

2. Inform the patient about the procedure and purpose of traction

3. Identify/ gather the mat needed

4. Assemble the Thomas splint & Peason attachment

5. Mount the TS & PA on the rest splint

6. Apply the slings

7. Tie the tie rope on the medial aspect upright of the TA with slipknot and
secure the other of the rope at the screw of the PA

8. Insertion of apparatus under the unaffected extremity

9. Check the principle of sling application are followed, check alignment and
make necessary adjustment

10. Application of traction weight

11. Application of suspension weight

12. Remove the rest splint

13. Apply foot board ribbon knot

14. Check the efficiency of traction

15. Check the principles of traction