CARE OF PATIENTS WITH TRACTION & FIXATORS

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SUBMITTED BY:MANREET KAUR

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INDEX
SR.N O PARTICULARS PAGE NO.

1.

CARE OF PATIENTS WITH TRACTION & FIXATORS

3-4

2.

SKIN TRACTIONS

4-9

3.

SKELETAL TRACTIONS

9-10

4.

TYPES OF FIXATORS

10-11

5.

SCIENTIFIC PRINCIPLES IN OL ED IN TRACTION

11-12

!.

CO"PLICATIONS OF TRACTION APPLICATION#

12-15

$.

GENERAL CARE OF PATIENTS WITH TRACTION AND FIXATORS

15-1$

%.

REFERENCES

1%

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CARE OF PATIENTS WITH TRACTION & FIXATORS

Fixator - Metallic plate or screw placed on the bone to provide support. It fixes the origin of prime movers so that the muscle acts in an exerted at the insertion Traction - is the application of a pulling force, used to stretch soft tissue and to separate join surfaces on bone fragments. It involves applying as a force of sufficient magnitude and duration while simultaneous resisting movement of the body

PURPOSE:
Used primarily as a short term intervention until other modalities such as external or internal fixator are possible reducing the risk of disuse syndrome. o relieve pain. !educe, align and immobili"e fractures, to reduce deformities and to increase space between opposing surfaces. o maintain proper alignment until bone develops.

INDICATIONS:
o reduce fractures # the application of traction overcomes the injured limbs tendency to shorten $d u e to muscle spasm% and holds the limb constantly in a position of corrective extension with the ends of the fractured bone aligned . Immobili"ation of an area before surgery. &ontrol and relieve of painful muscle spasm.

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 'tretching adhesion. reatment of painful arthritis, sore muscles and ligaments, dislocations, degenerated or ruptured intervertebral disks and spinal cord compression

(egenerative joint disease. )erve root syndromes and herniated discs. !elief from general, vague back pain.

CONTRAINDICATIONS:
*atients with structural diseases secondary to tumor or infection, rheumatoid arthritis and severe vascular compromise. +cute strains, sprains and inflammation conditions Malignancy aneurysm

APPLICATION OF TRACTION:
1. SKIN !+& I,) - In skin traction, the pull is applied to the client-s skin which transmitted the pull to the musculoskeletal structures. + belt, head halter, foam rubber wrapped with an elastic bandage, or a foam boot is applied to the client-s skin before the appendage is attached to traction.

TYPES OF TRACTION
a. P !"ic Traction

SKIN

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 Used in pelvic fractures to support separated bones. his traction may be applied by either a belt or a sling. he pelvic belt causes downward pull on the pelvis, while the pelvic sling supports the pelvis off the bed. .ith a pelvic belt, the upper rim of the belt should rest at the top of the iliac crest and not around the abdomen. his type of traction is a running traction that is used to reduced muscle spasm of the lower back, relieve sciatica, immobili"e a fractured pelvis, or correct lateral deviations of the spine. It is usually applied intermittently, on / hours, off / hours, while the client is awake. .eights on the traction are increased gradually. )ever remove or changed the weights on any traction device without a physician-s order. Car #or $ati nt% &it' $ !"ic traction:

0nsure that the pelvic girdle is properly si"e for patient 0nsure that pelvic girdle fits snugly over iliac crests and pelvis 0nsure integrity by providing back care 12h Maintain sling placement beneath lower back with buttocks elevated from mattress. !eplace soiled sling. 3ift and turn patient4s use of trape"e if it alters compressive forces on pelvis Maintain bed in flat position &hange bed linen from head to foot rather than from side to side (. )*c+,% Traction -)*c+,% Ext n%ion.

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 Is a running skin traction that can be used temporarily to immobili"e a fracture of the hip5femur until it is possible to do surgery. It can also be used to relieve muscle spasms in the lower back, to prevent contracture after computation, or to realign the vertebrae in a client with scoliosis. he leg is wrapped with an elastic roller bandage or tape. raction is applied through a weight attached to a spreader bar below the foot. + foam boot may also be used. he traction pull is toward the pulley at the bottom of the bed. Car o# $ati nt% &it' )*c+/% Traction:

0nsure skin integrity by avoiding pressure on heel, dorsum or foot, fibular head, or malleolus Maintain counteraction by elevating foot of bed or keeping head of bed flat 0ncourage independence with use of trape"e

c. R*%% !!,% Traction -)a!anc 0 Traction.

(ownward pull, as in 6uck-s traction, may be applied to the leg, but an additional overhead pulley system is incorporated into the traction apparatus with the leg supported by a sling. he pull is up $toward the ceiling% and toward the foot of the bed.
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Car

o# $ati nt% &it' R*%% !!/% Traction: +ssure skin integrity by avoiding pressure on heel, dorsum of foot, fibular head, or malleolus

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 Maintain counteraction by elevating foot of bed or keeping head of bed flat 0ncourage independence with use of trape"e 0nsure sling is smooth and does not apply undue pressure on popliteal space or peroneal nerve or lateral aspect of knee 0. )r1ant,% Traction

Is used to immobili"e a fracture of the femur in children who weigh less than 27 pounds $89./ kg.%. his skin traction is a simple running traction in which the legs are raised at :7 degree angle to the body. 6oth legs are held in traction for comport and balance even though only one leg is affected. Car #or $ati nt% &it' )r1ant/% Traction:

!aise buttocks slightly from mattress ,bserve bandages carefully for slippage and bunching over heel cords ,bserve for skin sloughing on both legs &heck feet for color, pulses, warmth, and sensation 1/h to 12h Use harness restraint to prevent turning over +void thick, wide diapers between legs
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 Used in children younger than ; years, weighing less than ;7lb

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 +pply bilaterally with hips with hips flexed 2< degrees and legs in extension 0nsure skin integrity with nonadhesive straps and wraps that do not impair neurovascular status 0nsure buttocks are elevated 8 to /in. from mattress 0nsure parents4 understanding of the purpose and use of traction Utili"e jacket or vest restraint to prevent child from rotating in the bed . C r"ica! Traction H a0 Ha!t r

=or neck pain, neck strain and whiplash, traction can be applied to the cervical spine by means of a head halter. he pull of cervical skin traction should be felt as an upward pull on the back of the neck. + slight change in the level of the head of the bed is often the key to correct application of this type of traction. 6ecause this is a form of skin traction, it cannot be used for prolonged periods. his type of traction is often used by client at home with the client sitting in a chair.It can be used to alleviate painful muscle spasm of the neck, to create alignment, or to prevent deformities.

Car

#or $ati nt% &it' C r"ica! traction:

+pply manual traction if pin loosens or penetration occurs. )otify

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physician immediately. May use turning frames or special beds for positioning *osition without pillows ake care that weight and pulley are free of wall ,bserve for pressure areas >aws and ears 'ide of head 6ack of head *ad as necessary for comfort 2. SKELETAL TRACTION -is a applied directly to the bone with wires or pins that are inserted during surgery.

TYPES OF SKELETAL TRACTION

S+*!! Traction or H a0 Traction

this form of skeletal traction is accomplished by inserting a points of a skull tong device $such as ?inke or &rutchfield tongs% into the skull bone. It is used reduced a fracture of the cervical vertebrae. his type traction is often used only temporarily until a halo device can be placed. Car o# $ati nt% &it' S+ ! ta! Traction:

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&over ends of pin with cork ,bserve site of insetion !edness 'welling

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 (ischarge ,dor 6leeding &lean skin around puncture sites as ordered

3. RUNNING TRACTION Is a pulled in one direction against the long axis of the body or bone. .ith this type of traction, the body must be aligned with the pulling force to be effective

4. C on t i n u ou s T!#$tion

or

Int !"itt nt

TYPES FIXATOR
EXTERNAL F I X A T OR

OF

is the device is used to manage complex fractures that associated with soft tissue damage or with open wounds in the fractures area. + physician inserts multiple pins that protrude through the clients of skin into the bone fragments. he external fixation device is a metal frame that, on the outside of the body, holds the pins in place and maintains immobili"ation. he picture shown is an example of external fixator being used in the treatment of a fractured radius bone.

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INTERNAL FIXATORS

Internal fixation is done through open reduction, the surgeon places a pin, wire, screw, plate, nail or rod into or onto the bone to keep it reduced $properly aligned%, immobili"ed, or both. his procedure is called open reduction, internal fixation $,!I=% and is the treatment of choice for certain fractures in which casting is generally impossible $hip fracture%. Internal fixation can be performed using various devices. It is most fre1uently with fractures of the legs long bones, in which case the spike is called intramedullary nail

SCIENTIFIC PRINCIPLES IN2OL2ED IN TRACTION

3. Anato41 an0 $'1%io!o51 raction care involves the musculoskeletal system. )urses should be knowledgeable of the body parts affected to prevent complications. he knowledge about skeletal system which includes the bones, joints and the skin involved regarding to the care of the patients with traction. he nurse should know this to imply the different area affected and to make nursing interventions immediately if the patient undergone different complications towards the procedure. 6. 7icro(io!o51 *atients who have traction are of great risk for skin infection because the skin integrity is being altered. he nurse observes the pin sites at least every 9 hours for drainage, color and severe redness which indicate inflammation and possible infection. o prevent infection to happen the nurse must observe this principle.

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;. P'1%ic% he nurse should observe on the friction between traction part and the bed. +lso the nurse should know the mechanical devices such as ropes, pulleys, and weights supply is used properly for the part to be traction to prevent further injury.

2. P%1c'o!o51 +de1uate explanation of the procedure to be used in applying and maintaining the traction is essential. *rovide privacy to the patient. @ive time to patient that he can accept the injury that he had. *rovide good environment to prevent depression of the patient. <. Sa# t1 an0 S c*rit1 he nurse should observe on the safety of the patient to prevent aggravation on the injured part. his is also to prevent fall of the patient that may cause further injury.

CO7PLICATIONS APPLICATION:

OF

TRACTION

3. SKIN )REAKDOWN 8 results from irritation caused by contact of the skin with the tape or foam and shearing forces. ,lder adults are at greater risk for this complication because of their sensitive and fragile skin. 7onitorin5 an0 7ana5in5 S+in )r a+0o&n: 9 9 9 (uring the initial assessment, the nurse identifies sensitive, fragile skin $common in older adults% he nurse closely monitors the status of the skin in contact with tape or foam to ensure that shearing forces are avoided he nurse performs the following procedures to monitor and prevent skin breakdownA

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!emoves the foam boots to inspect the skin, the ankle and the +chilles tendon three times a day he nurse is needed to support the extremity during the inspection of akin care *alpates the area of the traction tapes daily to detect underlying tenderness *rovide back care at least every / hours to prevent pressure ulcers. he patient must remain in a supine position to prevent the increased risk of the development of pressure ulcers Uses a special mattress overlays $e.g filled, high-foam% to prevent pressure ulcers.

6. NER2E DA7A:E # skin traction can place pressure on peripheral nerves. .hen traction is applied to the lower extremity, care must be taken to avoid pressure on the peroneal nerve at the point at which it passes around the neck of fibula just below the knee. *ressure at this point can cause foot drop. .eakness of dorsiflexion or foot movement and inversion of the foot indicate pressure on the common peroneal nerve. *lantar flexion demonstrates function of the tibial nerve. he following are important points to keep in mind when caring for patient in tractionA regularly assess sensation and motion immediately investigate any complaint of burning sensation under the traction bandage or boot promptly report altered sensation or impaired motor function

;. CONSTIPATION AND ANOREXIA 8 reduced gastrointestinal motility results to constipation and anorexia. 0ncourage a diet high in fiber and fluids may stimulate motility
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gastric

 If constipation develops # herapeutic measures may includeA stool softeners o improve patient4s appetite, the nurse identifies and includes the patient4s food preferences, as appropriate, within the prescribed therapeutic diet.

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2. 2ENOUS THRO7)OE7)OLIS7 8 venous stasis that predisposes the patient to venous thromboembolism occurs with immobility. he nurse teaches the patient to perform ankle and foot exercises within the limits of the traction therapy every 8-/ hours when awake to prevent (? . he patient is encouraged to drink fluids to prevent dehydration and associated hemoconcentration, which contributes to stasis. he nurse monitors the patient for signs of (? including unilateral calf tenderness, warmth, redness and swelling $increased calf circumference% he nurse promptly reports finding to the physician for definitive evaluation and therapy.

<. CIRCULATORY I7PAIRE7ENT 8 is manifested by cold skin temperature, decreased peripheral pulses, slow capillary refill time and bluish skin. +fter traction is applied, the nurse assesses circulation of the foot or hand within 8< to ;7 minutes and every 8 to / hours. he nurse encourages the patient to perform active foot exercise every hour when awake.

B. PRESSURE ULCERS he nurse examines the patient4s skin fre1uently for evidence of pressure or friction, paying special attention to bony prominences. It is helpful to reposition the patient fre1uently and to use protective devices $e.g elbow protectors% to relieve pressure. he nurse consult with the physician and the woundostomy- continence nurse.

C. URINARY STASIS AND INFECTION 8 incomplete emptying of the

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bladder related to positioning of the bed can result in urinary stasis in infection. In addition, the patient may find use of the bedpan uncomfortable and may limit fluids tominimi"e the fre1uency of urination. he nurse monitors the fluid intake and character of the urine.

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he nurse teaches the patient to consume ade1uate amounts of fluid and to void every ;-2 hours If the patient exhibits signs or symptoms of urinary tract infection ,the nurse notifies the physician

<. :ENERAL CARE OF PATIENTS WITH TRACTION AND FIXATORS

<.3. ASSESS7ENT OF A )ODY P A R T C.8.8 &irculation - check the skin color, joint motion, complaints of numbness, coldness or swelling over the extremity. +void pressure in the popliteal space. C.8./ &ondition of the skin - check the skin areas over +chille4s tendon, dorsum of the foot, heel, and sacral region. C.8.; 6ody alignment and position of the extremity - is the purpose of the traction being accomplishedD C.8.2 *revention of deformity - have measures been provided to prevent foot drop, hip flexion and contractureD Is the backrest lowered several times daily to provide for complete extension of the hip jointsD C.8.< &ountertraction - is countertraction sufficient or does the foot plate fre1uently rest against the foot of the bed. C.8.B 'lipping - is there slipping of the traction tapes and does outer bandage need rewrappingD
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C.8.C *ressure - is there pressure on the lateral aspect of the leg over the head of the fibulaD *ressure in this area may result in a palsy of the peroneal nerve. C.8.9 *atient4s &omfort - traction should never be a source of undue discomfort for the patient. 3isten carefully and heed complaints of discomfort. C.8.: &omplication - because of the prolonged bed rest and minimal activity, hypostatic pneumonia is a constant threat, particularly to the elderly patient. 0ncourage coughing and deep breathing. <.6. HANDLIN: NEW TRACTION - inspect traction apparatus fre1uently to ensure the ropes are running straight and through the middle of the pulleysE the weights are hanging freeE that bed clothes, the bed or the frame or bars of the bed are not impinging on any part of the traction apparatus - check ropes fre1uently to be sure they are not frayed. - +void releasing weights from or altering the line of pull of the traction. - +void adding weight to the traction - &heck the position of the homas splint fre1uentlyE if the ring is away from the groin, readjust the splint to its proper position without releasing the traction. - +void bumping into the bed or traction e1uipment - 6e sure that weights are securely fastened to their ropes - +void manipulation of pins <.;. SKIN CARE - encourage the patient to turn slightly from side to side and to lift hip up on the trape"e to relieve pressure on the skin on the sacrum and scapulae - avoid padding the ring of the homas splint- since this will create dampness next to the skin. 6athe the skin beneath the ring, dry it thoroughly, and powder the skin lightly.
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- inspect skin fre1uently to be sure that it is not being rubbed, macerated by traction e1uipmentE readjust splint or the extremity in the splint to free the

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skin from pressure - keep skin areas around the pin sites clean and dry C.=. TURNIN: - )ever lift or change traction weights without a doctor4s order - (o not remove traction or increase or decrease the amount of the weight without specific orders - +lways tell the patient when you4re going to remove or re-apply the tension - )ever drop a weight when reapplying traction but gradually lower the weight so the patient does not undergo sudden extreme stress - a patient who may have the head rest up and down should be positioned completely flat at least half the time to prevent hip flexion contractures. - .hen traction is applied to the leg a foot plate may be applied to prevent foot drop - If patient4s leg is in traction the foot should never rest urning to any position is generally permitted as long as the integrity of the traction is not compromised and the patient is comfortable. - prevent rotation of the leg and splint. bed or pressure necrosis will develop he heel should not rest on the

- If pillows are used they should be firmed so they will provide ade1uate support and will maintain alignment of the limb of the traction apparatus. - the elevation of the heel should not hyperextend the knee >. TOILETIN: - use a fracture pan with blanket roll or padding as support under the back - protect the homas ring splint with water proof material when female patients are using the bed pan.
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RE%ERENCES 1.&tt':(())).& #*io.$o"(o!t&o' +i$s(,ou!n#*s(o!t&o(-.B/10 314+##+/-42$#-#$2#-34445#/ #4.4-.D(&i6&- n !67-ti4i#*-'*#t #u1!#$tu! s-t! #t +-)it&-&74!i+-1i8#tion-is-9n -4!i+6in6-n $ ss#!7 2.&tt's:(()))2.#o1oun+#tion.o!6()'s('o!t#*(su!6 !7: s&o);#6 <! +1i8=4on <Ti4i#=s 6" nt<Dist#*=$*#ssi1i$#tion<43A1=t! #t" nt<=" t&o+<T!#$tion-22--22>initi#*-22'!o?ision#* -22st#4i*i@#tionA=i"'*#ntst7' <=#''!o#$&<=! +1i8Bu!*<123023353 04./=L#n6u#6 < n 3. &tt':(( " +i$in ." +s$#' .$o"(#!ti$* (12.2.1.-t! #t" nt 4.&tt':(())).s$!i4+.$o"(+o$u" ntB+o)n*o#+s(+i! $t(23255121: 8t nsion<'+1=1t<1351302122=*t<1351300.12=us !Bi+<1153341// =u#&9<$21R!76'3K1NAIUECR?3"/&+C'6

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