TRACTION

- The act of pulling associated with counterpull

PURPOSES
1. Reduce/immobilize fractures
2. Relieve muscle pain/spasm
3. Relieve pain
4. Prevent/correct deformities

TYPES OF TRACTION
A. Skin traction – uses elastic bandages and adhesives
– is used to control muscle spasms and to immobilize an area before surgery
- Is accomplished by using a weight to pull on traction tape or on a foam boot
attached to the skin
- The amount of weight applied must not exceed the tolerance of the skin
1. Buck’s Traction
- to temporary immobilize the leg in patient with a fractured hip
- shock blocks at the foot of the bed to produce counter traction and to prevent
the patient from sliding down in bed
- turn towards unaffected side, with 2 pillows in between legs
- check for pressure sore at the heel of the feet and signs and symptoms of
thrombophlebitis
2. Russell’s Traction
- Knee is suspended in a sling attached to a rope and pulley on a Balkan frame,
creating upward pull from the knee
- Weights are attached to the foot of the bed creating horizontal traction
- Used to treat fracture of the femur
- Allows patient to move about in bed more freely and permits bending of the
knee joint
- Hip should be flexed at 20 degrees; foot of bed usually elevated by shock blocks
to provide countertraction
- Assess back of the knee for pressure sores
- Check for signs and symptoms of thrombophlebitis
3. Bryant Traction
- Both legs raised at 90 degree angle to bed because the weight of the child is not
adequate to provide countertraction
- Used for children under 2 years and 30 pounds to treat fractures of the femur
and hip dislocation
- Buttocks must be slightly off the mattress to enhance efficacy of the weight as
countertraction
 - Knees slightly flexed to prevent hyperextension deformity
4. Cervical Traction
- Cervical head halter attached to weights that hang over head of bed
- Used for soft tissue damage or degenerative disc disease of cervical spine to
reduce muscle spasm and maintain alignment
- Usually intermittent traction, elevate head of bed to provide countertraction
- Do not shave beard for better anchorage of halter
5. Pelvic Traction
- Pelvic girdle with extension straps attached to ropes and weights used for low
back to reduce muscle spasm and maintain alignment
- Usually intermittent, patient in semi-Fowler’s position with knee gatched 20-30
degrees angle, secure pelvic girdle around iliac crests
- Encourage to use overhead trapeze
B. SKELETAL TRACTION
1. Balanced Suspension Traction
- Produced by a counterforce other than the patient’s weight
- Extremity floats or balances in the traction apparatus
- Patient may change position without disturbing the line of traction
2. Thomas Splint with Pearson attachment
- Used with skeletal traction in fractures of the femur, hip should be flexed at 20˚
- Use footplate to prevent footdrop
- Check pressure at the inguinal area (groin)
- Because upward traction is required, an overbed frame is used
3. Dunlop traction - horizontal traction to align fractures of the humerus; vertical
traction maintains the forearm in proper alignment
4. 90® – 90® Traction – for femoral fractures in children

NOTE: Only skeletal traction has pin site care to avoid development of osteomyelitis.

PRINCIPLES IN THE CARE OF THE CLIENT WITH TRACTION

1. Traction must be continuous to be effective in reducing and immobilizing fractures.
2. Skeletal traction is never interrupted.
3. Weights are not removed unless intermittent traction is prescribed.
4. Any factor that might reduce the effective pull or alter in resultant line of pull must be
eliminated:
a. The patient must be in good body alignment in the center of the bed when traction
is applied.
b. Ropes must be unobstructed.
 c. Weights must hang free and not rest on the bed or floor.
d. Knots in the rope or the footplate must not touch the pulley or the foot of the bed.
5. Turn the client as indicated.
6. Avoid friction.
7. Pin site care for skeletal traction:
- Cleanse and apply antibiotic ointment.
- Do neurovascular check.
- Prevent complications of immobility.

CASTING MATERIALS
TYPES:
1. Nonplaster (synthetic)
- Generally referred to as fiberglass casts which have the versatility of plaster but are
lighter in weight, stronger, water-resistant and durable
- Reach full rigid strength in minutes
- Are porous and therefore diminish skin problems
- Do not soften when wet which allows the use of hydrotherapy
- When wet, dry with a hair drier on a cool setting; dry thoroughly to prevent skin
breakdown
- Indication: used for nondisplaced fractures with minimal swelling and for long-term
wear

2. Plaster
- Rolls of plaster bandage wet in cool water applied smoothly to the body
- A crystallizing reaction can occur and heat is given off which can be uncomfortable,
therefore, nurse should inform patient about the sensation of increasing warmth so
patient does not become alarmed
- Cast needs to be exposed to allow maximum dissipation of the heat and that most
casts cool after about 15 minutes
- It does not have its full strength until dry
- When wet, cast can be dented, therefore, it must be handled with the palms of the
hand and not allowed to rest on hard surfaces or sharp edges
- Requires 24 to 72 hours to dry completely
- Freshly applied cast should be exposed to circulating air to dry and should not be
covered with clothing or bed linens
- Wet plaster cast: appears dull and gray, sounds dull on percussion, feels damp, and
smells musty
- Dry plaster cast: white and shiny, resonant, odorless, and firm
CARE OF THE CLIENT WITH CAST
1. Carry with palms of the hand, not the fingers to prevent indentation and pressure.
2. Do not insert anything into the cast.
3. Use blower to relieve itchiness inside the cast.
4. Elevate with pillow support for the first 24-48 hours to prevent edema.
5. Expose to air to dry.
6. Keep clean and dry.
7. Observe “hot spots” & musty odor. These are signs and symptoms of infection.
8. Maintain skin integrity – “petalling”
9. Do isometric exercises on the affected extremity and active ROM on unaffected
extremity.
10. Do neurovascular checks:
 Skin color: Check the extremity and the nail beds distal to the site of the fracture for
color. Pallor, discoloration, and coldness indicate circulatory impairment
 Skin temperature: “hot spots” (areas warm to touch) or any elevation of
temperature must be noted, documented and reported
 Sensation: Check for any diminished or absent sensation or for numbness or tingling
 Mobility: Check hand function by having the patient try to hyperextend the thumb
or wrist, oppose the thumb and little finger, and adduct all fingers. Check function
of the foot by having the patient try to dorsiflex (peroneal nerve = damage causes
footdrop) and plantarflex (tibial nerve) the ankles and flex and extend the toes.
 Pulse: If an upper extremity is involved, brachial, radial, ulnar, and digital pulses
should be checked. If a lower extremity is involved, femoral, popliteal, posterior
tibial, and dorsalis pedis pulses should be monitored.
 Pain: Any sign of pain should be noted and the exact area determined
11. Windowing – to facilitate observation under the cast if infected
12. . Bivalving – done for casts that are too tight to prevent compartment syndrome.

HIP REPLACEMENT
AVOIDING HIP DISLOCATION AFTER REPLACEMENT
SURGERY
needed until 4 months after surgery
1. Maintain abduction of the affected leg at all times with abductor splint or 2 pillows
between legs.
 2. Prevent external rotation by placing trochanter rolls along hip.
3. Use abductor splint or 2 pillows when turning or lying on side.
4. Keep the knees apart at all times.
5. Put a pillow between the legs when sleeping.
6. Never cross the legs when seated. The knees should be lower than the hip.
7. Avoid bending forward when seated in a chair. Hip should not bend more than 90˚
8. Do not elevate the head of the bed more than 60°.
9. Avoid bending forward to pick up an object on the floor.
10. Use a high-seated chair and a raised toilet seat.
11. Do not flex the hip to put on clothing such as pants, stockings, socks, or shoes.
12. For use of the fracture bedpan, flex the unaffected hip and use the trapeze to lift the
pelvis onto the bed pan. Never flex the affected hip.
13. Do not sleep on the affected extremity.
14. Affected leg should not cross the center of the body.
15. Affected leg should not turn inward while lying down.
F If prosthesis becomes dislocated, immediately notify the surgeon to reduce and
stabilize hip promptly to prevent circulatory and nerve damage.

SIGNS OF DISLOCATION OF PROSTHESIS

1. Popping sensation of the hip.
2. Pain and swelling at the groin.
3. Shortening of the affected leg.
4. Loss of function of the affected leg.
5. Abnormal internal or external rotation of the affected leg.

Care for Clients after Limb Amputation

1. Evaluate for phantom limb sensation and pain; explain sensation and pain to the client,
and medicate the client as prescribed.
 Providing activity to the client decreases phantom limb pain
 Stump desensitization by kneading massage brings relief
2. If prescribed, during the first 24 hours, elevate the foot of the bed to reduce edema;
then keep the bed flat to prevent hip flexion contractures
3. Do not elevate the stump itself but raise the entire foot of the bed because elevation
can cause flexion contracture of the hip joint.
4. After 24 and 48 hours postoperatively, position the client prone for 20-30 minutes 2-
3x/day if prescribed, to stretch the muscles and prevent flexion contractures of hip
 5. In the prone position, place a pillow under the abdomen and stump and keep the legs
close together to prevent abduction
6. Maintain application of an Ace wrap or elastic stump shrinker
 Wrap from distal to proximal
 If it falls off, nurse must immediately wrap the residual limb to prevent severe edema
7. Wash the stump with mild soap and water and apply lanolin to the skin if prescribed
8. Massage the skin toward the suture line to increase circulation
9. Encourage the client to look at the stump
10. Encourage verbalization regarding loss of the body part

Above the Knee Amputation

1. prevent edema – ace wrap
2. do not allow the stump to hang over the edge of the bed – prevent flexion contractures
3. do not allow the client to sit for long periods of time, to prevent contractures
Below the Knee Amputation
1. Prevent internal or external rotation of the limb
2. Place a sandbag or rolled towel along the outside of the thigh to prevent rotation

Note: A large tourniquet in plain sight at bedside must be on hand for hemorrhage

CTS MANAGEMENT
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carpal-tunnel-release

TRIGGER FINGER
https://orthoinfo.aaos.org/en/diseases--conditions/trigger-finger/