Skin Traction

Presenter: AP/JT
Supervisor: dr. Ira Nong, M.Kes, Sp.OT (K)
 Principle of Traction
• Traction is the application of a pulling force for medical purposes, to treat muscle or skeletal
disorders – for example, to reduce a fracture, stabilise and maintain bone alignment, relieve pain,
or prevent spinal injury.
• Traction is usually applied to the arms, legs, spine, or the pelvis. It is used to treat fractures,
dislocations, and long-duration muscle spasms, and to prevent or correct deformities.
• Traction can be used either short term, for example at an accident scene, or in A&E as pain relief
or as part of an interim care plan before surgery. It can also be used long term, as part of a non-
operative treatment plan.
• Traction is based on simple mechanical principles and is a well-established treatment in
orthopaedic settings. To pull (or apply) traction effectively, there must be something to pull
against, which is endeavouring to pull or thrust in the opposite direction. These two forces are
called traction and counter traction respectively.
• Counter traction is the force acting in the opposite direction to the applied traction. It is usually
achieved by a patient’s body weight and bed adjustment, sometimes with the use of additional
weights.
• Use of traction
• To relieve pain due to muscle spasm, maintaining the limb in a
position of comfort and rest.
• To restore and maintain alignment of bone following fracture and
dislocation.
• To help restore blood flow and nerve function.
• To allow treatment and dressing of soft tissues.
• To rest injured or inflamed joints, and maintain them in a functional
position.
• To allow movement of joints during fracture healing.
• To gradually correct deformities due to contraction of soft tissues,
caused by disease or injury.
• To allow the patient to be moved with ease.
Applications and care plans
• The application of skin traction should be carried out by at least two health care practitioners (HCPs)
who are trained in the procedure.
• Aim
• To safely apply skin traction.
• Equipment:
• one adhesive or non-adhesive traction kit
• crêpe bandages (if not in the kit)
• padding (if not integral to the kit)
• tape
• scissors.
• If you are using counter traction, you will need:
• traction cord
• weights and carriers
• balkan beam
• cross bars
• two pulleys
• spreader plate (if not in traction kit).
• Femoral shaft fractures are normally treated operatively, using
intramedullary nailing. They should only be considered for
nonoperative fracture treatment if there are neither facilities, nor
skills, for surgical treatment.
• Nonoperative treatment means that the patient will be in some
form of traction for at least 6-8 weeks, often 10-12 weeks.
• Treatment by traction appears simpler than surgery. However, it
requires great skill of application and constant monitoring
throughout the whole treatment period.
• The initial treatment is usually skin traction, later converted to
skeletal traction.

Disadvantages of prolonged skin traction are:

• Loosening
• Constriction
• Friction
• Allergy
• If skin traction is likely to be used for more than 24
hours, greater patient comfort and better control of
the femoral fracture can be achieved by using
Hamilton-Russell skin traction.

• A padded sling is placed behind the slightly flexed knee

and skin traction applied to the lower leg. The traction
cord and pulley system are as illustrated.

• The principle of the parallelogram of forces determines

that the upward pull of the sling and the longitudinal
pull of the skin traction create a resolution of force in
the line of the femur, as illustrated.

• This configuration of traction also allows control of

rotation, by side-to-side adjustment of the pulley
above the knee.
• Thomas’ Splint
• Temporary stabilization of femoral shaft fractures can be achieved using the
Thomas’s splint apparatus. It can also be used for transportation of patients. This
can provide adequate fracture stability and pain relief until definitive
stabilization is carried out.
If this method of treatment is chosen the appropriate size of the Thomas’s splint
has to be selected.
• In the event that there is no Thomas splint available, skin traction over
the end of the bed with 7 kg will be the initial treatment of a femoral
fracture.
• Note: With any longitudinal traction, the foot of the bed must be raised,
tilting the bed, to avoid the traction weight pulling the patient down the
bed.
With the tilted bed the weight of the patient acts as counter traction.
• Before the application of the adhesive traction strip, the skin is painted
with friar’s balsam.

The strip is then applied below the level of the fracture on the medial
and lateral aspects of the leg as shown, carefully avoiding any creases.
• To prevent the development of blisters, the skin traction needs to be applied
without folds or creases in the adhesive material and the covering bandage
should be non-elastic.

Should a crease be inevitable, due to the contour of the limb, the creased area
should be lifted, partially slit transversally and the edges overlap.
• Once the adhesive strip is satisfactorily in place, ensuring that the
padded lower section overlies the malleoli, a spiral inelastic bandage
is carefully wrapped around the limb from just above the malleoli to
the top of the strip.
• Apply the overlying bandages spirally overlapping by half.
The traction strip should be applied to the level of the fracture only, but
not above.
THANK YOU