BALANCE SKELETAL TRACTION APPLICATION

Traction : is the act of pulling or drawing which is associated with counter traction. The pulling force is applied to a part of the body
while a counter traction pulls in the opposite direction. In straight or running traction coutertraction is supplied by the patient’s
body with the bed in one of the following positions;

1. Flat
2. Tilted away from the traction pull
3. Altered by elevating the head and / or knee gatch

THE PROCEDURE
I. Purpose and identification of traction
a. Purpose: used in the treatment or fractured extremities;
1. To lessen muscle spasm
2. To reduce fracture
3. To provide immobilization
4. To maintain alignment
5. To correct or prevent deformities in the case of arthritis patient with flexion contraction
6. To help lessen the curvature of the spine before correction surgery
b. Basic types of traction;
1. Skin traction
2. Skeletal traction
3. Manual traction
2. Check for Doctor’s Order
3. Identification of parts
a. Orthopedic bed/ Balkan frame
- 2 horizontal bars
- diagonal bar
- 4 vertical bars
- 3 pulleys
- Clamps
- Overhead trapeze
- Cross bar
- Firm mattress
- Fracture board
- Shock blocks / lock
b. BST equipments
- Thomas splint
- Pearson attachment
- Rest splint
- Cord/Sash
- Foot rest
- Safety pins/ paper clips
- Thigh rope(shortest)
- Suspension rope(longest)
- Traction rope(longer)
- Traction weight
- Suspension weight
4. Traction set-up

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 a.
Thomas splint and pearson splint
1. Attach the rest splint to the Thomas splint with Pearson attachment
2. Upper part is the Thomas splint which will support the thigh and lower part is the Pearson attachment
that will support the leg.
3. Tie the short rope to the medial upright of the Thomas splint with slip-knot to ensure privacy to the
patient.
b. Application of slings to the Thomas splint and Pearson attachment.
1. Start from the large and wide slings (at least 2 pcs) to the Thomas splint and 3 slings smaller and
narrower to the Pearson attachment.
c. Principles of sling application
1. Smooth side should be touching the patient skin for comfort
2. At least 1 inch apart in between slings for ventilation
3. Not to tight not too loose to support the normal structure of the leg
4. Provide space at the popliteal and heel area to provide ventilation and prevent irritation.
5. Insertion of apparatus
a. Patient’s instructions
1. Instruct the patient to flex the unaffected leg and hold on the overhead trapeze bar
b. 3 manpower team
1. Apply manual traction (1st nurse) of the affected leg
2. In the count of 1,2, & 3 with the coordination in movement, simultaneously, 2nd nurse lifting the
affected leg and
3. 3rd nurse removing the Braun Bohler while inserting the assembled apparatus (Thomas splint, Pearson
attachment & rest splint).
6. Application of traction weight
a. Application of traction weight (10% of the body weight)
1. There should be continuous traction, so don’t remove the manual traction until kthe longer rope has
been tied to the steinman pin holder (club hitch knot/ eight knot), then insert the other end of the rope
to the third pulley to the traction weight(club hitch knot) and securely tied.
2. Check the groin part of the thigh if resting on the half ring to promote comfort.
b. Application of suspension weight (50% of the traction weight)
1. Tie first the other end of the short rope on the lateral aspect of the Thomas splint.
2. Tie the longest rope to the middle of the short rope with slip knot.
3. Insert the other end of the rope to the first pulley, passing through the hanged suspension weight, to
the 2nd pulley
4. Prior in tying the rope make it sure the rope is inside thetraction rope for support and prevent the
affected leg from swaying sideways. Then tie to the Thomas splint using clove hitch knot then to the
Pearson attachment.
5. Release the suspension weight
c. Removal of the rest splint
d. Applying of foot support
1. You may start applying ribbon knot at the lateral and medial side of the Thomas splint, then to Pearson
attachment.
7. Checking efficiency of traction
a. Principles of Skeletal Traction
1. Have an opposite pull or counter traction.
2. The application of shock block or lock and weight of the patient serve as the counter traction .
3. Line of pull should be in line with the deformity. The 1st pulley should be in line with the groin. The 2nd
pulley should be in line with the knee, and traction line should be straight with the deformity.
4. Traction should be continuous and weights should be hanging freely.

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 5.
The position of the patient should be in dorsal recumbent or supine position .
6.
It should be free from friction;
- Weights should be hanging freely.
- Observe for signs of wear and tear on the ropes and bags.
- Ropes should run freely along the grove of the pulley.
- Knots should be away from the pulley.
8. Transport/removal of traction ( what is being 1st assembled should be the last to remove);
a. Attach the rest splint,
b. Anchor the suspension weight,
c. Remove the suspension rope,
d. Apply manual traction,
e. Remove traction weight, then tie the rope to the rest splint, Thomas and Pearson using the clove hitch knot
f. Patient is ready for transfer to the stretcher, and
g. Instruct the patient to flex his unaffected leg while holding on the trapeze bar and simultaneously helping the
patient transfer to the stretcher.
9. Nursing care to patient in traction
a. Should be free from any of the following;
1. Impaired circulation of the extremeties,
2. Respiratory distress,
3. Emphasize good condition of the skin particularly at ischial, sacral, poplitieal, dorsum of foot, and heel
part,
4. Contracture of joint like footdrop
5. Signs of infection;
- Assess skin integrity
- Traction pin site dressing regularly
- Monitor for temperature, color, odor of the affected part.
b. Should have bone alignment and position of extremity in which the purpose of traction should be accomplished.
c. Provide patient’s comfort such as;
1. Traction should never be a source of undue discomforrt,
2. Care of the skin, mouth, hair, nails, toes, and genitals should be included in the plan of daily care.
d. Provide exercises such as;
1. ROM exercise of all the unaffected joints
2. Static quadriceps exercises,
3. Flexion and extension of the toes and fingers in traction.
e. Provide supportive therapy
f. Monitor the nutritional status of the patient
g. Complaint of the patient should be assess
h. Check the traction set-up if;
1. The apparatus is accomplishing each purpose of traction,
2. The equiments are safe as possible,
3. Sash, cords and pulleys is unobstructed,
4. Knots, clamps, and weighs are secured, and
5. Weights are free from any friction,
10. What are the complications to patient with traction?
a. Fat embolism
1. Patient with long bone fracture is prone like; tibia, fibula, radius, ulna, femur, and humerus. Fatty
globules from the bone goes to the lungs and usually occurs within 48 hours.
2. Signs/symptoms: restlessness, altered LOC, tachycardia, tachypnea, ŒBP, petichial rash over the upper
chest/neck.

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 3. Nursing consideration: inform the doctor.
b.
Compartment syndrome
1. Increase pressure within one or more compartment causing massive compromise circulation, leading to
Œtissue perfusion Šanoxia. This is w/n 4-6 hrs pc the onset neurovascular damage F irriversible.
2. Sx/Sy: ›pain & swelling, pain unrelieved by analgesic, Œdistal pulse, & loss of sensation.
3. Nsg consideration: Assess VS, & notify the doctor.
c. Infection/ osteomyelitis
1. Is an acute/chronic inflammatory process of the bone and its structures secondary to infection with
pyogenic organisms.
2. Sx/Sy: fever, pain, edema, warmth, tender, reduction in the use of extremity, ›WBC & pulse.
3. Nsg consideration: Assess, notify the doctor.
d. Avascular necrosis
1. Interruption of the blood supply to the bone tissue Šbone death.
2. Sx/Sy: pain & Œsensation
3. Nsg consideration: assess & notify doctor
11. What are the possible nursing diagnosis?
a. Pain
b. Highrisk for infection
c. Impaired physical mobility
d. High risk for skin integrity
e. High risk for injury
f. High risk for altered tissue perfusion
g. High risk for self-esteem disturbance

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