The principles of traction are a pulling force that is applied to part of the body, the limbs, the pelvis or the spine and a pulling force applied in the opposite direction called countertraction. Countertraction prevents the patient from being dragged into the traction pull direction. Without it, muscle spasms could not be overcome and all benefits of traction would not come to pass. The forces involved in traction are based on Newton’s third law of motion, which states that for every action there has to be an equal, and opposite reaction. In other words to pull an object into one direction an equal counter-thrust in the opposite direction has to be present.
Traction can be achieved via the use of hands [as in manual traction], the use of robes, splints, pulleys and weights [as in skin traction] and through pins, wires and tongs inserted into the bone [as in skeletal traction].
Traction is used to promote rest/immobilization, which restores and maintains alignment allowing bones and soft tissue to heal. It helps to rest inflamed joints and to correct deformities, overcome muscle spasms and therefore aids in the relief of pain.
Here are the main types of Traction:
1- Skeletal traction refers to pulling forces that are applied directly to the skeleton via pins, wires or screws that have been inserted into the bone. Due to this greater weights can be used. Skeletal traction is used for unstable fractures, for control of rotation where greater weights up to 25 pounds are needed and for fractures requiring long-term traction. Example: Ninety degree traction or a Dunlop traction (which is used for a fracture of the humerus.)
2- Skin traction refers to any traction where the pulling force is applied to the affected body part via the soft tissues. The term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. This can be done in a variety of ways: adhesive and non-adhesive skin extensions, splints, slings, foam boots, pelvic slings and cervical halters. Because skin traction is applied to the skin the grip is less secure, limiting the amount of weight that can be used. Weight should not exceed 7-9 pounds. Skin traction is used for short periods of time. Example: Russell’s Traction.
3- Buck’s Traction is used as a short-term measure where light traction forces are required to immobilize hip fractures before surgery and reduce muscle spasms. It is used preoperatively for clients with a HIP FRACTURE.
Nurses need to know how to apply it correctly and how to care for these patients.
- Impaired skin integrity is an obvious problem, especially in the elderly. Inspect the skin, and bony prominences need to be padded. Check skin and traction apparatus once per shift.
- Altered tissue perfusion, the danger of deep vein thrombosis or pulmonary embolism is another common problem. Deep breathing and ankle pump exercises, as well as the use of TEDS stockings and anticoagulant therapy are ways to prevent this. Calves should be inspected for tenderness, unusual warmth and redness and any signs of dyspnea and tachypnea.
- Pain management is another important part of the nursing care. Pain can be assessed using the 1-10 scale and patients should be encouraged to take analgesia before pain becomes severe. Education with regards to addiction fears and risk of constipation need to be provided.
- The use of fracture pans, provision of privacy, high fluid intake, and food high in fiber can all help in promoting normal bowel elimination and prevent constipation.
- The client in traction is at risk for respiratory problems. Assist the patient with coughing and deep breathing exercises and the use of a spirometer can assist to maintain a good gas exchange.
- Risk for injury and infection are also present.
if you see it in the wards..
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