How should the nurse position the weights for a client in skin traction?

The goals of treatment of fracture are to restore an injured part for its maximum functioning to prevent complications and to obtain the best possible cosmetic result. Most fractures are treated by ‘reduction’ and ‘immobilization’. Traction is one method of reducing a fractured bone. Fractures may be reduced in three ways:

1. By manipulation (closed reduction)

2. By operative procedure (open reduction)

3. By reduction (traction and extension)

Fracture reduction performed in an attempt to restore the injured bone’s normal anatomic alignment, position and length in order to bring the fracture fragments into close approximation so that healing could be promoted.

Closed Reduction

Closed reduction (manipulation) is performed by manually applying the traction to lock the ends of the fragments together and thus restore the normal bone alignment. The three basic maneuvers used during manipulations are traction and counter traction, angulation and rotation.

When closed reduction is used the client is usually given a general anaesthetic. The doctor then reduces the fracture by pulling on the distal fragment (manual traction) while another person applies counter traction to the proximal fragment until the bone fragments reconcile their normal alignment. The doctor also may apply direct pressure on the site of the fracture to correct angulation or lateral displacement. Following a closed reduction, X-ray films are taken and a plaster cast is applied.

Open Traction

Open traction is performed under surgical asepsis. After making an incision, the fractured bones are reduced under direct vision. Various internal fixation devices are applied to the bone to maintain the normal alignment. This device consists of metallic screws and plates, pins, wires, nails or rods. These may be placed through the bone fragments or fixed to the sides of the bones or inserted directly into the medullary cavity. When screws and plates inserted, they must be made of same metal to avoid possible electrolytic reaction. While internal fixation devices initially help to immobilize a fracture and prevent deformity, they are not a substitute for bone healing. If proper bone healing does not occur, the metallic structures may become loose or even break, thereby failing to achieve the purpose. For some fractures, the open reduction is the choice of treatment, but it has many potential hazards such as:

a. Introduction of infection into bone.

b. Accidental injury to the major nerves and blood vessels during surgery.

c. Additional damage to the bone or adjacent structures caused by the metallic fixation devices.

d. Impaired circulation due to the destruction of small blood vessels around the bones during surgery.

X-ray films are taken during and following open reduction to evaluate the alignments of the fractured bone.

Reduction Traction

Reduction traction means the restoration of displaced bony parts to its normal alignment, position and length. It is used to bring the displaced fragments of the broken bone into close approximation to one another and to maintain proper alignment until the healing take place completely.

Nurses are more concerned with the traction as they work in the ward for their maintenance. Traction is an application of a mechanical pull to a part of the body for the purpose of extending and holding that part in a desired position. Therapeutic traction is accomplished by exerting a pull on the head, body or limbs in two directions, i.e., traction and a counter traction. Traction is applied in the direction in which the weight is applied and the counter traction is applied in opposite direction. The weight applied, exerts a pull on the body and it is equal to the amount of weight applied. Counter traction may be either the weight of the body (when the body is in an inclined position) or other weights applied and are always equal to the traction applied. 

The counter traction may be obtained by elevating the bed in such a way that the client’s body weight opposes the pull of traction, e.g., the foot of the bed is elevated when traction is applied to the lower extremities, the head end is elevated when traction is applied to the lower extremities, the head end is elevated when a skull traction is applied. If the bed is not tilted properly, the counter traction achieved will be inadequate and the client will tend to slide in the direction of traction force, thus, the purpose of the traction will not be achieved.

Purpose of Traction

1. To restore and maintain the proper alignment of the broken bones, in a fractured site.

2. To relieve pain caused by muscle spasm.

3. To prevent deformities.

4. To correct deformities.

5. To treat dislocations and spinal cord compressions due to prolapsed intervertebral disc.

6. To immobilize a part.

 

​WOUND DRAINS - TYPES AND CHARACTERISTICS OF DRAIN

Methods of Applying Traction

Traction is applied by a system of ropes and pulleys. The weights are attached to a fixed point below the area of injury or disease. They are different types of tractions:

1. Skin Traction:

  Skin traction is achieved by clinging wide bands of adhesives directly to the skin and applying weights to these bands. The pull of the weight is transmitted indirectly to the involved bone. Buck’s extension, Bryant’s traction and Russell traction are the three most common forms of skin traction used in injury to the lower extremities.

2. Skeletal Traction

   In skeletal traction, the traction is applied directly to the bone. Under strict aseptic precautions, a rustless pin or wire (e.g., Steinmann pin or Kirschner wire) is inserted through the bone fragment distal to fracture and out through the skin on the opposite side of the limb. A metal U-shaped spreader is then attached to the wire or pin and the weights are attached to the spreader. Skeletal traction can be used for the fracture of the femur, tibia, humerus and cervical spine. In case of cervical spine, the traction is achieved by the use of Crutchfield tongs applied to the skull.

3. Specific Types of Tractions

Pelvic traction, head halter traction are the examples.

 

GENERAL INSTRUCTIONS

1. Traction is applied under the guidance of a doctor. Ask for the specific instructions regarding the types of traction, the amount of weight to be applied etc.

2. The extremity should be supported and stretched in a direction that will bring the displaced bone fragments to its normal alignment; at the same time, there should be no overstretching because it results in an excessive gaping of bone fragments.

The traction forces must remain constant (in amount and direction) until bone union occurs.

3. By the periodic inspection (daily) ensure that the apparatus is accomplishing its purpose and that the equipment is as safe as possible.Traction ropes should be of adequate strength to support the weights without breaking. See that the frayed rope is replaced with fresh rope to prevent accidental breakage.

Where should traction weights be?

What are the nursing considerations for a patient in traction?

What is the procedure for applying traction to a patient?

What is the ideal weight used for skin traction?