Traction

care of a patient with traction -definition, history, principles, advantages,disadvantages ,types complications, nursing care

1. GOOD MORNING

2. traction

3. LEARNING OBJECTIVES Define traction Understand the principles of traction Enlist the different types of traction Discuss the advantages, disadvantages and complications of traction List the specific traction system and their uses Explain the nursing management.

4. Definition ‘ ’Traction is the application of a pulling force for medical purposes, to treat muscle or skeletal disorder - for example, to reduce fracture, maintain bone alignment, relieve pain, or prevent spinal injury”

5. HISTORY The use of traction dates a s far back as 3000 years ( ancient Egyptians ). Hippocrates (350BC) wrote manual traction and the forces of extension and counter extension. Used extensively in civil war for fractured femurs.

6. PRINCIPLES

7. Purposes

8. ADVANTAGES Decrease pain. Maintains functional position until healing is complete. Restricts movements while the injury heals Prevent or reduce skeletal deformities Allows more joint mobility than plaster

9. DISADVANTAGES

10. types

11. types BASED ON MECHANISM Fixed traction By applying force against a fixed point of body. Ex: fixed traction by Thomas splint.

12. Sliding traction By tilting bed so that patient tends to slide in opposite direction to traction force. Ex: Hamilton Russell traction, Perkins traction.

13. BASED ON METHOD SKIN TRACTION The traction force applied over a large area of skin.

14. SKELETAL TRACTION Applied directly to the bone either by a pin or wire through the bone. ( eg - Steinmann pin, denham pin , kirschner wire

15. Differentiating points SKIN TRACTION SKELETAL TRACTION Indication Mild to moderate force Moderate to severe force Weight p e r m i tt e d 3-4kg Up to 20kg Applied with Adhesive /non adhesive tape e.g: Buck’s Traction/ Gallow’s/ Bryant Ste i nmann pin,Kwire Crutchfield tong/Ilizarow wire/ D e nham pin Applied on Skin Bone Age used C hild Adult Used for short duration long duration

16. APPLAINCES BALKEN BEAM FRAMES KNOTS PULLEYS WEIGHTS

17. SKIN TRACTION Traction force is applied over a large area of skin. Traction force transmitted from skin to deep fascia and intermuscular septa to bone . Applied over limb distal to fracture site. Anteromedial and posterolateral part should be covered with cotton.

18. Weight

19. Application Adhesive skin traction : Prepare the skin by shaving as well as washing & applying tincture benzoin which protects the skin and acts as an additional adhesive. Avoid placing adhesive strapping over bony prominences, if not, cover them with cotton padding and do the strapping. Leave a loop of 5 cm projecting beyond the distal end of limb to allow movement of fingers and foot.

20. Non adhesive skin traction Useful in thin and atrophic skin. Frequent reapplication may be necessary. Attached traction weight must not be more than 4.5 kgs .

21. Indications of skin traction Temporary management of neck of femur fracture. Femoral shaft fracture in children. Un displaced fracture of acetabulum . After reduction of dislocation of Hip. To correct minor fixed flexion deformities of hip and knee. Management of low back ache.

22. Contraindications Abrasions and lacerations of skin in the area to which traction is to be applied Varicose veins, impending gangrene Dermatitis Patients with loose skin.

23. Complications Allergic reactions from the adhesive material. Blister formation and pressure sores from slipping straps.

24. Complications Compartment syndrome from over-tight wrap. Peroneal nerve palsy from wraps about the knee.

25. COMMON SKIN TRACTION BUCK’S TRACTION HAMILTON RUSSEL TRACTION GALLOW’S OR BRAYANT’S TRACTION PELVIC TRACTION DUNLOP TRACTION

26. Bucks traction Femoral neck fracture Inter Trochanteric fracture After reduction of a hip dislocation To correct minor flexed deformities of the hip or knee Management of low back pain. Not more than 4.5 kgs .

27. Used in femur trochanteric # . Bucks with sling

28. Bryants / GALLOWS traction Fracture shaft of femur in <2yrs age. Skin traction is applied to both legs child is suspended from a beam Raise mattress for counter traction Rarely used currently.

29. Treatment of tibia and femur from the sub trochanter region distally . Denham pin is inserted through upper end of tibia for fracture of femur, the mid tibia for fracture of condyles of tibia

30. Agnus hunt traction Agnus hunt traction is used for correction of mild flexion deformity of hip joint in poliomyelitis .

31. Dunlop’s traction Used for supracondylar and transcondylar fractures in children Forearm skin traction with weight on upper arm Elbow flexed at 45 degrees.

32. SKELETAL TRACTION It may be used as a means of reducing or maintaining the reduction of a fracture It should be reserved for those cases in which skin traction is contraindicated.

33. steel pins of varying lengths 4 – 6 mm in diameter. Bohler stirrup is attached to steinmann pin which allows the direction of the traction to be changed without turning the pin in the bone.

34. Denham Pin Identical to stienmann pin except for a short threaded length in the center . This threaded portion engages the bony cortex and reduce the risk of the pin sliding.

35. Kirschner wire They are easy to insert and minimize the chance of soft tissue damage and infections, It easily cuts out of the bone if a heavy traction weight is applied, Most commonly used in upper limb eg . Olecranon traction

36. Application Use GA or LA. Paint the skin with iodine and spirit. Mount the pin/wire on the hand drill. Identify the site of insertion and make a stab wound. The pin should pass only through skin, SC tissue and bone avoiding muscles and tendons.

37. Crutchfield traction To hyper extend the head and neck of patients with fractured cervical vertebrae for the purpose of immobilizing and aligning the vertebrae

38. Complications

39. common nursing problems encountered Impaired Physical Mobility Risk for Impaired Skin Integrity Risk for Infection Ineffective Tissue Perfusion

40. Nursing management

41. Minimizing the Effects of Immobility Encourage active exercise of uninvolved muscles and joints. Encourage deep breathing and coughing Auscultate lung fields twice per day. Encourage fluid intake of 2,000 to 2,500 ml daily . Provide balanced high- fiber diet rich in protein. Prevent pressure on the calf , to prevent thrombophlebitis . Check traction apparatus at repeated intervals.

42. Maintain Skin Integrity Examine bony prominences frequently for evidence of pressure or friction irritation. Observe for skin irritation around the traction bandage. Observe for pressure at traction skin contact points. Report complaint of burning sensation under traction. Relieve pressure without disrupting traction effectiveness.

43. Avoid Infection at Pin Site Watch for signs of infection, especially around the pin tract. Monitor vital signs for fever or tachycardia. If directed, clean the pin tract with sterile applicators and apply the prescribed solution/ ointment

44. Promoting Tissue Perfusion Assess motor and sensory function of specific nerves that might be compromised . Determine adequacy of circulation ( eg , colour, temperature, motion, capillary refill of peripheral fingers or toes ). Report promptly if change in neurovascular status is identified.

45. MNEMONICS CARE OF CLIENT IN TRACTION T Temperature R Ropes hang freely A Alignment C Circulation check (5 P’s) T Types and location of fracture I Increase fluid intake O Overhead Trapeze N No weights on bed or floor Extremity infection

46. Circulation assessment 5p’s P AIN P ULSE P ALLOR P ARESTHESIA P ARALYSIS ouch Can u move this