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Traction is a set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.

There are two major types of traction: skin traction and skeletal traction. They can also be classified to as either fixed, pulp, or balanced tractions

Types of traction

Fixed traction

Here the traction is attached to a stationary point e.g. Thomas splint

Pulp traction

Used in the management of fracture of the fingers and toes;

To correct the shape of fingers

A suture passes through a pulp(bone) of the fingers then fastened to an extension piece in cooperated in the P.O.P applied to a hand or foot

Balanced traction

Composed of two opposing forces that are separated by a raised structure e.g. elevated bed to balance the forces.

Weights hung from cords that pass over pulleys in the edges of the bed then are attached to the patient's limb.

The opposing force is called counter- traction and is equal to that of traction but pulls in the opposite direction.

Counter-traction is provided by pt’s own body weight and raised foot of the bed so that the weight of the body counteracts pull on the limb.

Advantages of Balanced traction
Allows pt to move freely in bed without interfering with fracture site thus reducing complications of immobility

Precautions
Pulleys should run smoothly without any interference
Cords should be in a straight line without nodes
The weights should hang freely
Bed elevators should never be removed even for a few seconds

Types of balanced traction

Skin traction

The traction is applied to the skin from which the force is transmitted to the muscles then to the bones.

A special type of strapping is used.

Skin does not tolerate large weights hence 2.7 – 3.6 kgs used

Indications

Patients with arthritis
Fractures of lower limbs
Dislocation of the spine

Cervical skin traction

Relieves muscle spasms and compression in the upper extremities and neck.
Uses a head halter and a chin pad to attach to the traction

The head of the bed is elevated at 30- 40 degrees and weights are attached to a pulley system over the head of the bed.

Use powder to protect the ears

Buck’s skin traction

This is a longitudinal skin traction applied to one or both limbs

Buck's skin traction is widely used in the lower limb for femoral fractures, lower backache, acetabular and hip fractures. Skin traction rarely reduces a fracture, but reduces pain and maintains length in fractures.

Method

The skin is prepared and shaved -it must be dry. Friar's balsam may be used to improve adhesion. The commercially available strapping is applied to the skin and wound on with an overlapping layer of bandage.

The bandage should not extend above the level of the fracture.

Gallows Traction

This is used in infants and children with femoral fractures.

Indications Gallows Traction

• The child must weigh less than 12 kg
• 
  
• Femoral fractures
• 
  
• Skin must be intact

Both the fractured and the well femur are placed in skin traction and the infant is suspended by these from a special frame.

Vascular compromise is the biggest danger.

The buttocks should be just off the bed

Pelvic skin traction

Used to relieve low back, hip & leg pain

Traction is applied over the pelvis, iliac crest, and weights are attached.

Russell´s traction

The horizontal pulling force applied to the lower leg

Used to manage fracture of the tibial plateau

Supports the flexed knee in a sling

Dangers of Skin Traction

Avoid complications resist the temptation of trying to improve adhesion by wrapping the bandages more tightly.

• Distal Oedema
• 
  
• Vascular obstruction
• 
  
• Peroneal nerve palsy
• 
  
• Skin Necrosis over bony prominence's

Types of balanced traction

Skeletal traction

Traction applied directly to skeletal structure or bone using pins, wires, or tongs

Indications

When continuous force is needed

When heavier weights are required to overcome traction e.g.11-18kgs

Types
1. Balanced skeletal traction
2. Overhead arm traction
3. Skull traction –used in spinal cord injuries
4. Cervical traction with tongsBalanced skeletal traction

Balanced skeletal traction

 Indication

Treatment of long bone and cervical spine fractures

Pin placement is done under G/A or L/A and parental analgesia using aseptic technique.

Prepare patient for insertion to allay anxiety, ensure pt.'s comfort and cooperation

A pull is exerted directly on the bones by means of Steinman's pin, Kirchner wire or Denham’s pin then balance suspension is applied such that the limb is supported off the bed by ropes, pulleys, and heights.

Skeletal traction

Thomas splint with Pearson attachment used to suspend the leg in fractures of the femur.

A Thomas splint is applied in femur fractures in adults. Three flannel slings are secured by safety pins under the thigh.

The "Master splint" is the one under the fracture. The correct tension on this sling will align the fracture in the lateral plane. The knee can be flexed by using a Pearson flexion splint attached to the Thomas splint at the knee. The desired knee flexion can be maintained by a rope at its end leading from the Thomas splint to the Pearson attachment.

Ropes from the Denham pin can either be tied distally to the Thomas splint or they can be led over a pulley on the end of the The Balkan frame.

In either case, start with 7 kg ( or 10% body weight) in the long axis of the femur. This opposes the pull of the thigh muscles.

As with the child, the traction is made balanced by a system of pulleys on the horizontal limb of the Balkan frame to allow the patient to move his limb.

Traction is continuous once applied

It May take 3-4 months

Advantages

Permits pt to move easily and comfortably in bed

Enables the patient to lift himself off the bed for skincare, bedpan use without discomfort or motion at the fracture site.

References

Orthopedics at a glance ,Department of Orthopaedic Surgery - University Stellenbosch, South Africa