is the use of a pulling

n
force to treat muscle and
skeleton disorders.
Purpose
 Traction is usually applied to the arms
and legs, the neck, the backbone, or the
pelvis. It is used to treat fractures,
dislocations, and long-duration muscle
spasms, and to prevent or correct 
deformities. Traction can either be
short-term, as at an accident scene, or
long-term, when it is used in a hospital
setting.
Traction serves several purposes:
 it aligns the ends of a fracture by

pulling the limb into a straight

position
 it ends muscle spasm
 it relieves pain
 it takes the pressure off the bone

ends by relaxing the muscle

 There are two main types of traction:
skin traction and
skeletal traction.

Within these types, many specialized forms of traction

have been developed to address problems in particular
parts of the body. The application of traction is an exacting
technique that requires training and experience, since
incorrectly applied traction can cause harm.
 Positioning the extremity so that the angle
of pull brings the ends of the fracture
together is essential. Elaborate methods of
weights, counterweights, and pulleys have
been developed to provide the appropriate
force while keeping the bones aligned and
preventing muscle spasm.
The patient's age, weight, and medical
condition are all taken into account when
deciding on the type and degree of traction.
 
 Other forms of skeletal traction are
tibia pin traction, for fractures of the
pelvis, hip, or femur; and overhead
arm traction, used in certain upper
arm fractures. Cervical traction is
used when the neck vertebrae are
fractured.
For tibial traction, a pin is surgically placed in the lower leg (A). The pin is
attached to a stirrup (B), and weighted (C). In cervical traction, an incision is
made into the head (D). Holes are drilled into the skull, and a halo or tongs
are applied (E). Weights are added to pull the spine into place (F). (
Precautions
 People who are suffering from skin disorders
 or who are allergic to tape should not undergo
skin traction, because the application of
traction will aggravate their condition.
Likewise, circulatory disorders or 
varicose veins can be aggravated by skin
traction. People with an inflammation of the
bone (osteomyelitis) should not undergo
skeletal traction.
Skin traction

Skin traction uses five- to seven-pound

weights attached to the skin to indirectly apply
the necessary pulling force on the bone. If
traction is temporary, or if only a light or
discontinuous force is needed, then skin
traction is the preferred treatment. Because the
procedure is not invasive, it is usually
performed in a hospital bed.
 Weights are attached either through
adhesive or non-adhesive tape, or with straps,
boots, or cuffs. Care must be taken to keep the
straps or tape loose enough to prevent swelling
and allow good circulation to the part of the
limb beyond the spot where the traction is
applied. The amount of weight that can be
applied through skin traction is limited
because excessive weight will irritate the skin
and cause it to slough off.
 Specialized forms of skin traction have been
developed to address specific problems. Dunlop's
traction is used on children with certain fractures of
the upper arm, when the arm must be kept in a flexed
position to prevent problems with the circulation and
nerves around the elbow. Pelvic traction is applied to
the lower spine, with a belt around the waist. Buck's
skin traction is used to treat knee injuries other than
fractures. The purpose of this traction is to stabilize
the knee and reduce muscle spasm.
Skeletal traction
Skeletal traction is performed when more
pulling force is needed than can be
withstood by skin traction; or when the part
of the body needing traction is positioned
so that skin traction is impossible. Skeletal
traction uses weights of 25-40 pounds.
Skeletal traction requires the placement
of tongs, pins, or screws into the bone so
that the weight is applied directly to the
bone. This is an invasive procedure that is
done in an operating room under general,
regional, or local anesthesia.
 Correct placement of the pins is essential
to the success of the traction. The pin can
be kept in place several months, and must
be kept clean to prevent infection. Once the
hardware is in place, pulleys and weights
are attached to wires to provide the proper
pull and alignment on the affected part.
 Specialized forms of skeletal
traction include cervical traction used
for fractures of the neck vertebrae;
over-head arm traction used for
certain types of upper arm fractures;
and tibia pin traction used for some
fractures of the femur, hip, or pelvis.
 
Preparation
X-rays are done prior to the
application of both forms of
traction, and may be repeated
during treatment to assure
that the affected parts are
staying in alignment and
healing properly.
 Since the insertion of the
anchoring devices in skeletal
traction is a surgical procedure,
standard preoperative blood and 
urine testing are done, and the
patient may meet with an 
anesthesiologist to discuss any
health conditions that might
affect the 
administration of anesthesia.
Traction refers to the usage of a pulling force and special devices,
such as a cast or splint, to treat muscle and skeletal disorders. It is
used to treat fractures, dislocations, and long-duration muscle
spasms, and to prevent or correct deformities. The illustration
above features several commonly used forms of
traction. (Illustration by Electronic Illustrators Group.)
Aftercare
Aftercare for skin traction involves
making sure the limb stays aligned,
and caring for the skin so that it does
not become sore and irritated. The
patient should also be alert to any
swelling or tingling in the limb that
would suggest that the limb has been
wrapped too tightly.
 Aftercare for skeletal traction is more
complex. The patient is likely to be immobile
for an extended period. Deep breathing
exercises are taught so that 
respiratory function is maintained during this
time of little activity. Patients are also
encouraged to do range-of motion exercises
with the unaffected parts of the body. The
patient is taught how to use a trapeze (an
overhead support bar) to shift on and off a
bedpan, since it is not possible to get up to use
the toilet. In serious injuries, traction may be
continued for several months until healing is
complete.
Risks
The main risks associated with skin traction
 are that the traction will be applied incorrectly
and cause harm, or that the skin will become 
irritated. There are more risks associated with
skeletal traction. Bone inflammation may occur
in response to the introduction of 
foreign material into the body.Infection can
occur at the pin sites. If caught early, infection
can be treated with antibiotics, but if severe, it
may require removal of the pin.
 Both types of traction have
complications associated with long 
periods of immobility. These include
the development of bed sores,
reduced respiratory function, 
urinary problems, and circulatory
problems. Occasionally, fractures fail
to heal. Being confined to traction for
a long period can take a an
emotional toll on the patient, also.
Normal results
When correctly applied, traction
generally produces very good, if
slow, results.
 
Different Types Of Skeletal Traction
 1.)Balanced suspension traction
is used to stabilize fractures of the
femur. It can be the skin or skeletal
type. If it is skeletal, a pin or wire is
surgically placed through the distal
end of the femur. If it is skin traction,
tape and wrapping or a traction boot
of the kind described under Buck’s
traction is used.
 The patient is in the supine
position, with the head of the bed
elevated fro comfort. As the name
suggests, the affected leg is
suspended by ropes, pulleys, and
weights in such a way that
traction remains constant, even
when the patient moves the upper
body.
 Two important components of
balanced suspension traction are the
Thomas splint and the Pearson
attachment. The Thomas splint
consists of a ring, often lined with
foam, that circles and supports the
thigh. Two parallel rods are attached
to the splint and extend beyond the
foot. A Pearson attachment consists of
a canvas sling that supports the calf.
 Parallel rods lead from the
pin sites on the distal and of
the attachment for the rope.
Traction to the femur is
applied through a series of
ropes, pulleys, and weights.
These weights hang freely at
the foot off the bed.
 The skin should be inspected frequently to identify
problems early. The ring of the Thomas splint can
excoriate the skin of the groin. Special padding may have
to be used. Again, the foot should always be at a right
angle on the footrest to prevent footdrop. If pins are used
for fixation, aseptic technique must be used around pin
sites until they have healed. From then on, clean
technique can be used. The pin sites are cleansed
carefully with soap and water and rinsed thoroughly,
unless this varies from policy. An antiseptic, such as
povidone-iodine ointment, may then be applied.
Dressings are usually not required. You should, however,
constantly assess for infection at the pin sites. Indications
include redness, heat, drainage, pain, or fever. Review
your facility’s policy on pin care.
2.) Skull Tongs Traction

are used to immobilize the cervical spine in

the treatment of unstable fractures or dislocation
of the cervical spine. Although Crutchfield tongs
were used almost exclusively in the past,
Gardner-Wells skull tongs are in wide use. Some
think these are less likely to pull out than the
Crutchfield tongs. The patient is prepared for
either type with a local anesthetic to the scalp.
The tongs are surgically inserted into the bony
cranium, and a connector half-halo bar is
attached to a hook from which traction can be
applied.
 The patient is supine and is
usually on a special frame instead
of the regular hospital bed. If a
hospital bed is used, two or more
people are required to assist the
patient with any turning
movements. The head of the bed
may be elevated to provide
counter traction.
 Because patients remain in this type
of traction for an extended period,
observe the precautions taken for the
patient in other types of skeletal
traction. Difficulties with the
performance of activities of daily
living, infection at the tong sites, and
restlessness and boredom are
common. It is useful to teach the
patient range-of-motion exercises,
provide good nutrition and suggest
recreational or occupational activities.
3.)Halo Traction
provides stabilization and support for
fractured cervical vertebrae. The surgeon
inserts pins into the skull. A half circle of
metal frame connects the pins around the
front of the head. Vertical frame pieces
extend from a halo section to a frame brace
that rests on the patient’s shoulders. The
halo traction allows the patient to be out of
bed and mobile while stabilizing the cervical
vertebrae could injure the spinal cord.
Specific Types of Traction

1.)Thomas Splint Traction

Hugh Owen Thomas introduced his splint
which he called "The Knee Appliance" in
1875
The method of Hugh Owen Thomas uses
fixed traction with the counter traction
being applied against the perineum by the
ring of the splint
This is in contrast to other methods using
weight traction which is countered by the
weight of the body
2.)Hamilton Russell Traction
Robert Hamilton Russell wrote "Fracture of the femur:
A clinical study" in which he described his traction in
1924
Sling under the distal 1/3 of the thigh provides
upward lift, as well as longitudinal traction in the line
of the tibia
The sling under the distal fragment controls posterior
angulation and the lifting force is related to the main
traction force through the medium of pullies
No rigid splinting is used in this method
Combines a means of suspending the lower extremity
and a means of applying traction in the axis of the
femur
Many other varieties of both skeletal and skin traction
result in a similar effect
3.)Buck Traction
Buck introduced simple
horizontal traction in 1861
Traction is analogous to
Pugh's traction only the
inclination of the bed is
replaced by the application of
weights over a pulley
4.)Bryant's traction
Vertical extension traction was described
by Bryant in 1873 and applied to the
management of femoral fractures
The development of ischemia of the lower
leg through reduced perfusion resulted in
limitation of its application to the short
term management of a fractured femur
A modification of his traction has been
shown to reduce the risk of limb ischemia
and may be applicable where prolonged
traction is required in an infant
5.)Braun Frame
This is merely a cradle for the limb
Disadvantage is that the position of
the pulleys cannot be altered and the
size of the splint often does not fit
the limb as might be wished
Lateral bowing is common as the
splint and the distal fragment are
fixed to the frame, while the patient
and the proximal fragment can move
sideways leaving the frame behind
6.)Perkins Traction
Here no splinting is used at
all
The posterior angulation of
the thigh is controlled by a
pillow 
The alignment and fixation
depend entirely on the action
of continuous traction
7.)Fisk Traction
Hinged version of a Thomas splint is
arranged to allow 90o of knee
movement
It is particularly attractive as it
allows active extension of the knee
joint
Fixation and alignment is dependent
entirely on the weight traction and
the splint merely applies the motive
power for assisted knee movement
8.)90 - 90 Traction
The thigh is suspended in
the vertical plane by weight
traction pulling vertically
upwards
The ill effect of gravity as the
cause of backward angulation
of the fragments is thus
eliminated
9.)Charnley
 Strongly recommends the use of a BK POP incorporating the
Steinmann or Denham pin in the upper end, in order to
reduce pressure on the soft structures around the knee
 Benefits of POP/Traction unit (Charnley) :
 Foot supported at right angles to the tibia
 Common peroneal nerve and calf muscles protected from
pressure against the slings of the splint and the splint itself
 The tibia is suspended from the skeletal pin inside the POP, so
that an air space develops under the tibia as the calf muscles
loose their bulk
 External rotation of the foot and distal fragments is controlled
 The tendo achilles is protected from pressure sores
 Comfort; The patient is unaware of the traction when applied
through the medium of a nail
10.)Upper Limb
A number of skin traction methods have been
described and a number more utilised without
documentation in the literature
Ingerbrightsen's overhead skin traction (A);
Dunlop's side arm skin traction (B); and Graham's
extension skin traction (C) are but a few
Skeletal pin traction can also be utilised :
 Overhead (A)
 Overhead with secondary distal forearm traction
directed cephalad (B)
 Side arm pin traction (C)
 THE END