Topic: Traction By: Mr Murdin b Amit Lecturer cum CoordinatorDiploma In Medical Assistant Program Faculty of Allied Health ScienceUniversity College Shahputra, Kuantan Pahang
Learning objectives: 1. Define traction.2. State the purpose and indications of traction3. State the type of traction4. Describe the application of traction procedure5. Explain the attention that needs to be done afterthe application of traction (circulation / effectivenessof traction)6. Describe the advice that should be given topatients after applications of traction
IntroductionTraction is one of the methods used in thetreatment of fractures. Where, a pulling isused for fighting natural tension or muscletissue that surrounds the broken bone.A high force apply by using weights, ropesor pulleys needed to ensure that the brokenbone is in the right position (right) as theoriginal in the early stages of healing.Example, fracture of femur bone.
The purpose of traction:1. Reduction - To maintain the position of thebones are in a real position to preventdislocation or defect.2. Correct small defects3. Reduce / relieve pain4. Ensure immobilization of infections thatcan impair the bone joints5. Prevent broken bones and joints frombeing deformed6. Control the movement of the injured leg7. To reduced muscle spasm
METHODS IN TRACTION1. Skin traction2. Skeleton traction
1. SKIN TRACTION- is a pulling with a supporter who affixed directly to the skin in the area of fracture involved- It is intended to draw a broken bone without makingthe skin incision. But it involves the soft tissues beneaththe skin are involved. Thus if we impose excessive pull itwill damage or cause disruption in other tissues.- The maximum weight that is commonly used is notmore than 95 1bs (6.7kg) in accordance with conditions- Through this fact we are able to say, that skin traction ismore suitable for use in children or as a temporaryprocedure in adult patients while waiting for the propertreatment
• How to use / use skin traction a. Area for installation splint b. Installation of felt strip c. The area has been fitted with splint d. Bandaged splint used to hold back from moving
Contra indications in the use of skintraction1. Patients may lose skin burns or getsnecessitates abrasive / flails2. There are a lot of cuts or wounds in3. There is a disturbance in bloodcirculation such as varicose vein organgren4. Patients have dermatitis
Complications skin traction1. Erythema2. Allergic3. Muscular atrophy4. Paralysis5. Foot drop6. Pressure afternoon7. Edema8. Cause skin in the affected area burst(excoriation) or torn
Skin traction purposes1. Reduction - fracture, dislocation, andmaintaining the alignment2. Reduced muscular spasm3. Relieve pain4. Rectify, reduce or prevent deformity5. Maintaining Immobilization (swelling,pain, arthritis, and inflammation)6. Correct defects
2. Skeletal TRACTION- It is pull and involving bone as a supporter; where a pinor wire implanted in the bone, and serves as a tool to pull- When this pin or wire through the bone, it looks verypainful but otherwise it is more comfortable whencompared with using skin traction- It also member greater traction and precision to placefracturing- It is commonly used in fracturing lower limb, upper limband a common place for tight pin or wire is like calcaneumbone, tibia bone, skull, pelvic bone, and a few other places- Pin type that is commonly used is the Steinman pin, andThreaded pin- The most commonly used type of wire is wire Kirschner
Complications skeletal traction1. Infection were2. Mal union3. Deformities4. If the pin walked or wire can cause:a. As a result of the injury to the pin on the side inhappinessb. Movements become difficultc. Difficult to install splintd. Attraction may not equal5. To attract the fracture requires quite a lot ofweights6. Ligament will be damaged7. Can cause pressure sores
USE COMMON TYPE TRACTION1. FIXED TRACTIONa. The principle used is that every appealmade in this way does not require anyweights, but instead it against the patientsbody found onb. There are two ways that can be used withthis type of Pull, namely: -i. Fixed traction with splintii. Fixed traction that changed the gravity
Fixed traction with splint - It is a simple method of attraction, which involved members placed over splint, usually using Thomas Splint - The force produced pulling, not supported by the weight, but otherwise produced by binding traction splint ends at the end of the patient bed and raise a little foot patient bed - This attraction will be changed from week to week based on the impression produced by the x- ray by way of further shortening the bond at the end of the patient bed
Fixed traction using gravity The basic principle used in this way is to uphold and suspend the limb involved. It is called the Gallows traction, which is usually done on children under the age of 3 years. It can be used for femur fracture and the child would be in this position for 2 to 3 weeks according to the fracture and age
• 2. Sliding OR BALANCED TRACTION - Pull used in this method is assisted by weight, where the weight against the weight of the patients had imposed upon him; however, the amount of weight used is equal to the weight of the patient. - Pull this type can be used for any type of fracture and principles used usually is the same. - Pull the privilege of use is easier to move patients and allow movement of bed involved when converting Pull into a desired position
Traction sliding type commonly used are: a. Simple traction i. Pull this kind are usually followed by the method of skin traction ii. It can be used in any situation iii. It is more appropriate and effective to fracture at the waist and covers the portion of the spine. Examples of such patients get prolapsed inter vertebral disc (PID).
b. Longitudinal tractioni. commonly used for fracture femurii. It is used in conjunction Thomas Splintwhich acts as a fixed tractioniii. Pull the used is skeletal tractionmethod, where the pins to be mounted onthe tibia bone and feet act as a supporterof Thomas Splint
c. Bohler-Braun Traction (BBT)i. Pull used with this type usually used fortibia fracture and thighsii. The legs supported in a straight line onthe sling is tensioned across a frame
d. Hamilton - Russell Traction (HRT)i. Pull this type usually used for femur fracture, involving the buttocks andlower limbsii. Can be used for both sides of the fracture or one leg onlyiii. It is usually used in conjunction with a skin extensioniv. Pull in, it uses 4 seed pulley. Where the only piece of this pulley isplaced at the top and vertical tubercle on the tibia bone.v. Two other seeds were placed at the foot of installed crossed patient bed.Meanwhile, another piece pulley mounted at the foot of a patient who wastied with skin tractionvi. Ropes of swings located at the knee would pass pulley at the top and thenext is wheel - pulley on the feet bed patients.vii. When the Pull is, the cradle of the patient in question would lift theknee forward.
e. Bryant tractioni. Used in the treatment of femur fracture onchildren under 6 years oldii. Commonly used where it involvesfracturing on both sides of theiii. To determine the position of the child isalways stable, a special jacket fitted over thechild and fastened to a frame (Brad FordFrame), where children will be lying on thisframe until healed.
f. Dunlop tractioni. Methods used for fracturing treatmentinvolving clavicle bone, the supracondylarfracture, humerus bone and the head orneck of the humerus bone.
g. Pelvic tractioni. Lumber used in the treatment ofprolapsed inter vertebral disc (PLIVD)ii. Where, kidney patients will be pairedwith a wide belt made of cloth or leatherknaves, and it must be installed tightly.
h. Skull tractioni. Used in clavicle fractures due to bone or clavicleslipped from its original position.ii. Available in two ways, namely by using tongsor Vinke Crutchfield tongsi. Pelvic slingi. Used in pelvic fracture is not severe, as there is adistance in the pubic or ischial hemp
Factors to determining Pull Weighting1. Place fracturing2. Age - old, young, children3. Weight4. Patients muscle strength5. Breadth of patient muscle injury6. Heavy weight 10% of the patients body weight7. If necessary, add weight - total is 0.46kg (1lb) to2.5cm (1 inch) height of the edge of the bed waselevated8. Traction on skull 7 to 12 kg
• Special care to Pull skeletal: Pull the skull - Allow a small sand bag under the neck - Pull the tool and check the entry pin to detect any signs of infection such as - Redness and discharge - Tighten the tools pull is loose - Make sure the patient is not interested in a bed or pulled down on the bed by the weight
• Pull the skeletal - Installed on as fumer fracture, humerus, tibia, fibula and cervical spine - Practice aseptic technique during the installation pin or wire and during dressing place a pin or wire entry - Make sure the weight is 7 -12 kg
Pull the skin - Do the custody of the Pull skin if installed together with Pull skeletal - Do the custody of the pin or wire - Observation of color discharge, wound dressing situation-always close with dry dressing or have the spray - Value-odor, signs of infection and present crust place pin entry - Avoid pressure sores place in ischial tuberositi, popliteal space,
• Achilles tendon and heel - Maintain position foot - plantar dorsi, spin in, spin out, to support the footprint and flexible movement Patients - Care to do the following: - o mental state o physiotherapy o nutrition and fluids o hygiene
• Management - Physiotherapy, muscle atrophy, DVT - Care of skin-pressure pm - A wound care - Care of bowel-aperients - Diet - Medications