• Traction - Is the application of a pulling force to a
part of the body with counter traction a pull in the
opposite direction. More specifically, orthopaedic
traction occurs when “ A pulling force is exerted on
a part or parts of the body”(Davis, 1996).
Purpose of traction
• To reduce a fracture and realign bone fragments
by overcoming muscle spasms.
• To maintain skeletal length and alignment.
• To reduce and treat dislocations.
• To immobilize and to prevent further tissue
Purpose of Traction
• To relieve muscle spasms that occur as a reaction
to musculoskeletal trauma in the absence of a
fracture such as cervical sprain or low back pain.
• To lesson deformities, such as with arthritis.
• To rest a diseased joint.
Is attached directly to the patient’s skin to immobilize a
body part continuously or intermittently over a short or
extended period. The direct application of a pulling
force to the patients skin and soft tissues may be
accomplished by using adhesive or non adhesive
traction tape or other skin traction devices such as a
cast, a boot, a belt or a halter. - (Schoen 2000)
Buck’s Traction or Extension
Used in temporary
Femoral shaft in older children
Undisplaced fractures of the
After reduction of a hip
To correct minor flexed
deformities of the hip or knee
In place of pelvic traction in
management of low back pain
Can use tape or pre-
Not more than 4.5 kgs
Not used to obtain or
Hamilton Russell Traction
Buck’s with sling
May be used in more
distal femur fracture in
Can be modified to hip
and knee exerciser
Useful for treatment of
femoral shaft fracture in
infant or small child
traction and Buck’s
Raise mattress for
Rarely used currently
Forearm Skin Traction
Adhesive strip with Ace
Useful for elevation in
Can treat difficult
clavicle fractures with
Risk is skin loss
Double Skin Traction
Used for greater
tuberosity or proximal
humeral shaft fracture
Arm abducted 30
Elbow flexed 90
Risk of ischemia at
antecubital fossa a
Used for supracondylar
fractures in children
Used when closed
reduction difficult or
Forearm skin traction with
weight on upper arm
Elbow flexed at 45
Used for distal forearm
Can get skin
Recommend no more
than 20 minutes
Head Halter traction
Simple type cervical
Management of neck
Weight should not
exceed 2.3 kg
Can only be used a few
hours at a time
Abrasions and lacerations of skin in the area to which
traction is to be applied
Impairment of circulation - Varicose veins, impending
When there is marked shortening of the bony fragments,
the traction weight required will be more then 6.7 kg which
cannot be applied through the skin
Allergic reactions to adhesive
Excortication of skin
Pressure sores around the malleoli and over the tendo
Common peroneal nerve palsy
Explain the purpose of traction
related to injury and healing
process. Explain the traction
apparatus. For skeletal traction
explain pin insertion and removal
procedures and care of pin-sites.
Maintaining activities of daily living
while in traction.
Assess the patient’s level of
pain and administer analgesia
Explain that traction
decreases muscle spasms and
will gradually help lessen pain.
· Providing information helps
alleviate anxiety and enables the
patient to retain further
information and instructions.
· To monitor the effectiveness of
the prescribed analgesia
· Patient’s treated in traction have
pain due to soft tissue and bone
Eliminate additional sources
of pain by providing comfort
Assess for correct positioning
of traction and alignment of
Risk for Impaired Skin Integrity
The patient’s Waterlow Score is
assessed. Assess skin over bony
prominences (sacrum, trochanters,
scapulae, elbows, heels, inner and
outer malleolus, inner and outer knees
and back of head). Areas
where skin is stretched tautly over bony
prominences are at a greater risk for
breakdown because the possibility of
ischeamia to skin is high due to
compression of skin capillaries between
a hard surface
(mattress, chair,) and the bone.
-Diversionary activities (books, games,
television etc), heat or cold treatments and
-Incorrect positioning and
malalignment can be sources of
· Frequent repositioning is
required to alleviate pressure
pain and discomfort. A thorough
skin assessment should be
carried out each time the
patient is repositioned.
The decision to nurse the
patient on a pressure-relieving
mattress depends on the
nurse’s clinical judgment.
Maintain correct padding for
affected extremity in traction,
keep bed-linen wrinkle free and
Assess for fecal or urinary
incontinence, clean and dry skin
-These measures help to
minimize the risk of
complications of skin
· Pressure areas and skin irritation
can develop under or at the edge
of traction device.
· The urea in urine turns into ammonia
within minutes, and is
caustic to the skin. Feces may
contain enzymes that cause skin
Impaired Physical Mobility.
Instruct in the use of assistance devices
i.e. Monkey pole.
Teach strengthening exercises
to affected limb and other limbs
Encourage activities of selfcare and the
use of the trapeze
if the patient’s arms will allow.
-To promote independence.
-Exercises should be active to
prevent muscle atrophy and joint
stiffness, which occur quickly in
the situation of reduced mobility.
· To promote independence.
High risk of injury.
-Keep weights hanging freely, tighten
all traction equipment and secure all
-Cords should be checked daily for
fraying, particularly where they pass
-Monitor the patient for signs and
symptoms of neurovascular
compromise, comparing findings to
the unaffected limb.
a) Check for diminished or absent
b) Check for capillary refill time >3
The traction system should be checked
thoroughly at least daily and always after
interventions such as physiotherapy and x-ray.
· To maintain a safe environment.
- Careful monitoring enables early detection. The
traction equipment may through increased
pressure on nerves and blood vessels cause
temporary or permanent damage.
-Surgical trauma causes swelling
and oedema, which can compromise circulation
and compress nerves.
- Prolonged capillary refill time
points to diminished capillary
c) Observe for pallor, blanching,
cyanosis and coolness of
d) Check for complaints of
abnormal sensations, e.g.
tingling and numbness.
e) Observe for increased pain not
controlled by medication.
Assess the affected extremity
for signs and symptoms of altered
perfusion of compartment
syndrome. (See guideline on
- These signs may indicate
- These symptoms may result
from nerve compression.
- Tissue and nerve ischemia produces a
deep, throbbing unrelenting pain.
Compartment syndrome results
from severe tissue swelling that
decreases blood flow, causes
ischemia and may cause
Risk for Deep venous thrombosis/Pulmonary
- Ensure anti-embolic stockings are fitted on both
- Continuously assess the patient for signs and
symptoms Of: Deep Venous Thrombosis
* Positive Homan’s Sign ( Forced dorsiflexion of
the foot causing discomfort in the upper calf.)
• Swelling of leg,
• Tenderness in calf.
Dyspnea, Chest pain, Tachycardia, Hemoptysis,
Cyanosis, Anxiety, Pyrexia of unknown origin.
i.e.Clexane s/c Daily
Elastic stockings have been
shown to reduce the risk of
D.V.T. by about 25%
Compression stockings must be
used correctly, otherwise they
may become a cause rather than
a deterrent of D.V.T. (Evans,
· Early detection and treatment.
-To prevent complications of deep
venous thrombosis or pulmonary
Apley, A.G., Solomon, L. (1993) Apley’s System of
Orthopaedics and Fractures. 7th
Black, Matassarin, Jacobs (1993). An Introduction
Nursing 2nd Edition. Naon Productions
Davis, P.S. (1996) Nursing the Orthopaedic
Evans A. (1991) Sensible Stockings. Nursing
Times 87 (51) 40-41.
Todd B.,Sitzman M.D. (1998) Prevention of
Perioperative Deep Vein
Thrombosis and Pulmonary Embolism.
Schoen D.C. (2000). Adult Orthopaedic Nursing.1st