Skin Traction types plus nursing care plan

1. SKIN TRACTION
Prepared by: Jacqueline Bacayo; RN
Jayson Teruel; RN

2. Definition
• 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).

3. 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
damage.

4. 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.

5. SKIN TRACTION

6. Skin Traction
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)

7. Buck’s Traction or Extension
 Used in temporary
management of
fractures of
 Femoral neck
 Femoral shaft in older children
 Undisplaced fractures of the
acetabulum
 After reduction of a hip
dislocation
 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-
made boot
 Not more than 4.5 kgs
 Not used to obtain or
hold reduction

8. Hamilton Russell Traction
 Buck’s with sling
 May be used in more
distal femur fracture in
children
 Can be modified to hip
and knee exerciser

9. Bryant’s Traction
 Useful for treatment of
femoral shaft fracture in
infant or small child
 Combines gallows
traction and Buck’s
traction
 Raise mattress for
counter traction
 Rarely used currently

10. Forearm Skin Traction
 Adhesive strip with Ace
wrap
 Useful for elevation in
any injury
 Can treat difficult
clavicle fractures with
excellent cosmetic
result
 Risk is skin loss

11. Double Skin Traction
 Used for greater
tuberosity or proximal
humeral shaft fracture
 Arm abducted 30
degrees
 Elbow flexed 90
degrees
 Risk of ischemia at
antecubital fossa a

12. Dunlop’s Traction
 Used for supracondylar
and transcondylar
fractures in children
 Used when closed
reduction difficult or
traumatic
 Forearm skin traction with
weight on upper arm
 Elbow flexed at 45
degrees

13. Finger traps
 Used for distal forearm
reductions
 Changing fingers
imparts radial/ulnar
angulation
 Can get skin
loss/necrosis
 Recommend no more
than 20 minutes

14. Head Halter traction
 Simple type cervical
traction
 Management of neck
pain
 Weight should not
exceed 2.3 kg
 Can only be used a few
hours at a time

15. Contraindications
 Abrasions and lacerations of skin in the area to which
traction is to be applied
 Impairment of circulation - Varicose veins, impending
gangrene
 Dermatitis
 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

16. Complications
 Allergic reactions to adhesive
 Excortication of skin
 Pressure sores around the malleoli and over the tendo
calcaneus
 Common peroneal nerve palsy

17. Action/Responsibility
Action
Knowledge Deficit.
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.
Pain Management.
Assess the patient’s level of
pain and administer analgesia
as prescribed.
Explain that traction
decreases muscle spasms and
will gradually help lessen pain.
Rationale.
· 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
Trauma.

18. Eliminate additional sources
of pain by providing comfort
measures.
Assess for correct positioning
of traction and alignment of
affected extremity.
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
position changes.
-Incorrect positioning and
malalignment can be sources of
pain.
· Frequent repositioning is
required to alleviate pressure
pain and discomfort. A thorough
skin assessment should be
carried out each time the
patient is repositioned.

19. 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
dry.
Assess for fecal or urinary
incontinence, clean and dry skin
daily.
-These measures help to
minimize the risk of
complications of skin
breakdown.
· 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
breakdown.

20. Impaired Physical Mobility.
Instruct in the use of assistance devices
i.e. Monkey pole.
Teach strengthening exercises
to affected limb and other limbs
as appropriate.
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.

21. High risk of injury.
Traction Device:
-Keep weights hanging freely, tighten
all traction equipment and secure all
knots.
-Cords should be checked daily for
fraying, particularly where they pass
over pulleys.
-Monitor the patient for signs and
symptoms of neurovascular
compromise, comparing findings to
the unaffected limb.
a) Check for diminished or absent
pedal pulses.
b) Check for capillary refill time >3
seconds.
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
perfusion.

22. c) Observe for pallor, blanching,
cyanosis and coolness of
extremity.
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
Compartment Syndrome.)
- These signs may indicate
compromised circulation.
- 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
permanent motor/sensory
damage.

23. Risk for Deep venous thrombosis/Pulmonary
embolus.
- Ensure anti-embolic stockings are fitted on both
limbs.
- 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.
Pulmonary Embolus.
Dyspnea, Chest pain, Tachycardia, Hemoptysis,
Cyanosis, Anxiety, Pyrexia of unknown origin.
Give anti-coagulant
i.e.Clexane s/c Daily
Elastic stockings have been
shown to reduce the risk of
D.V.T. by about 25%
(Todd&Sitzman 1998).
Compression stockings must be
used correctly, otherwise they
may become a cause rather than
a deterrent of D.V.T. (Evans,
1991).
· Early detection and treatment.
-To prevent complications of deep
venous thrombosis or pulmonary
embolus.

24. References
Apley, A.G., Solomon, L. (1993) Apley’s System of
Orthopaedics and Fractures. 7th
Edition.Butterworth Heinemann.
Black, Matassarin, Jacobs (1993). An Introduction
to Orthopaedic
Nursing 2nd Edition. Naon Productions
Davis, P.S. (1996) Nursing the Orthopaedic
Patient. Churchill
Livingstone.
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
Publication
Philadelphia Lippincott.

25. THANK YOU
and
HAVE A NICE DAY