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TRACTION - this is the act of pulling and drawing which is associated with counter traction PURPOSES: - For immobilization - For support - To prevent and correct deformity - To maintain good alignment - To reduce pain and muscle spasm - To reduce fracture PRINCIPLES: - Patient should be in dorsal recumbent position. - There must be a counter traction (patients weight serves as the counter traction). - It should be continuous. - Line of pull should be in line with the deformity. - It should be free from any friction. HOW TO CHECK AVOIDANCE OF FRICTION W Weights should be hanging freely O Observe for the wear and tear of the bags and cords R Rope should run along the groove of the pulley K Knots should be away from the pulley NURSING CARE OF PATIENTS WITH TRACTION Assessment - Assess the patient as to level of understanding, consciousness. Potential complication Upper respiratory - PNEUMONIA Bronchial tapping and deep breathing. - Bedsore Good perineal care, proper skin care turning left buttocks once in a while. - Urinary and kidney problem

good perineal care, increase fluid intake. Bowel complication fear of apparatus, no privacy, lack of fluids, perineal care. Pin site infection observe for S/S of infection, loosening pin tract, pus coming out, foul smelling, fever. aseptic technique and proper referral to DIC. Deformity contracted knee, atrophy of muscles, foot drop, joint contractures. Provision of Exercises ROM exercise with the use of trapeze Deep breathing exercises Static quadriceps exercises, alternate contractions and relaxation of quadriceps muscles. Toes pedal exercises.

MANUAL TRACTION PURPOSES: - It is a temporary measure sometimes employed in handling neck injury when there is fracture of the cervical spine. - It is used to apply the necessary pull to an extremity when cast is being applied. SKIN TRACTION - pulling force is applied to the skin and is transmitted to the muscle, then to the bones. TYPES: ADHESIVE TYPE this is made of adhesive type materials like elastic bandage EXAMPLES: - Bryant Traction - Dunlop Traction - Bucks Extension Traction

NON- ADHESIVE TYPE this is made up of canvas, slings, leather straps with buckles and laces. EXAMPLES:

Head Halter Traction Hammock Suspension Traction Pelvic Traction Anklet Traction

A. Adhesive use of adhesive, elastic bandage, spreader 1. Bucks Extension Traction Affection of the hip and femur 2. Bryant Traction Affection of hip and femur for children below three (3) years of age 3. Dunlop Traction Affection of supracondylar of the humerus 4. O Traction For affection of surgical neck of humerus B. Non Adhesive use of canvass, slings , straps with buckles and laces 1. Hammock Suspension Affection of the pelvis (malgained) 2. Head halter Cervical spine affection 3. Pelvic Traction Lumbo sacral spine affection and Herniated Nucleus Pulposus (HNP) 4. Cotrel Traction Combination of head halter traction and pelvic traction for scoliosis 5. Anklet Traction

Affection of lumbar spine, hip and femur 6. Stove-in Traction For massive rib fracture 7. Boot cast Traction For post polio with residual paralysis hip and knee contracture III. SKELETAL TRACTION a pulling force is applied directly to the bones with the use of wires, pins and tongs EXAMPLES OF SKELETAL TRACTION Hardware/Traction 1. Crutchfield tong Inserted at the parietal area, for affection of the upper dorsal cervical spine 2. Vinkes skull retractor Inserted the temporo-parietal area, for affection of the cervical spine 3. Kirschners wire Thinner than steinmanns pin, for affection of the radius, ulna 4. Steinmanns Pin Affection of the humerus, femur, tibia, fibula 5. Halo-pelvic traction For C-type scoliosis 6. Halo-femoral traction For S-type scoliosis 7. Balance Skeletal traction For affection of the hips and or femur 8. Overhead Traction For supracondylar fracture of the humerus 9. 90 90 traction Subtrochanteric and fracture of proximal 3rd of femur CAST This is a temporary immobilization device made of gypsum sulphate rendered anhydrous which when mixed with water, swells and form into a hard cement. FUNCTIONS OF CAST - For immobilization - To correct or prevent a deformity

To support, maintain, and protect realigned bone To promote healing and early weight-bearing To obtain a mold of a limb to serve as a model in making artificial limb

PRINCIPLES IN APPLICATION OF CAST - Apply padding first before applying cast - Apply cast by including the joint above and the joint below the affectation - Apply cast in circular motion and smoothen with the palm - Support with the palm CONTRAINDICATIONS - Pregnancy - Skin Disease NURSING RESPONSIBILTY IN CARING PATIENT WITH CAST - Psychological support - Reassure patient about feeling of warmth as a normal sensation - Encourage muscle exercises - Keep the edges up the cast clean and dry - Protect the cast from injury - Consider diet - Observe for signs of infection - Do Neuro vascular check/blanching sign check o color cyanosis o motion pain o temperature coldness, edema o sensation numbness on toes and fingers EXAMPLES OF THE CAST I. CAST IN THE TRUNK AREA 1. Collar cast Affection of the cervical spine 2. Minerva cast

Affection of upper thoracic and cervical spine 3. Rizzers Jacket Affection of thoraco-lumbar spine 4. Body cast Affection of lower thoracic and upper lumbar spine II. CAST IN THE UPPER EXTREMITY 1. Short arm circular cast Affection of wrist and fingers 2. Long arm circular cast Affection of radius and ulna 3. Munsters / Fuensters cast Affection of radius and ulna with callus formation 4. Hanging cast Affection of shaft of the humerus and the shoulder joint 5. Functional cast Affection of the shaft of the humerus and the shoulder joint which allows flexion and extension of the humerus with callus formation 6. Shoulder Spica cast Affection of the upper portion of the humerus and shoulder joint 7. Abduction Splint/Airplane Affection of the neck of the humerus 8. Sugar tong Affection of the upper portion of the humerus and shoulder joint with swelling or infection 9. Airplane cast For recurrent shoulder dislocation CAST IN THE LOWER EXTREMITY 1. Short leg circular cast Affection of ankle and toes 2. Long leg circular cast Affection of tibia-fibula 3. Walking cast Affection of ankle and toes with callus formation 4. Cylinder cast Affection of the patella 5. Pantalon cast III.

Affection of the pelvis 6. Patellar Tendon Bearing cast Affection of tibia-fibula with callus formation 7. Delvit cast Affection of distal 3rd of tibia with callus formulation 8. Quadrilateral cast/ Ischial weightbearing cast Affection of shaft of femur with callus formation 9. Cast Brace Affection of distal 3rd of femur and proximal 3rd of tibia which allows flexion and extension of lower extremity 10. Basket cast For massive bone injury, to facilitate dressing of wound 11. Frog cast For congenital hip dislocation 12. Night splint For post-polio with contractures of hip and knee; applied at HS 13. Internal Rotator Splint For post hip surgery, to maintain knee abduction 14. Single hip spica Affection of hip and one femur 15. 11/2 hip spica Affection of both hips and one femur 16. Double hip spica Affection of both hips and two femur BRACE This is a mechanical support used for weakened muscles, joints, and bones for rehabilitation FUNCTIONS - For immobilization - To control on voluntary movements - For support - Permit patients to walk without fatigue - Prevent and correct deformity - Maintain body alignment

EXAMPLES 1. Shuntz collar Cervical spine affection 2. Philadelphia collar For cervical spine injury but softer than shuntz collar 3. Forester brace Cervico-thoraco-lumbar spine 4. Four-poster brace Cervical spine affection 5. Milwaukee brace For scoliosis 6. Knight Taylor brace Upper thoracic affection 7. Jewett brace Lower thoracic affection 8. Chair-back brace Lumbar spine affection; lumbo-sacral spine and HNP 9. Cock-up splint For wrist drop 10. Banjo splint For peripheral nerve injury 11. Bilateral long leg brace For clubfoot, for post polio with residual paralysis 12. Unilateral Short leg brace For clubfoot, for post polio with residual paralysis 13. Dennis browne shoe For congenital clubfoot (talipes equinovarus) 14. Oppen Heimer For radial nerve injury 15. Yamamoto For scoliosis 16. SOMI brace Sterno- Occipito- Mandibular Immobilizer