The Balance Skeletal Traction

The traction is the act of pulling and drawing which is associated with counter traction

INDICATION
to reduce fracture For immobilization For support To reduce pain and muscle spasm To maintain good alignment To prevent and correct deformity

PREPARATION
1. check the doctors order

Patients name
Extremity to be placed on BST Weight to be applied

2. Prepare patient psychologically Introduce yourself Inform patient on what is to be done The purpose of the treatment Expectation from the patient

 3. prepare the bed and equipment needed A. orthopedic bed Firm mattress Fracture board Bed elevator/ shock block

Balkan frame (cross bar, curve bar, vertical, horizontal and diagonal bar)
3pulleys

3clamps
Overhead trapeze

 B. traction equipment
Thomas splint (with half ring) Pearson attachment

Rest splint
Steinmanns pin holder Braun bohler splint

Slings with clips or pins

3sash cords (thigh rope, traction rope, suspension rope)

2weights (traction weight 10% of the patients weight; suspension weight of traction weight)
Foot pedal or foot board

PRINCIPLES
1. patient should be in dorsal recumbent

position 2. there must be counter traction (pt. weight) 3. there must be continous traction 4. the line of the pull should be in line with the deformity (the first pulley is in the line with the inguinal area, the 2nd pulley is in the line with the knee, the 3rd pulley is in the line with the 1st and 2nd pulley

 5. avoid friction There should be no knots near the pulley Cords should be running along the grooves of

the pulley Weights should be hanging freely Observe for the wear and tear of the bags and the cords

APPLICATION
1. measure the distance form the lateral side of the trochanter to the knee by using one of the

cords 2. position the pearsons attachment under the thomas splint according to above measrement screw them together 3. apply the rest splint 4. apply the slings following the principles below A. start from the medial aspect to the thomas splint and fasten at the lateral aspectwith pins (to prevent injury)

 B. apply slings snugly, no too tight (so as not

to impede circulation) nor too loose (w/c defeats the purpose to support) C. the smooth surface of the sling should come in contact with the patient skin (to prevent skin irritation) D. provide approximately an inch space between slings (for ventilation) E. if slings is too long, fanfold it F. number of slings will vary on the size of patinets leg

 G. keep the ankle and the popliteal area free

from slings (these are highly vascular areas) H. the broader and longer of the slings are for the thigh area while the narrower and shorter ones are for the leg area 5. Using a slip knot , tie one end of the thigh rope at the junction of the medial upright of the thomas splint (done before the petients leg is placed on the thomas splint for privacy)

 6. decide on the three manpower A. insert TS and PA correctly without moving the leg inappropriately B. provides continous manual traction and pushes braun bohler splint away from the work area C. supports leg with palm of the hand 7. Instruct the patient on the following: A. hold on the overhead trapeze B. flex the unaffected leg and lift the buttocks C. at the count of 3, swing the body so that we simultaneously transfer the affected leg on the thomas splint

 8. at the count of 3, transfer the affected leg while providing manual traction
9. using a slip knot, tie one end of the

traction cord at the steinmanns pin holder. Pass the cord along the groove of the 3rd pulley, then attach the traction weight bag(10% of the weight of the client) to the other end of the traction cord using any kind of knot. There should be 1foot distance from the pulley to the knot or the bottom part of the bag should be at the level of the bed. Consume the rope

 10. tie the other end of the thigh cord to the lateral aspect of the thomas splint using a slip knot
11. using again a slip knot, tie one end of the

suspension cord to the middle of the thigh cord. Pass the cord along the groove of the 1st pulley, then to the suspension weight bag (1/2 of the weight of the traction weight), temporarily hang the weight bag over the pulley. Then pass the same cord along the groove of the 2nd pulley, down to the other side of the traction cord, then under the rest splint. Tie it over the end of the thomas splint using a clove-hitch knot and another clove-hitch knot at the end of the pearsons attatchment. Consume the rope

 12. release the suspenson weight aand remove the rest splint
13. apply foot pedal using a ribbon knot. The

shorter the cords should be tied at the thomas splint while the longer cords are tied to the pearsons attatchment in between the last and the second to the last sling 14. check for the effeciency of traction by swinging backwards and forward then sideway

HOW TO REMOVE THE TRACTION

1. hang the suspension weight 2. apply the rest splint 3. remove the suspension cord and

suspension weight 4. apply manual traction and remove the traction weight 5. tie the traction rope instead to the rest splint using a single knot, then to the thomas splint and to the pearsons attatchment using the clove-hitch knot

Nursing care
Hygeine and comfort Avoid infection Proper nutrition Prevent pressure sores

Exercise of the unaffected extremity and of affected extremity

Prevent pulmonary problems

Diversional activity
Attend to any complaint of the patient

 Nursing Management