The knee can be flexed by using a Pearson flexion splint attached to the Thomas splint at the knee. The desired knee flexion can be maintained by a rope at its end leading from the Thomas splint to the Pearson attachment.
This opposes the pull of the thigh muscles. As with the child, the traction is made balanced by a system of pulleys on the horizontal limb of the Balkan frame to allow the patient to move his limb. A "monkey chain" hung above the arms also allows the patient to transfer himself onto a bedpan.
The Thomas splint must be aligned by pointing the Balkan frame in the direction of the proximal fragment. Bed Blocks must be placed under the foot end of the bed with all the above types of traction. Raising the foot of the bed a few centimeters provides a counter force to prevent the patient being pulled distally down the bed by the longitudinal traction. Skin Traction - Lower Extremity Buck's skin traction is widely used in the lower limb for femoral fractures, lower backache, acetabular and hip fractures.
Method The skin is prepared and shaved -it must be dry. Skin traction in a Thomas Splint. Slings of flannel mm wide are positioned down the length of the Thomas splint.
The Master sling should be just distal to the fracture, allowing the proximal fragment to reduce under gravity. Site for prox. Thomas Traction -Adult Click to see annotated larger image. When skeletal pins are applied potential complications may occur, this includes cortical defects, which act as stress risers and may predispose to fractures, or pin site infection can develop secondary pin-tract osteomyelitis or septic arthritis if placed intra-articularly [ 22 ].
Hence it is of essential importance to carefully place pins while not causing iatrogenic injury. Pins should be applied transmedullary with the aid of fluoroscopy to prevent transcortical placement reducing risk of fracture.
Pins advanced into the bone using drills should be pulsed with saline to reduce thermonecrotic damage. The pin should not be driven forward and then retracted to prevent early loosening. There is a higher chance of developing pin site infection in some tractions such as femoral traction due to bulky muscle, hence chlorhexidine swabbed gauze or sponge should be placed around the pin site and to have regular monitoring of pin sites to prevent infection. Furthermore, certain tractions require specific rehabilitation to ensure stiffness doesn't develop and to avoid flexion contractures Table 1 Figure 24 [ 16 , 21 ].
Traction is used for immobilisation of limbs and despite recent advances in internal fixation, it remains an important technique for pain relief, keeping long bone fractures reduced and preventing joint contractures.
The skills, however, are often forgotten unless one rehearses them with the same frequency and discipline as one would their routine surgical skills. We hope this provides an aid for the practitioner when the need arises, to guide them in application, planning and decision-making processes when traction is considered. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein.
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Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. National Center for Biotechnology Information , U. Journal List Cureus v. Published online Aug Author information Article notes Copyright and License information Disclaimer. Corresponding author.
Baseem Choudhry ten. Received Jun 5; Accepted Aug This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This article has been cited by other articles in PMC. Abstract The trauma and orthopaedic speciality continues to advance as surgery becomes more accessible and safe.
Keywords: traction, skeletal traction, bryant's traction, thomas splint, halo traction, hamilton-russell traction. Introduction and background Introduction Traction is one of the oldest principal tenets of treatment in orthopaedics. Principles of Traction Tractions' main goals are to control pain from muscle spasm, reduce fractures maintaining anatomical reduction, and to prevent and correct deformity.
Types of Traction 1. Manual: applying the pull manually with the hands 2. Two additional methods for skin and skeletal traction: a Fixed: the pull is between two fixed points. Expected times for treatment Total fracture healing time in weeks is the age of child plus two, early callus formation is one-third of total healing time, and rehabilitation time is two to four weeks [ 3 ]. Knots Knots are used to secure traction cord to the end of the bed or frame. Open in a separate window. Figure 1.
Review Femur Skin Traction Skin traction is the commonest and most popular form of traction used. Figure 2. Skin traction Illustration courtesy E. Figure 3. Figure 4. Hamilton-Russell skin traction Illustration courtesy B. Figure 5. Hamilton-Russell skeletal traction via tibial pin Illustration courtesy B.
Figure 6. Bryant's skin traction Illustration courtesy B. Figure 7. Halter's traction Illustration courtesy E. Figure 8. Application of Gardner-Wells tongs Illustration courtesy E. Figure 9. Gardner-Wells tongs Illustration courtesy E. Figure Finger trap traction Illustration courtesy E.
Dunlop traction Illustration courtesy E. Surface marking for tibial pin P: patella; F: fibula head; O: adductor tubercle; X: pin insertion site Photo courtesy K.
Steps in applying tibial pin Illustration courtesy E. Perkin's traction Illustration courtesy B. Surface marking for distal tibial pin X: Pin insertion site Photo courtesy K.
Distal tibial pin traction Illustration courtesy E. Overhead olecranon pin traction Illustration courtesy E. Metacarpal pin traction Illustration courtesy E. Table 1 Indication, landmarks and danger structures of various skeletal traction. Conclusions Traction is used for immobilisation of limbs and despite recent advances in internal fixation, it remains an important technique for pain relief, keeping long bone fractures reduced and preventing joint contractures.
To address these issues, your healthcare provider may recommend physical therapy as a follow-up to traction. This will help you regain your strength and movement after having spent so much time without movement of parts of your body.
A physical therapist can also show you how to manage any discomfort, weakness, or paralysis you may have experienced because of your fracture or injury. You may also have occupational therapy to help regain your strength and to relearn skills that may have been affected or impaired by your injury.
It's important to stick with any therapies your healthcare provider recommends in order to maximize your chance for a full recovery. Traction can be a very challenging treatment—physically, emotionally, and psychologically because you are severely limited in movement and so undoubtedly feeling quite vulnerable.
This may be compounded by the pain that you have to deal with associated with a bone fracture or dislocation of some part of your body. Your healthcare provider can play a big role in easing your anxiety by fully explaining the procedure, including what you can expect and how long the traction will be necessary.
Communication with the health professionals who care for you during this difficult time can go a long way to assuage your anxiety and help you get through the experience of having traction. Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body.
Click below and just hit send! Encyclopedia of Surgery Traction. Foster K. A brief review of the effects of preoperative skin traction on hip fractures.
Journal of Orthopaedic Nursing. The effect of skin traction on preoperative pain and need for analgesics in patients with intertrochanteric fractures: A randomized clinical trial. Arch Trauma Res. Why are we still using pre-operative skin traction for hip fractures? Int Orthop. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth.
At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification. Skin traction. Skin traction Introduction Aim Definition of terms Management Special Considerations Potential Complications Companion Documents References Evidence Table Introduction Femoral fractures are often managed using skin traction prior to their definitive surgical management.
Aim This clinical practice guideline aims to ensure that the application and management of skin traction is consistent and that potential complications are identified early and managed correctly. Definition of terms Fracture: Any type of break in a bone. Traction: Traction is the application of a pulling force to an injured part of the body or extremity.
Neurovascular observations : Is an assessment of circulation, oxygenation and nerve function of limbs within the body. Compartment syndrome : Increased pressure within one of the bodies compartments which contain muscles and nerves.
Management Acute management Ensure Order for Skin traction is documented by the Orthopaedic Team- including weight to be applied in kgs Preparation of equipment Hospital Traction bed with bar at the end of the bed Traction kit paediatric OR adult size foam stirrup with rope and bandage Overhead traction frame Pulley Traction weight bag Water Sleek Picture 1 - Traction Kit; Picture 2 - Foam stirrup with rope; Picture 3 -Traction weight bag Pain relief A femoral nerve block is the preferred pain management strategy and should be administered in the emergency department prior to being admitted to the ward.
Diazepam and Oxycodone should always be charted and used in conjunction with the femoral nerve block. Distraction and education Explain the procedure to the parents and patient before commencing.
Plan appropriate distraction from play therapy, parents or other nursing staff. Application of traction Ensure the correct amount of water has been added to the traction weight bag as per medical orders. Formula to calculate weight in kgs to come Fold foam stirrup around the heel, ankle and lower leg of affected limb. Apply bandage, starting at the ankle, up the lower leg using a figure 8 technique, secure with sleek tape.
Place rope over the pulley and attach traction weight bag. If necessary trim rope to ensure traction weigh bag is suspended in air and does not sit on the floor. Picture — Foam stirrup and bandage. Encourage the patient to reposition themselves or complete pressure area care four hourly.
Remove the foam stirrup and bandage once per shift, to relieve potential pressure and observe condition patients skin. Keep the sheets dry.
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