DEFINITION OF TERMS: 1. Counter traction - pulling force equal and opposite the traction weights.

Usually the patients body weight and bed position adjustment.

2. Fixator - metallic plate or screw placed on the bone to provide support. It fixes the origin of prime movers so that the muscle acts in an exerted at the insertion
3. Traction - is the application of a pulling force, used to stretch soft tissue and to separate join surfaces on bone fragments . It involves applying as a force of sufficient magnitude and duration while simultaneous resisting movement of the body 4. Trapeze - an overhead patient helping device to promote mobility in bed. A triangular device hung from the ceiling or from a bar over the bed which can be adjusted to the patients reach. Patient should be assisted upon changing positions or sitting.

PURPOSE: used primarily as a short term intervention until other modalities such as external or internal fixator are possible reducing the risk of disuse syndrome to relieve pain reduce, align and immobilize fractures, to reduce deformities and to increase space between opposing surfaces to maintain proper alignment until bone develops

INDICATIONS: to reduce fractures the application of traction overcomes the injured limbs tendency to shorten ( due to muscle spasm) and holds the limb constantly in a position of corrective extension with the ends of the fractured bone aligned immobilization of an area before surgery control and relieve of painful muscle spasm stretching adhesions

 degenerative joint disease

relief from general, vague back pain treatment of painful arthritis, sore muscles and ligaments, dislocations, degenerated or ruptured intervertebral disks and spinal cord compression

CONTRAINDICATIONS: Patients with structural diseases secondary to tumor or infection, rheumatoid arthritis and severe vascular compromise Acute strains, sprains and inflammation conditions Malignancy aneurysm

1. SKIN TRACTION - in skin traction, the pull is applied to the client's skin which transmitted the pull to the musculoskeletal structures. A belt, head halter, foam rubber wrapped with an elastic bandage, or a foam boot is applied to the client's skin before the appendage is attached to traction.

 a. Pelvic Traction

 used in pelvic fractures to support separated bones. This traction may be applied by either a belt or a sling. The pelvic belt causes downward pull on the pelvis, while the pelvic sling supports the pelvis off the bed. With a pelvic belt, the upper rim of the belt should rest at the top of the iliac crest and not around the abdomen. This type of traction is a running traction that is used to reduced muscle spasm of the lower back, relieve sciatica, immobilize a fractured pelvis, or correct lateral deviations of the spine. It is usually applied intermittently, on 2 hours, off 2 hours, while the client is awake. Weights on the traction are increased gradually. Never remove or changed the weights on any traction device without a physician's order.

Care for patients with pelvic traction:

1. 2. 3. 4. 5. 6. Ensure that the pelvic girdle is properly size for patient Ensure that pelvic girdle fits snugly over iliac crests and pelvis Inspect skin areas over iliac crests for pressure points q4h Provide perineal area hygiene after bedpan use Ensure integrity by providing back care q4h Maintain sling placement beneath lower back with buttocks elevated from mattress. Replace soiled sling. 7. Lift and turn patients use of trapeze if it alters compressive forces on pelvis 8. Maintain bed in flat position 9. Change bed linen from head to foot rather than from side to side

 is a running skin traction that can be used temporarily to immobilize a fracture of the hip/femur until it is possible to do surgery. It can also be used to relieve muscle spasms in the lower back, to prevent contracture after computation, or to realign the vertebrae in a client with scoliosis.
the leg is wrapped with an elastic roller bandage or tape. Traction is applied through a weight attached to a spreader bar below the foot. A foam boot may also be used. The traction pull is toward the pulley at the bottom of the bed.

Care of patients with Bucks Traction:

Ensure skin integrity by avoiding pressure on heel, dorsum or foot, fibular head, or malleolus Maintain counteraction by elevating foot of bed or keeping head of bed flat Encourage independence with use of trapeze

Care of patients with Russells Traction:

1. Assure skin integrity by avoiding pressure on heel, dorsum of foot, fibular head, or malleolus 2. Maintain counteraction by elevating foot of bed or keeping head of bed flat 3. Encourage independence with use of trapeze 4. Ensure sling is smooth and does not apply undue pressure on popliteal space or peroneal nerve or lateral aspect of knee

Care for patients with Bryants Traction:

1. Raise buttocks slightly from mattress 2. Observe bandages carefully for slippage and bunching over heel cords 3. Observe for skin sloughing on both legs 4. Check feet for color, pulses, warmth, and sensation q2h to q4h 5. Use harness restraint to prevent turning over 6. Avoid thick, wide diapers between legs

7. Used in children younger than 3 years, weighing less than 30lb 8. Apply bilaterally with hips with hips flexed 45 degrees and legs in extension

9. Ensure skin integrity with nonadhesive straps and wraps that do not impair neurovascular status
10. Ensure buttocks are elevated 1 to 2in. from mattress 11. Ensure parents understanding of the purpose and use of traction 12. Utilize jacket or vest restraint to prevent child from rotating in the bed

2.SKELETAL TRACTION
-is a applied directly to the bone with wires or pins that are inserted during surgery.

Care of patients with Skeletal Traction:

Cover ends of pin with cork Observe site of insertion Redness Swelling Discharge Odor Bleeding Clean skin around puncture sites as ordered

 TYPES OF FIXATOR
E X T E R N A L F IX A T O R

 -is the device is used to manage complex fractures that associated with soft tissue damage or with open wounds in the fractures area. A physician inserts multiple pins that protrude through the clients of skin into the bone fragments. The external fixation device is a metal frame that, on the outside of the body, holds the pins in place and maintains immobilization. The picture shown is an example of external fixator being used in the treatment of a fractured radius bone.

IN T E R N A L F IX A T O R

 Internal fixation is done through open reduction, the surgeon places a pin, wire, screw, plate, nail or rod into or onto the bone to keep it reduced (properly aligned), immobilized, or both. This procedure is called open reduction, internal fixation (ORIF) and is the treatment of choice for certain fractures in which casting is generally impossible (hip fracture). Internal fixation can be performed using various devices. It is most frequently with fractures of the legs long bones, in which case the spike is called intermedullary nail