Skin traction is a non-invasive orthopedic technique used to apply a gentle, continuous pulling force to an injured limb through the skin and soft tissues. It’s commonly used for temporary stabilization of fractures, especially in children or before definitive surgical treatment.
Definition
A nonsurgical procedure that makes use of adhesive straps, slings, and halters applied to skin for attachment of weight, to exert indirect pull or traction on underlying structures.
Purposes
- To immobilize a part requiring partial or temporary immobilization.
- To reduce fractures and dislocations in children.
- To reduce fractures in adults temporarily before definitive treatment is given.
- To correct flexion deformities of knee or hip.
- To relieve pressure on nerves, especially spinal nerves.
Articles
A tray containing:
- Adhesive plaster.
- Scissors.
- Measuring tape.
- Spreader.
- Roller bandages.
- Tincture benzoin for skin preparation.
- Cotton swabs.
- Bath sheet.
- Kidney tray.
- Shaving set.
Additional articles
- Traction ropes.
- Cross bars and clamps to fix pulleys.
- Bed blocks and weights.
- Balkan frame with trapeze bar.
- Bed cradle.
- Thomas splint.
Types of traction
| Bryant’s traction | Vertically held type of bilateral traction to the legs. |
| Buck’s extension | Horizontally applied unilateral traction. |
| Contrell’s traction | Skin traction consisting of two separate forms: Head halter and pelvic belt. Occasionally used as a preoperative treatment to help to straighten spinal curvatures before insertion of skeletal rods for correction of scoliosis. |
| Dunlop’s traction | Simultaneous horizontal form of Buck’s extension to the humerus with an accompanying vertical Buck’s extension to the forearm. |
| Head halter | Traction involves a especially shaped halter with cut out areas for the ears, face, and top of the head. |
| Pelvic traction | Traction consisting of a girdle-like belt that fits around the lumbosacral and abdominal areas, fastening in the middle of the abdomen with pressure sensitive straps or buckles. This traction basically serves to keep the patient in bed, thus relieving inflammation and irritation of nerves or muscle. |
| Pelvic sling | Traction consisting of a hammock-like belt wherein the sling cradles the pelvis in its boundaries for treatment of one or more fractures of the pelvic bones. |
| Russell’s traction | This is a balanced traction arrangement of pulleys, slings, and weights used to treat knee or hip injury in adult and to reduce femur fracture in children. The weights used in application of skin traction are: In children: 1-2 1b in Bryant’s traction. :7-10 lb for head halter traction. : 5-7 lb for Buck’s extension. In adult :7-10 lb for Dunlop’s traction. :10-15 1b for pelvic belt traction. :10-20 lb for pelvic sing. |
Guidelines for use of traction
- Maintain the established line of pull.
- Prevent friction.
- Maintain counter traction.
- Maintain continuous traction unless otherwise ordered.
- Maintain correct body alignment.
Procedure
| Nursing Actions | Rationale | |
| 1 | Before procedure Assess patient’s overall health including degree of mobility. | Determines patient’s health status and ability to tolerate traction. |
| 2 | Assess condition of specific tissues to be placed in traction. Note skin condition, excessive hair, bruises, and other lesions. Head halter: Assess head, ears, chin, and neck. Bryant’s traction: Assess both legs. Buck’s extension: Assess one or both legs. Dunlop’s traction: Assess arm and forearm. Pelvic belt: Assess lower back and abdomen. Pelvic sling: Assess back and abdomen. Russell’s traction: Assess lower limbs. | Determines ability of local tissues to tolerate traction. |
| 3 | Assess patient’s understanding of reason for traction. | Determines concerns, acceptance, and need for instruction. |
| 4 | Assess patient’s level of pain. | Serves as baseline for later comparison. |
| 5 | Explain procedure to patient, including traction set-up and mobility restrictions. | Promotes cooperation and reduces anxiety. |
| 6 | During procedure Prepare patient and area of body to be in traction. Head halter: Cleanse face and neck. For male patient, shave face unless he prefers to keep beard. Bryant’s traction: Cleanse both legs. | Lessens irritation under head halter. |
| 7 | Position patient as requested by physician: Head halter: Patient flat on back. Bryant’s extension: Child flat on back. Buck’s traction: Patient on back head of bed flat or elevated at 30°. Dunlop traction: Patient flat on back. Pelvic belt: Patient flat on back. Pelvic sling: Patient flat on side or back. Russell’s traction: Patient on back, head of bed slightly elevated. | Position varies with part of body to be placed on traction, plus effects of weight and gravity. |
| 8 | Assist with application of specific head halter, adhesive strips and elastic bandages and pelvic belt or sling as needed. Nurse may be asked to hold patient in desired position or apply halter, strips or elastic bandages while physician and other assistants hold patient’s limb in desired position. | For lower extremity, adhesive strips are applied beginning below head of fibula on lateral surface of leg to avoid pressure over peroneal nerve. Ensure proper alignment of body parts under traction, Elastic bandages are applied from distal to proximal to promote venous return. |
| 9 | Assist with attachment of spreader bars, ropes, and pulleys. Ropes are tied securely in knot and passed in grooves of pulleys to weights. | Provides proper weighted traction for extremity alignment. |
| 10 | When all traction materials and spreader bars are in place, weights are placed on weight holder and hooked to loop in rope till it is taut. Physician determines exact amount of weight to be applied and position to be maintained by patient. | Traction is slowly established to avoid involuntary muscle spasm or ut. pain for patient. Weight should be sufficient to create enough pull on to overcome muscle spasm, but not to cause distraction or marked increase in pain. |
| 11 | Before physician leaves, check patient’s position and ask about additional permissible positions for patient in bed. Head halter: Patient stay flat on back, or head of bed may be elevated 15-20o if ordered. Bryant’s traction: Baby or child must stay on back at all times. Buttocks are held slightly off bed if traction weight is correct amount. Buck’s extension: Patient may be allowed to turn to unaffected side for brief period. Pillow placed under leg in traction may be used only when patient is on side. Dunlop’s traction: Patient must lie on back. Bed may be tilted on FI low shock blocks toward the side opposite to traction. Head of bed is kept flat. Pelvic sling: Patient lies on back when in sling and should have Ha enough weight attached to raise buttocks slightly off bed. If sling is off, it can be used carefully as turning sheet if patient’s fractures permit side lying. Russell’s traction: Patient lies on back, head of bed may be Lo elevated to 25-30° depending on injury. | Ensures safety of care and position for effective traction. Angle of pull may allow head to be elevated, to use body weight as counter traction. Child cannot turn to side or abdomen because traction would be ineffective and re-injury could occur. Positioning on side permits back care and rest to tissues. Pillows under legs in traction create friction and should not be used because they lessen traction effectiveness. Tilting uses body for some counter traction. Flexion of hips and knees relaxes lumbosacral muscles to lessen spasms. Hammock effect of sling is most effective when patient is on back Sling must be removed for placement of bedpan. Low Fowler’s position creates most effective traction pull. |
| 12 | Ask patient how traction is affecting injured tissues if patient is able to Ini respond. Babies or young children may cry when weights are initially applied but may soon stop crying and appear more comfortable. | Initial reaction may be slight increase in soreness or pain until patient is able to relax and allow traction to perform as designed. |
| 13 | Place side rails elevated as appropriate. Patient in Bryant’s traction should always have someone in attendance. | Promotes patient’s safety. |
| 14 | Gather unused materials and return to storage areas. | |
| 15 | Wash hands. | Reduces transmission of microorganisms. |
| 16 | Observe entire skin traction set up and its functioning, check all knots, ropes in pulleys, weight on weight holder, whether apparatus is hanging freely, position of halter sling, belt or other material for specific traction. | Reassessment is necessary to determine if traction is functioning as designed or described or to make needed adjustments. |
| 17 | Assess condition of skin around straps or bandages. | Ensures early identification of irritation or breakdown. |
| 18 | Ask if patient is experiencing pain or burning sensation. | Indicates misalignment of bones or presence of muscles spasms. |
| 19 | After procedure Conduct neuromuscular checks every 1-2 hours initially, then every 4 Pro hours if patient is stabilizing. | Provides objective data concerning peripheral perfusion to tissues. |
| 20 | Observe patient’s participation in self-care. | Patient may refrain from activity unnecessarily. |
| 21 | Record type of traction, site to which applied, amount of weight, person Ens applying traction, and time, patient’s response, and other pertinent con data in nurse’s notes. | Ensures continuity of care and provides documentation for legal consideration. |
| 22 | Record traction functioning every shift. Observe all ropes, pulleys, Safe weights, and strings at the beginning of shift and after turning or position changes or if traction is removed for providing nursing care. | Safety, continuity of care, and legal factors require recording of all details. |
Special considerations
- If institution policies or physician’s order specify, remove traction for skin care for short periods. If removed for skin care, patient is out of traction only for 10-15 minutes before it is reapplied.
- Muscles and joints may be weakened from bed rest or traction and need time to regain strength.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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