Different Types Of Skeletal Traction
Balanced Suspension Traction
Balanced suspension traction is used to stabilize fractures of the femur. It can be the skin or skeletal type. If it is skeletal, a pin or wire is surgically placed through the distal end of the femur. If it is skin traction, tape and wrapping or a traction boot of the kind described under Buck’s traction is used.
The patient is in the supine position, with the head of the bed elevated fro comfort. As the name suggests, the affected leg is suspended by ropes, pulleys, and weights in such a way that traction remains constant, even when the patient moves the upper body.
Two important components of balanced suspension traction are the Thomas splint and the Pearson attachment. The Thomas splint consists of a ring, often lined with foam, that circles and supports the thigh. Two parallel rods are attached to the splint and extend beyond the foot. A Pearson attachment consists of a canvas sling that supports the calf.
Parallel rods lead from the pin sites on the distal and of the attachment for the rope. Traction to the femur is applied through a series of ropes, pulleys, and weights. These weights hang freely at the foot off the bed.
The skin should be inspected frequently to identify problems early. The ring of the Thomas splint can excoriate the skin of the groin. Special padding may have to be used. Again, the foot should always be at a right angle on the footrest to prevent footdrop. If pins are used for fixation, aseptic technique must be used around pin sites until they have healed. From then on, clean technique can be used. The pin sites are cleansed carefully with soap and water and rinsed thoroughly, unless this varies from policy. An antiseptic, such as povidone-iodine ointment, may then be applied. Dressings are usually not required. You should, however, constantly assess for infection at the pin sites. Indications include redness, heat, drainage, pain, or fever. Review your facility’s policy on pin care.
Skull Tongs Traction
Skull tongs are used to immobilize the cervical spine in the treatment of unstable fractures or dislocation of the cervical spine. Although Crutchfield tongs were used almost exclusively in the past, Gardner-Wells skull tongs are in wide use. Some think these are less likely to pull out than the Crutchfield tongs. The patient is prepared for either type with a local anesthetic to the scalp. The tongs are surgically inserted into the bony cranium, and a connector half-halo bar is attached to a hook from which traction can be applied.
The patient is supine and is usually on a special frame instead of the regular hospital bed. If a hospital bed is used, two or more people are required to assist the patient with any turning movements. The head of the bed may be elevated to provide counter traction.
Because patients remain in this type of traction for an extended period, observe the precautions taken for the patient in other types of skeletal traction. Difficulties with the performance of activities of daily living, infection at the tong sites, and restlessness and boredom are common. It is useful to teach the patient range-of-motion exercises, provide good nutrition and suggest recreational or occupational activities.
Halo traction provides stabilization and support for fractured cervical vertebrae. The surgeon inserts pins into the skull. A half circle of metal frame connects the pins around the front of the head. Vertical frame pieces extend from a halo section to a frame brace that rests on the patient’s shoulders. The halo traction allows the patient to be out of bed and mobile while stabilizing the cervical vertebrae could injure the spinal cord.