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Buck's skin traction is widely used in the lower limb for femoral fractures, lower backache,

acetabular and hip fractures. Skin traction rarely reduces a fracture, but reduces pain and

maintains length in fractures.

Method

The skin is prepared and shaved -it must be dry.Friar's balsam may be used to improveadhesion. The commercially available strapping is applied to the skin and wound on with anoverlapping layer of bandage. The bandage should not extend above the level of the fracture.

Dangers of Skin Traction

Distal Oedema

Vascular obstruction

Peroneal nerve palsy

Skin Necrosis over bony prominence's

Avoid complications resist the temptation of trying to improve adhesion

by wrapping the bandages more tightly. If the tapes slip rather use

skeletal traction if possible (not a child)

Gallows Traction

This is used in infants and children with femoral fractures.

Indications Gallows Traction

Child must weigh less than 12 kg

Femoral fractures

Skin must be intact

Both the fractured and the well femur are placed in skin traction and the infant is

suspended by these from a special frame. Vascular compromise is the biggestdanger. Check the circulation twice daily. The buttocks should be just off the bed.


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At Tygerberg hospital the Denham pin is commonly used. This has a threaded middle portion

that keeps it in the tibia. For femoral fractures the Denham Pin through the proximal tibia.

Always insert from lateral to medial in the proximal tibia, as the peroneal nerve needs to bemissed and the site of exit is unpredictable. On some occasions a distal femoral site, or even the

calcaneus may be used.

A Thomas splint, (check it fits, by trying on the well leg) is applied. Three flannel slings are

secured by safety pins under the thigh. The "Master splint" is the one under the fracture. Thecorrect tension on this sling will align the fracture in the lateral plane.

The knee can be flexed by using a Pearson flexion splint attached tothe Thomas splint at the knee. The desired knee flexion can bemaintained by a rope at its end leading from the Thomas splint to the

Pearson attachment. Ropes from the Denham pin can either be tied

distally to the Thomas splint (static traction) or they can be led over apulley on the end of theBalkan frame (dynamic Traction) In either

case start with 7 kg ( or 10% body weight) in the long axis of the

femur. This opposes the pull of the thigh muscles. As with the child, the traction is madebalanced 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. as he moves in the bed.

Alignment of Thomas Splint

The Thomas splint must be aligned by pointing the Balkan frame in the direction of the proximal

fragment.

Displacement of a femur fracture

Site for prox. tibial Denham pin 2.5 cm inferior and distal to tibial tubercle

Thomas Traction -AdultClick to see annotated larger image
http://www0.sun.ac.za/ortho/webct-ortho/general/trac/femur-b4.pnghttp://www0.sun.ac.za/ortho/webct-ortho/general/trac/thomas-trac.jpghttp://www0.sun.ac.za/ortho/webct-ortho/general/trac/denham.gif


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Muscles causing the

displacement

How to align the Thomas Splint.Also raise foot-end to provide

flexion

Balkan Frame Adjustment: For flexion, raise pulley (a). For

abduction, swing foot-end of balkan wide of bed (b)

Displacement - Proximal femur fracture

Prox. Femur - Flexion

Prox. Femur - Abduction

Align frame - Flexion & Abduction

Mid-shaft fractures remain relatively un displaced as the proximal and distal muscles balance.

Distal femur fracture displacement

Posterior angulation - pull of gastrocnemius

Solution - flex the knee as far as possible
http://www0.sun.ac.za/ortho/webct-ortho/general/trac/displacement-vectors.png


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Bed Blocks

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

Skin traction is one of two basic types oftraction used for the treatment of fracturedbones. It works by applying weight to tape, sponge rubber, or canvas materials whichhave been attached to the skin surrounding the damaged body structure.

The amount of weight which can be applied to skin traction is limited to the tolerance ofthe skin. Skin traction is used for the control of muscle spasm and to provide

immobilisation, in this case while Bob awaited theatre in the morning. If prolonged orheavy traction weight is needed then skeletal traction is usually used rather than skintraction.

Traction must be applied in the direction and magnitude to obtain its desired effect. Assoft tissue and muscle relax, the amount of weight required may change to maintain thedesired pulling force. When traction is applied countertraction needs to be considered.Countertraction is a force acting in the opposite direction, for Bob this was achieved byelevating the foot of the bed.

When applying traction there are many factors to be considered for example, any factor

which might reduce the pull or alter the line of pull must be eliminated. Skin should beassessed for abrasions and circulatory problems before the application of skin traction,as it must be in a healthy condition to tolerate the traction. The patient should be ingood body alignment in the middle of the bed. Ropes and weights must beunobstructed. Knots in the rope or footplate must not touch the pulley or the foot of thebed.

There are three main types of skin traction used in the care of adults, these are, Buck'sextension traction, Russell's traction and Dunlop's traction:

Buck's traction is a form of traction where pull is exerted in one plane. It is used when

partial or temporary immobilisation is required, and it is used to provide comfortfollowing injury while awaiting surgical fixation, especially in hip and femur injuries. Toapply Buck's traction, foam rubber padded straps are placed with the foam surfaceagainst the skin on each side of the affected leg. A loop of tape is extended beyond thesole of the foot, and a spreader is applied to the distal end of the tape which preventspressure along the side of the foot. The malleolus and proximal fibula are protectedwith cast padding, this prevents pressure sores and skin necrosis. While one personsupports the leg, another wraps elastic bandage in a spiral fashion over the traction
http://www.avonside.net/casestudy/Bobs%20Glossary.htm#Tractionhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Planehttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Distalhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Malleoulushttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Proximalhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Necorsishttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Tractionhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Planehttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Distalhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Malleoulushttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Proximalhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Necorsis


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tape beginning from the ankle. The elastic bandage helps to prevent slipping, and asheepskin pad is placed under the leg to reduce friction. If Buck's traction with a foamboot is applied, the heel of the affected leg must be placed well into the heel of theboot. Velcro straps are then secured around the leg. Weights are applied to the ropefixed to the spreader or footplate and passed over a pulley fastened to the bed end.

Russell's Traction can be used for fractues of the tibial plateau, it works by supportingthe flexed knee in a sling and applying a horizontal pulling force by use of traction tapeand elastic bandage attached to the lower leg.

Dunlop's Traction is used for fractures of the upper extremities. It works in the form ofhorizontal traction which is applied to the abducted humerous, while vertical traction isapplied to the flexed forearm.

Nursing Considerations

To ensure that traction is effective, countertraction must be maintained, and wrinklingand slipping of the traction bandage must be avoided. Positioning of the patient isimportant, and proper positioning i.e. with good body alignment in the middle of the bed,must be maintained to keep the affected limb in a neutral position. The patient cannotbe moved from side to side but can only shift position slightly to prevent bony fragmentsfrom moving against one another.

The patient in traction will have restricted mobility and independence, being confined toa limited space may become frustrating. Traction equipment can often look threatening,and the patient may express anxiety over their injury and subsequent changes this willpresent. Therefore a therapuetic relationship with your patient and an ability to assess

their psychological responses to their situation is important. The body part placed intraction should be assessed for colour, temperature, oedema, pulse, sensation,moveability and skin integrity. Potential problems for the patient may include pressuresores, constipation, urinary tract infection, loss of appetite, deep vein thrombosis, lungcongestion, skin breakdown, nerve pressure from the skin traction, and circulatoryimpairment.

(Glanze, W., 1990; Smeltzer & Bare, 1996).

Summary

Skin traction is one of two basic types of traction used for the treatment of fracturedbones. It used weights applied to tape, sponge rubber or canvas materials attached tothe skin surrounding the damaged body structure to be effective. Integrity of the skinand skin tolerance need to be considered before the use of skin traction, which isusually used for the control of muscle spasm or short term immobilisation. Skeletaltraction is used for prolonged or heavy weighted traction. There are three main types ofskin traction used in the care of adults, Buck's traction, Russell's traction and Dunlop'straction. When caring for the patient in traction some of the things the nurse should
http://www.avonside.net/casestudy/Bobs%20Glossary.htm#Abductionhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Flexionhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Deep%20Vein%20Thrombosis%20(DVThttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Abductionhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Flexionhttp://www.avonside.net/casestudy/Bobs%20Glossary.htm#Deep%20Vein%20Thrombosis%20(DVT


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consider include: maintaining effective traction, the psycological impact on the patient,and the potential for physiological complications.

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