Traction
Traction is the use of a pulling force to treat muscle and skeleton disordersand is usually applied to the arms and legs, the neck, the backbone, or thepelvis. It is used to treat fractures, dislocations, and long-duration musclespasms, and to prevent or correct deformities.
Traction serves several purposes:
- It aligns the ends of a fracture bypulling the limb into a straight position.
- It ends muscle spasm.
- It relieves pain.
- It takes the pressure off the bone ends by relaxing the muscle.
There are two main types of traction: skin traction and skeletal traction. Within these types, many specialized forms of traction have been developed to address problems in particular parts of the body. The application of tractionis an exacting technique that requires training and experience, since incorrectly applied traction can cause harm. Positioning the extremity so that the angle of pull brings the ends of the fracture together is essential. Elaboratemethods of weights, counterweights, and pulleys have been developed to provide the appropriate force, while keeping the bones aligned and preventing muscle spasm. The patient's age, weight, and medical condition are all taken intoaccount when deciding on the type and degree of traction.
Skeletal traction is performed when more pulling force is needed than can bewithstood by skin traction, or when the part of the body needing traction ispositioned so that skin traction is impossible. Skeletal traction uses weights of 25-40 pounds. Skeletal traction requires the placement of tongs, pins, or screws into the bone so that the weight is applied directly to the bone. This is an invasive procedure that is done in an operating room under general,regional, or local anesthesia. Correct placement of the pins is essential tothe success of the traction. The pin can be kept in place several months, andmust be kept clean to prevent infection. Once the hardware is in place, pulleys and weights are attached to wires to provide the proper pull and alignment on the affected part. Specialized forms of skeletal traction include cervical traction used for fractures of the neck vertebrae, overhead arm traction used for certain types of upper arm fractures, and tibia pin traction used forsome fractures of the femur, hip, or pelvis.
X rays are done prior to the application of both forms of traction, and may be repeated during treatment to assure that the affected parts are staying inalignment and healing properly. Aftercare for skin traction involves making sure the limb stays aligned, and caring for the skin so that it does not become sore and irritated. The patient should also be alert to any swelling or tingling in the limb that would suggest that the limb has been wrapped too tightly.
Aftercare for skeletal traction is more complex. The patient is likely to beimmobile for an extended period. Deep breathing exercises are taught so thatrespiratory function is maintained during this time of little activity. Patients are also encouraged to do range of motion exercises with the unaffected parts of the body. The patient is taught how to use a trapeze (an overhead support bar) to shift on and off a bedpan, since it is not possible to get up touse the toilet. In serious injuries, traction may be continued for several months until healing is complete.
The main risks associated with skin traction are that the traction will be applied incorrectly and cause harm, or that the skin will become irritated. There are more risks associated with skeletal traction. Bone inflammation may occur in response to the introduction of foreign material into the body. Infection can occur at the pin sites. If caught early, infection can be treated with antibiotics, but if severe, it may require removal of the pin.
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