Skin Traction

Skin traction is one of two basic types of traction used for the treatment of fractured bones.  It works by applying weight to tape, sponge rubber, or canvas materials which have 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 of the 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 or heavy traction weight is needed then skeletal traction is usually used rather than skin traction.

Traction must be applied in the direction and magnitude to obtain its desired effect.   As soft tissue and muscle relax, the amount of weight required may change to maintain the desired 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 by elevating 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 be assessed 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 in good body alignment in the middle of the bed.  Ropes and weights must be unobstructed.  Knots in the rope or footplate must not touch the pulley or the foot of the bed. 

There are three main types of skin traction used in the care of adults, these are, Buck's extension 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 comfort following injury while awaiting surgical fixation, especially in hip and femur injuries. To apply Buck's traction, foam rubber padded straps are placed with the foam surface against the skin on each side of the affected leg.  A loop of tape is extended beyond the sole of the foot, and a spreader is applied to the distal end of the tape which prevents pressure along the side of the foot.  The malleolus and proximal fibula are protected with cast padding, this prevents pressure sores and skin necrosis.  While one person supports the leg, another wraps elastic bandage in a spiral fashion over the traction tape beginning from the ankle.   The elastic bandage helps to prevent slipping, and a sheepskin pad is placed under the leg to reduce friction.  If Buck's traction with a foam boot is applied, the heel of the affected leg must be placed well into the heel of the boot.  Velcro straps are then secured around the leg.  Weights are applied to the rope fixed 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 supporting the flexed knee in a sling and applying a horizontal pulling force by use of traction tape and elastic bandage attached to the lower leg.

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

Nursing Considerations

To ensure that traction is effective, countertraction must be maintained, and wrinkling and slipping of the traction bandage must be avoided.  Positioning of the patient is important, 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 cannot be moved from side to side but can only shift position slightly to prevent bony fragments from moving against one another. 

The patient in traction will have restricted mobility and independence, being confined to a limited space may become frustrating.  Traction equipment can often look threatening, and the patient may express anxiety over their injury and subsequent changes this will present.  Therefore a therapuetic relationship with your patient and an ability to assess their psychological responses to their situation is important.  The body part placed in traction should be assessed for colour, temperature, oedema, pulse, sensation, moveability and skin integrity.  Potential problems for the patient may include pressure sores, constipation, urinary tract infection, loss of appetite, deep vein thrombosis, lung congestion, skin breakdown, nerve pressure from the skin traction, and circulatory impairment.

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

Summary

Skin traction is one of two basic types of traction used for the treatment of fractured bones.  It used weights applied to tape, sponge rubber or canvas materials attached to the skin surrounding the damaged body structure to be effective.  Integrity of the skin and skin tolerance need to be considered before the use of skin traction, which is usually used for the control of muscle spasm or short term immobilisation.  Skeletal traction is used for prolonged or heavy weighted traction.  There are three main types of skin traction used in the care of adults, Buck's traction, Russell's traction and Dunlop's traction.  When caring for the patient in traction some of the things the nurse should consider include: maintaining effective traction, the psycological impact on the patient, and the potential for physiological complications.