Balanced Suspension Skeletal Traction

NURSING CARE MANAGEMENT 102ORTHOPEDIC NURSING

BALANCED SUSPENSION SKELETAL TRACTION

Balanced suspension traction is used to stabilize fractures of the femur and requires an invasive procedure in which pins, screws or wires are surgically installed.

Weights used in skeletal traction generally range from 25-40lbs (11-18kg)

Purpose: To maintain the anatomical position of the fractured bone.

Materials needed:1. Thomas splint – placement of the thigh2. Pearson attachment – placement of the leg3. Steinman’s holder4. Steinman’s pin5. Traction weight

a. 10% of the body weightb. Inside of the suspension rope

6. Suspension weighta. 50% of the traction weight

7. Rest splint8. 3 ropes:

a. Thigh rope – the shortestb. Suspension rope – the longestc. Traction rope

9. Slings and pins10. Foot board

Steps in the application of traction: 1. Verify doctor’s order

Steinman Holder

Steinman Pin

Rest Splint

Thomas Splint

Pearson Attachment

2. Inform patient about the need and purpose of the procedure

3. Preparation:a. Identify the different types of orthopedic bedb. assemble the needed equipments

Thomas Splint Pearson attachment

c. Know the affected extremityd. Where to stand – look for the last pulley and

stand on the side

4. Mount the Thomas and Pearson on the rest splint.5 Principles in the application of slings

Not too tight not too close 1 inch distance between the slings to

promote aeration or ventilation Popliteal and heel portion should be from

sling Smooth and right side should come in

contact with the patient’s skin (2) longer and wider slings for thigh

portion and (3) for the leg area

How to apply sling? Start from the medial side to the lateral side Secure both ends together Fan fold nicely on the lateral aspect and

secure with pin or clip Observe the principle of not too tight and

not too loose and avoiding hitting the patient’s extremity with the pin

The thigh rope should be attached on the medial aspect to the lateral aspect.

5. Insertion of the apparatus under the affected extremityThree Manpower neededa. To insert the whole apparatus under the

affected extremityb. Manual traction to be released after the

completion of traction weight in the 3rd pulleyc. To lift the affected extremity

Simultaneously at the count of three Instruction to the patient:

o Hold on the trapezeo Flexed the unaffected leg at the count

of 3 The three manpower must do their work

simultaneously

6. Application of traction weighta. Rope attached to the Steinman pin holder to

run along the 3rd pulley and attached the prescribed weight.

b. Check the principles of sling application and make the necessary adjustment and also check the correct alignment.

7. Apply suspension tractiona. One end of the thigh rope to be attached to

the lateral aspect of the ischial ring with a slip knot.

b. Attach suspension rope on the mid part of the thigh rope, to the 1st pulley

c. Insert the suspension weightd. Hang it on the 1st pulleye. Then pass it on the 2nd pulley under the rest

splint and clobe it with hitch knot on the Thomas splint

f. And another clobe hitch knot on the Pearson, and finally close it with a knot to secure it.

8. Remove the rest splint9. Apply foot support10. Check the principle of traction emphasizing the 5

Principles of traction and discuss the nursing care.

Swing the patient to and from side to side to check the efficiency of traction

1. Patient should be on a dorsal recumbent position.2. Line of pull should be in line with the deformity

positioning of a diamond bar positioning of a pulley.a. 1st pulley should be in line with the thighb. 2nd pulley should be in line with the knee or

screwc. 3rd pulley should be in line with the (1st) and

(2nd) pulley.

3. Should always be continuous; emphasize the importance of manual traction.

4. Avoid friction5. Provide counter traction – patient’s body weight

will serve as counter traction.

Removal of Traction1. Apply rest splint.2. Hang suspension weight on the 1st pulley.3. Remove the knot on the Pearson attachment and

Thomas splint. – to completely remove suspension weight.

4. Apply manual traction on the Steinman pin holder.

5. Remove the traction weight on the 3rd pulley; secure the traction rope on the rest splint another on the Thomas and Pearson attachment.

Steinman Pin

Steinman Holder Thigh rope

Pearson AttachmentRest Splint

Traction Rope

2nd Pulley

1st Pulley

1st Pulley

Trapeze

Traction Rope

Suspension Rope

Suspension Weight

Horizontal Bar

Thomas Splint

Suspension Rope

Vertical Bar

The Thomas Splint (half ring) is applied in various ways: with the ring fitted posteriorly against the ischium or anteriorly in the groin. The thigh rest in the canvas or bandage strip sling with the popliteal space left free. The leather ring should not be wrapped or padded. If kept smooth, dry and polished, the leather of the ring is being designed to rest against the skin and resist moisture.

The Pearson Attachment is attached by clamps to the Thomas Splint at the knee level. A canvas or bandage-strip sling supports the lower leg and provides the desired degree of knee flexion. A footplate is attached to the distal end of the Pearson Attachment to support the foot in a neutral position. The heel should be left free.

The traction should be in line with the long axis of the femoral shaft and is maintained by the rope, pulley and weights attached to the skeletal tractor, which is fitted onto the wire or pin. Counter traction and balanced suspension are provided by the ropes, pulleys and weights attached to the Pearson attachment. When all is operational the thigh and Thomas splint will be suspended at about 45 degree angle with the bed and the lower leg and Pearson attachment will be suspended horizontally to the mattress.

The patient may sit up, turn toward the traction side and raise his hips above the bed by means of the trapeze and still maintain the line of traction.

Traction Weight

Vertical Bar

Diagonal Bar