Traction

Definition

Traction is the use of a pulling force to treat muscle and skeleton disorders.

Purpose

Traction is usually applied to the arms and legs, the neck, the backbone, or the pelvis. It is used to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities. Traction can either be short-term, as at an accident scene, or long-term, when it is used in a hospital setting.

Traction serves several purposes:

• it aligns the ends of a fracture by pulling 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 traction is 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. Elaborate methods 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 into account when deciding on the type and degree of traction.

Precautions

People who are suffering from skin disorders or who are allergic to tape should not undergo skin traction, because the application of traction will aggravate their condition. Likewise, circulatory disorders or varicose veins can be aggravated by skin traction. People with an inflammation of the bone (osteomyelitis) should not undergo skeletal traction.

Description

Skin traction

Skin traction uses five-to seven-pound weights attached to the skin to indirectly apply the necessary pulling force on the bone. If traction is temporary, or if only a light or discontinuous force is needed, then skin traction is the preferred treatment. Because the procedure is not invasive, it is usually performed in a hospital bed.

Weights are attached either through adhesive or nonadhesive tape, or with straps, boots, or cuffs. Care must be taken to keep the straps or tape loose enough to prevent swelling and allow good circulation to the part of the limb beyond the spot where the traction is applied. The amount of weight that can be applied through skin traction is limited because excessive weight will irritate the skin and cause it to slough off.

Specialized forms of skin traction have been developed to address specific problems. Dunlop's traction is used on children with certain fractures of the upper arm, when the arm must be kept in a flexed position to prevent problems with the circulation and nerves around the elbow. Pelvic traction is applied to the lower spine, with a belt around the waist. Buck's skin traction is used to treat knee injuries other than fractures. The purpose of this traction is to stabilize the knee and reduce muscle spasm.

Skeletal traction

Skeletal traction is performed when more pulling force is needed than can be withstood by skin traction; or when the part of the body needing traction is positioned 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 to the success of the traction. The pin can be kept in place several months, and must 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 for some fractures of the femur, hip, or pelvis.

Preparation

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 in alignment and healing properly. Since the insertion of the anchoring devices in skeletal traction is a surgical procedure, standard preoperative blood and urine testing are done, and the patient may meet with an anesthesiologist to discuss any health conditions that might affect the administration of anesthesia.

Aftercare

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 be immobile for an extended period. Deep breathing exercises are taught so that respiratory 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 to use the toilet. In serious injuries, traction may be continued for several months until healing is complete.

Risks

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.

Both types of traction have complications associated with long periods of immobility. These include the development of bed sores, reduced respiratory function, urinary problems, and circulatory problems. Occasionally, fractures fail to heal. Being confined to traction for a long period can take a an emotional toll on the patient, also.

Normal results

When correctly applied, traction generally produces very good, if slow, results.

Resources

BOOKS

"Traction." In Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corp., 1996.

Traction

Definition

Traction is force applied by weights or other devices to treat bone or muscle disorders or injuries.

Purpose

Traction treats fractures, dislocations, or muscle spasms in an effort to correct deformities and promote healing.

Description

Traction is referred to as a pulling force to treat muscle or skeletal disorders. There are two major types of traction: skin and skeletal traction, within which there are a number of treatments.

Skin traction

Skin traction includes weight traction, which uses lighter weights or counterweights to apply force to fractures or dislocated joints. Weight traction may be employed short-term, (e.g., at the scene of an accident) or on a temporary basis (e.g., when weights are connected to a pulley located above the patient's bed). The weights, typically weighing five to seven pounds, attach to the skin using tape, straps, or boots. They bring together the fractured bone or dislocated joint so that it may heal correctly.

In obstetrics, weights pull along the pelvic axis of a pregnant woman to facilitate delivery. In elastic traction, an elastic device exerts force on an injured limb.

Skin traction also refers to specialized practices, such as Dunlop's traction, used on children when a fractured arm must maintain a flexed position to avoid circulatory and neurological problems. Buck's skin traction stabilizes the knee, and reduces muscle spasm for knee injuries not involving fractures. In addition, splints, surgical collars, and corsets also may be used.

Skeletal traction

Skeletal traction requires an invasive procedure in which pins, screws, or wires are surgically installed for use in longer term traction requiring heavier weights. This is the case when the force exerted is more than skin traction can bear, or when skin traction is not appropriate for the body part needing treatment. Weights used in skeletal traction generally range from 25–40 lbs (11–18 kg). It is important to place the pins correctly because they may stay in place for several months, and are the hardware to which weights and pulleys are attached. The pins must be clean to avoid infection. Damage may result if the alignment and weights are not carefully calibrated.

Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis, hip, or femur; and overhead arm traction, used in certain upper arm fractures. Cervical traction is used when the neck vertebrae are fractured.

Proper care is important for patients in traction. Prolonged immobility should be avoided because it may cause bedsores and possible respiratory, urinary, or circulatory problems. Mobile patients may use a trapeze bar, giving them the option of controlling their movements. An exercise program instituted by caregivers will maintain the patient's muscle and joint mobility. Traction equipment should be checked regularly to ensure proper position and exertion of force. With skeletal traction, it is important to check for inflammation of the bone, a sign of foreign matter introduction (potential source of infection at the screw or pin site).

Preparation

Both skin and skeletal traction require x rays prior to application. If skeletal traction is required, standard pre-op surgical tests are conducted, such as blood and urine studies. X rays may be repeated over the course of treatment to insure that alignment remains correct, and that healing is proceeding.

Normal results

There have been few scientific studies on the effects of traction. Criteria (such as randomized controlled trials and monitored compliance) do exist, but an outcome study incorporating all of them has not yet been done. Some randomized controlled trials emphasize that traction does not significantly influence long-term outcomes of neck pain or lower back pain.

Resources

books

"Cervical Spine Traction." In Noble: Textbook of Primary Care Medicine, 3rd ed.Mosby, Inc., (2001): 1132.

periodicals

Glick, J.M. "Hip Arthroscopy. The Lateral Approach." Clinics in Sports Medicine 20, no.4 (October 1, 2001): 733-41.

Overly, M.D., Frank and Dale W. Steele, M.D. "Common Pediatric Fractures and Dislocations." Clinical Pediatric Emergency Medicine 3, no.2 (June 2002).

Nancy McKenzie, Ph.D.

QUESTIONS TO ASK THE DOCTOR

• How long will traction be required?
• What are the risks and benefits?
• What is the goal of traction?
• What is the chance of complications?

trac·tion / ˈtrakshən/ • n. 1. the action of drawing or pulling a thing over a surface, esp. a road or track: a primitive vehicle used in animal traction. ∎  motive power provided for such movement, esp. on a railroad: the changeover to diesel and electric traction. ∎  locomotives collectively. 2. Med. the application of a sustained pull on a limb or muscle, esp. in order to maintain the position of a fractured bone or to correct a deformity: his leg is in traction. 3. the grip of a tire on a road or a wheel on a rail: his car hit a patch of ice and lost traction.

traction (trak-shŏn) n. the application of a pulling force, especially as a means of counteracting the natural tension in the tissues surrounding a broken bone, to produce correct alignment of the fragments. Considerable force, exerted with weights, ropes, and pulleys, may be necessary to ensure that a broken femur is kept correctly positioned during the early stages of healing. Traction is also used by physiotherapists for the treatment of back pain.

traction drawing, draught XVII; drawing of vehicles or loads along a road (hence t. engine) XIX. — F. traction or medL. tractiō, -ōn-, f. pp. stem of trahere draw; see -ION.
So tractor (-OR1) (med.) device to be drawn or rubbed over the skin XVII; instrument for pulling XIX; traction engine XX.

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