Skin traction is indicated for fractures or dislocations that require only a moderate amount of traction force for a relatively short period of time.

The goals of effective skin traction are to:

  1. Prevent muscle spasm
  2. Immobilisation of the effected limb.
  3. Reduction of fracture.

Skin traction must not be applied over an open wound.
Take care with correct preparation of any superficial lacerations, incisional wounds or infections that will be covered by the skin traction or the bandage. Again this may lead to a decision that the traction is contra-indicated.
If you are using adhesive traction tape check for potential allergies to adhesives. Personally I do not like the adhesive traction. We only use the skin traction with vented foam strips. If you apply a firm ‘figure of eight’ bandage properly, the traction will not slip.

Tip: if the leg is particularly slippery (e.g. really hairy or diaphoretic) you can apply some Tinc Benz along the length of the leg beneath where the traction tape will sit. Tinc benz dries to be very tacky and will both hold the tape in place and provide increased grip

Application:

  1. Collect your equipment.
    You will need at least 2 people to apply this traction ( one to hold the leg).
    OK… lets just stop here for a second.
    Legs are very heavy objects, and I can tell you from personal experience that you are at risk of back pain/injury from holding a patients leg up in the air for just a short period of time. So take care. We actually have a sling attachment on our electronic patient lifting device for just this task.
    If you are going to lift the leg, the way I do it is to raise the patients bed up high. Position myself to hold the leg at the heel whilst applying steady, firm traction (you do not want to be leaning forward over the bed) and then lower the bed.
    You will also need your traction tape and bandage, water bag (filled to the prescribed weight), pulley system (sometimes called a Goose-neck or Bucks extension), and a roll of tape.
  2. Inform and prepare the patient.
    Adequate analgesia may be required during this procedure.
    The patient should be supine with the legs slightly abducted. If there is rotation due to the fracture the leg should not be manipulated into a correct anatomical position as this may lead to neurovascular damage.
  3. One person now holds the leg (as above) and applies traction.
  4. The spreader plate is positioned three finger widths out from the sole of the foot.
  5. The foam strips are then positioned up the sides of the leg.
    The lateral strip should be slightly below the medial one to prevent external rotation.
  6. A figure of eight bandage is applied the length of the leg and secured with tape.
    The malleoli, head of fibula & popliteal fossa are NOT bandaged over.
  7. The traction rope is then passed over the pulley (which is placed in alignment with the foot) and the water bag is attached.


The above diagram shows one secure way to secure the traction water bag to the rope.
Think: Up and Over. Down and Over. Up and Through.

Nursing Care of the patient:

Counter-traction: An important part of maintaining effective traction is the application of counter-traction. Without this, the patient may eventually slide (or wriggle) down the line of the traction force. Counter-traction may be applied by tilting the bed slightly into Trendelenburg (head down) position.
NOTE: If tilting the bed do NOT leave the patient in a head down position. The head of the bed must be raised slightly to compensate.

Pressure area care: Meticulous attention to prevent the development of pressure areas with patients in skin traction. This includes both the increased risk from laying in a supine position and particular risk from the traction itself:

  • Hamstring tendons at the back of the knee.
  • Bony prominences of the ankle.
  • Back of the heels.
  • Greater trochanters. Outer thighs.

It is recommended that the bandage be removed once every shift to check for skin integrity.

Neurovascular status: regular assessment or circulatory and neurological state of the leg in traction.
Document: colour, movement, sensation, capillary refill time, pulse (dorsalis paedis / posterior tibial), temperature, presence of swelling and pain experienced.

Altered tissue perfusion: These patients are at risk of DVT or PE’s and TED stocking plus anticoagulant therapy will have been ordered.

Pain management: This is a whole separate post. But the goal is to maintain good analgesic cover.

The video below shows the application of skin traction to a patients leg. It is not bad, but there are a few improvements we could make.
Hit us with your suggestions (as well as any other additions or disagreements) in the comments……

———————-
References:
Zimmer Traction Handbook PDF

Traction & Buck’s Traction. Josephine A. Kruse
Excellent essay well worth reading for deeper understanding.

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