Zimmer Traction Handbook PDF
Zimmer Traction Handbook PDF
Zimmer Traction Handbook PDF
Traction Handbook
Acknowledgments: Preface
We would like to acknowledge grateful appreciation to those The principal aim of this book is to present a thorough yet easily
who contributed their time and expertise in the development understandable explanation of basic traction systems. Through
of the ninth editon of The Zimmer Traction Handbook: its numerous illustrations and simplified language, this book
makes it possible for the trained orderly or orthopaedic
Thomas Byrne, OPAC, OTC technician to bring to the patient’s bedside all the necessary
University of California components for applying several basic types of traction.
San Diego Medical Center Moreover, it serves as a source of continuing education,
San Diego, California and as a reference for experienced orthopaedic personnel.
3
Traction and Balanced Suspension
4
With the traction arrangements, countertraction is a
consideration. Countertraction, which is the resistance of the
body to move in the direction of the forces exerted by a traction
device, is a factor which is built into each setup by utilizing the
patient’s body weight. When necessary, the countertraction of
the patient’s body weight may be increased by elevation of the
foot of the bed or using blanket rolls, sand bags, etc.
Figure 1 Figure 2
5
Types of Traction
THREE BASIC TYPES: For adults, skin traction is often used as a temporary measure
prior to more definitive treatment such as open reduction or
skeletal traction. Because of the possibility of severe skin
1. Manual Traction
irritation, skin traction should not be used on fractures which
2. Skin Traction
require more than 5 to 7lbs. (2.7 to 3.2kg) of longitudinal force.
3. Skeletal Traction
It is also not recommended for continuous traction which is
expected to exceed three to four weeks. Finally, skin traction
Each has its own special function in the management of
is not recommended when controlling limb rotation is of
fractures depending on physician preference, the type of
major importance.
fracture and, in some cases, the patient himself.
6
Manual Traction
Skin Traction
Skeletal Traction
7
For serious cervical spine fractures or injuries, Crutchfield or Generally, any loss is negligible, and therefore, for each pound
Vinke cervical tongs are inserted directly into the skull and of weight applied, 1 pound of force is delivered.
attached to the traction system. This stabilizes the vertebrae and
reduces the chances of spinal cord damage or further injury. The second of these categories is the block and tackle or
suspension type of traction. This is shown in the Russell’s
For some fractures of the pelvis, a special pelvic traction Traction illustration. In this type of traction the traction system
screw is inserted into the ilium and connected to the traction is attached to the patient in two or more places and also to one
system at the appropriate angle for maintaining fracture or more other stationary points on the traction frame. Each time
alignment. the traction force is attached from the patient to the frame and
back to the patient, directional lines of pull, or vectors of force,
For long bone fractures, skeletal traction requires the use are being applied.
of Steinmann Pins or Kirschner Wires. The basic difference
between the two is their diameter. Steinmann Pins have a larger
diameter, generally from 5/64in. to 3/I6in. (2.0mm to 4.8mm).
Kirschner Wires generally range from .028in. to 0.62in. (.7mm to
15mm) in diameter. Both pins also come in a variety of lengths
and point styles. These choices are generally based on physician
preference, the density of bone through which the pin or wire is
to be inserted, and the forces to be applied.
Once inserted, the Steinmann Pin or Kirschner Wire is Cervical Tongs Pelvic Traction Screw
connected to its respective holder. The holder is then
connected to the traction force. It must be emphasized
that Steinmann Pins are not compatible with the Kirschner
Wire Tractor and vice versa. The Kirschner Wire Tractor and
the Steinmann Pin Holder are designed for use only with their
respective pins.
8
With the vectors of force principle, it is important to remember
that the actual horizontal pulling force on the extremity is double
the amount of applied weight.
Buck’s Traction
For example, the vectors of force illustration shows two pulling
forces (A & B) on the footplate. Each has a pulling force of five
pounds. These two forces combine to produce what is known as
the resultant force (R), or as in this case, 10 pounds. The vertical
pull on the knee sling (C) remains at 5 pounds and serves only to
suspend the knee off the bed.
Vectors of Force Principle A Steinmann Pin is inserted through the proximal tibia. Two
Böhler Steinmann Pin Holders are then applied as shown in the
illustration. One pin holder (with a pulley) applies the traction
force, while the second holder provides lift to the knee.
9
Applications of Traction
10
d. Although the photos in this handbook show the traction 6. If the patient must be moved while in traction, the attending
weights off the foot of the bed, some hospitals and physician or authorized healthcare provider who set up
physicians may require them to come off at the head of the the traction must be present. Failure to readjust traction to
bed. Both methods are acceptable, however, the reasoning the same precise configuration after transport can result in
behind each differs. misalignment with serious consequences.
From Foot End: 7. All traction equipment must be cleaned with some type of a
liquid sterilizing solution (ex. 10% bleach solution etc.) after
a. Weights are out of patient’s reach. each patient use.
b. They are readily visible for inspection.
c. With shock blocks under the head of the bed, weights
hang freely with less equipment.
11
Principles of Traction
RELATIONSHIP TO NURSING CARE e. The patient’s heels are not digging into the mattress.
If any of these conditions are not being met, immediate
corrective action is indicated.
A great deal of the nursing care (and a good deal of equipment
maintenance) related to the patient in any traction application
is based upon certain fundamental principles. It is, therefore, 4. CONTINUOUS
imperative that the nurse/technician be constantly alert for the In general, for traction to be effective, it should be continuous.
following: NEVER remove it without a doctor’s order. Furthermore, check
frequently to make sure tapes are not slipping, that pulleys
are working properly and that the components of the traction
1. POSITION
apparatus are correctly and tightly assembled.
The patient should be in the supine position (on his/her back).
Proper position includes keeping the entire body in good
alignment. Also, either a solid bottom bed or bed boards must 5. LINE OF PULL
be used for all orthopaedic patients. Once established correctly, the line of pull should be
maintained.
2. COUNTERTRACTION
For any traction to be effective, there must be countertraction. 6. PROTECTION OF THE CARDIOVASCULAR SYSTEM
If the force of pull of the traction is greater than the Immobilized patients are at risk for venous thrombosis
countertraction supplied by the body weight, the patient will and/or pulmonary embolus. The nursing goals are to monitor
slide towards the traction force, or his traction splint may orthostatic tolerance and prevent venous stasis. Interventions
impinge on the traction pulley. Should this happen, additional to prevent venous stasis include:
countertraction may be obtained by tilting the bed away from
the traction force. Traction and countertraction represent a. Instructing the patient in hourly ankle rotation, flexion
forces in balance; for this reason the patient and extension exercises.
should not have his back raised more than 20 degrees, b. Avoiding or minimizing positioning that causes external
or be allowed to sit up. pressure on venous walls such as knee gatching or
crossing legs.
c. Using, on physician order, anti-embolism stockings or
3. FRICTION
pneumatic sleeves.
Any type of friction will reduce the efficiency of traction and
hinder the pull. Implications for nursing care include checking
to see that: 7. MAINTENANCE OF NEUROVASCULAR STATUS
a. The spreader or footplate is not touching the end of the Neurovascular compromise may be avoided by using the
bed. following interventions: regularly assessing neurovascular
b. The weights are positioned at a reasonable level from the status with particular attention to traction apparatus and
floor; a considerable distance below the pulley; hanging pressure areas; changing the patient’s position within the
free of the bed; and away from the patient. limitations of the traction every two to four hours; reporting
c. All knots are clear of the pulleys. any signs and symptoms of neurovascular compromise to the
d. There is no impingement on the traction cord from bed attending physician.
clothes or any other apparatus.
12
8. SKIN CARE
Static positioning in traction can cause pressure that impairs Up Down Up
capillary flow to the skin, resulting in tissue necrosis and and and and
pressure sores. Skin integrity can be maintained by: Over Over Through
a. Assessing skin integrity over bony prominences and any
areas of the body which are covered by or attached to
traction apparatus.
b. Massaging potential pressure areas every two to
four hours.
c. Using pressure relief devices or pressure relief beds.
If skin breakdown occurs, massage should be
discontinued to prevent further tissue damage. The
adhesive straps used in skin traction heighten the risks HOW TO TIE A TRACTION KNOT
to the skin and should be selected, applied, and
monitored very carefully. To save time, follow this simple phrase: up and over,
down and over, up and through. Practice a few times with
9. MAINTENANCE OF THE MUSCULOSKELETAL SYSTEM a traction cord and this illustration.
Immobility decreases muscle strength, impairs skeletal
strength, and limits joint mobility. These problems can be Once you have tied the traction cord, allow about 4in.
minimized by: (10cm) at the end. This extra length of cord allows you to
a. Having the patient perform regular isometric and/or adjust the knot later without replacing the cord. Secure
isotonic exercises of uninvolved extremities and the all knot ends tightly with adhesive tape.
involved extremities as prescribed by a physician.
b. Periodically positioning the patient in the fully
extended position. 10.NEVER IGNORE A PATIENT’S COMPLAINT
c. Allowing the patient to perform as many daily activities This rule should be followed above everything else.
as possible. Check it out.
If the patient will use crutches after the traction is 11. TRACTION SYSTEMS CAN VARY
discontinued, he/she should strengthen his/her While it is essential for those caring for traction patients
quadriceps by: to know the correct application of traction, the nurse in
a. Pulling his/her toes toward his/her nose while pushing charge must remember that doctors may vary their
his/her knee into the bed. traction methods for specific reasons. The nurse should,
b. Sitting up in bed and pushing his/her palms against therefore, inform all floor personnel concerning any
the bed to raise his/her buttocks off the bed. modifications to a particular traction setup instituted
by a physician.
Directions for setting up the upper and lower extremity
exercises appear on page 44-47. Sometimes it may be helpful to take a photo of the setup.
This will show nursing personnel on all shifts how the
traction setup should be maintained.
13
Every traction system begins with a basic traction frame.
Basic Traction Frame Types Essentially, the basic frame is the foundation around which
the complete system is built. For a listing of traction frames
for specific bed models, see page 82.
Child’s Crib
• Used for fractures of the femur in children under two years
old or weighing less than 30lbs. (14kg).
• Provides stabilization of the hip joint where use of cast is
not indicated.
• Bilateral traction helps prevent rotation and facilitates
stabilization of the patient.
00-0640-008-00 Pulley 4
14
Straight Frame
Basic frame setup for beds with I.V. Sockets. See page 82 on
components for individual bed models.
Offset Frame
Basic frame setup with an additional feature of an offset upright
bar at the head to allow clearance for a wall light fixture. See
page 84 on components for individual bed models.
15
Four-Poster (Balkan) Frame
16
Metal Bed Frame
STRAIGHT FRAME
Prod. No. Components Dimensions Qty.
OFFSET FRAME
Prod. No. Components Dimensions Qty.
17
Hill-Rom TotalCare * Traction Frame
® ®
DESCRIPTION CAUTIONS
Components used to apply basic types of traction for a patient 1. A full fracture frame is not to be used on the TotalCare
using the Hill-Rom TotalCare Bed System. bed without the use of the I.V. Post Adapter Brackets.
2. Begin by placing the four 61in. (155cm) upright posts into
INDICATIONS the holes in the adapter brackets, and assemble the frame
The purpose of this traction setup is one or more of as shown in the drawing to the right.
the following: 3. When mounting Buck’s Traction, the knee controls on the
1. Prevent or reduce muscle spasm. bed should be locked out. Refer to the TotalCare bed
2. Immobilize a joint or part of the body. documentation for instructions.
3. Reduce a fracture or dislocation. 4. When mounting Cervical Traction, the head and knee on the
4. Treat joint pathology(s). bed should be locked out. Refer to the bed documentation
for instructions.
Claims made regarding weight limitations and/or warning during 5. To avoid injury, the bed should not be operated until all
operation/use are done so with regard to the use of Zimmer persons are clear of mechanisms and the I.V. Post
components only. These warnings are void if components other Adapter Brackets.
than Zimmer are used. 6. Do not use the fracture frame to push, pull or steer the bed.
Use the transport handles, the foot prop or the siderails so
as not to accidentally weaken or destabilize the frame.
GENERAL TIPS ON FRAME ASSEMBLY
7. Do not exceed the safe working load of the TotalCare Bed
1. Adjust the bed to its lowest position. Refer to the TotalCare
System. Refer to the TotalCare bed documentation on
documentation for instructions.
specifications.
2. When attaching horizontal bars, position the clamp so that the
8. Before activating any of the bed controls, make sure the
knob is on top. This will help prevent complete detachment of
traction frame will remain clear of other structures or
the clamp should the knob become loose.
equipment during movement.
3. For maximum frame stability, install the curved double clamp
bar at the foot of the bed as shown. * Hill-Rom and TotalCare are trademarks of Hillenbrand Industries.
4. The flat surface of the bar must be facing upward on all
horizontal bars and facing to the side on upright / vertical
bars.
5. “Load” the fracture frame by securing the horizontal plain bar
within the vertical posts. Close the cross clamp on one end of
the plain bar and fully tighten. Grasp the opposite vertical post
and exert a longitudinal pull. Tighten the second cross clamp
on the plain bar.
18
INSTALLATION OF I.V. POST
ADAPTER BRACKETS
• The mount holes for I.V. Post Adapter Brackets are located
on the weigh frame, under the head section and the thigh
Prod. No. Components Dimensions Qty.
section of the TotalCare bed.
00-2700-020-00 Traction Frame for TotalCare Bed (Complete) 1 • Raise the head section and thigh section approximately
20 degrees.
00-1042-004-00 Cross Clamp 6
• Remove the two mounting bolts and nuts from the
00-2700-040-00 Plain Bar 40in. (101cm) 3 bracket.
• The head brackets are smaller than the foot brackets, do
00-0640-023-00 Overhead Bar 85in. (216cm) 2
not interchange. (See photo of installed brackets at left.)
00-2700-021-00 Vertical Post 61in. (155cm) 4 • The left and right brackets are identical and can be
mounted on either side.
00-0640-021-00 Curved Double Clamp Bar 2
• Align the bracket so that the I.V. hole will be toward the
00-0640-067-00 Trapeze 1 outside of the bed. Slide the mounting plates of the
bracket over the tube of the weigh frame.
00-2700-022-00 I.V. Post Adapters (Head end of bed) 2
• Align the holes of the adapter mount plate with the holes
00-2700-023-00 I.V. Post Adapters (Foot end of bed) 2 in the weigh frame.
• Insert the bolts from the top of the weigh frame and
tighten the locking nut securely on the bottom of the
weigh frame using a 1/2in. (13mm) wrench.
• Repeat procedure at all four corners of the bed.
• The fracture frame can now be assembled.
19
BÖHLER-BRAUN FRAME
Used with Böhler-Braun Leg Traction. See page 34 for specific
setup details.
COMPONENT PARTS
Prod. No. Description
20
Frame Measurements for Beds Not
Listed in this Handbook
HOW TO MEASURE Ordering the correct I.V. Post for your bed is critical for your
satisfaction with the traction frame. Accurate measurement
To determine the correct frame for a bed not listed at the back of
of (A) through (G) is essential to obtaining the correct I.V. Post.
this catalog, the following measurements must be taken at both
Therefore, please measure carefully.
the head and foot ends of the hospital bed:
21
22
Types of Traction
BEFORE PROCEEDING
The next section explains the various procedures for setting up
several basic traction systems. As you look through this section,
remember that there are many ways in which these systems
can be modified, depending on physician preference, hospital
procedure, the relative conditions of the patient and so forth. If
a particular setup in your hospital does not look similar to those
in the following illustrations, do not assume it is wrong. Always
check with the physician or head orthopaedic nurse before
making any modifications.
23
Bryant’s Traction
INDICATIONS 4. Problems with this type of traction are difficult to define due to
1. Fractures of the femur in children up to two years old or the age of the child. These problems include:
weighing less than 30 lbs. (14kg). a. Inability to communicate wants and needs.
2. Stabilization of the hip joint where use of the cast is not b. Toilet needs.
indicated. c. Feeding.
d. Diversion.
GENERAL INFORMATION e. Maintaining position which makes it sometimes necessary
1. Traction is bilateral (even if pathology is unilateral) to help to use some form of jacket or restraint, especially to keep
prevent rotation and to facilitate better stabilization of the the child from “rotating” around the traction apparatus.
patient, thereby maintaining better control. 5. All of the above need to be handled with individual
consideration. Get to know the child. Talk with the parents!
POSITION OF BED AND PATIENT
1. With the bed in a level position and body flat on the bed, TRACTION SETUP
vertical suspension traction of the legs should be set up so 1. Attach 66in. (168cm) swivel clamp bar with panel clamp-
that the hips are flexed at right angles. upper (UC) and panel clamp-lower (LC) to foot of crib.
2. When the traction is in place, the buttocks should just clear 2. Attach 27in. (69cm) single clamp bar to upright post,
the mattress. extending over bed.
3. Lift the buttocks a few inches off the mattress. When the 3. Attach 9in. (23cm) single clamp bar to upright post, extending
buttocks are released, the child should return to the “just beyond end of bed.
clear” position described above. If not, check with the 4. Attach 36in. (91cm) center clamp bar horizontally to 27in.
attending physcian regarding a possible change in the amount (69cm) single clamp bar and position it directly above the
of weight. outside of the patient’s hips.
5. Attach a pulley to each end of bar, positioning them directly
TIPS AND PRECAUTIONS above the outside of the patient’s hips.
1. Warning: Dangerous complications leading to ischemic 6. Attach pulleys to the 9in. (23cm) single clamp bar.
contractors can occur. Check both feet at least every 7. Tie traction cord to Deluxe Convoluted Zim-Trac® Traction
two hours for color, pulse, motion, temperature, and Splints, thread through pulleys, then tie to weight carriers.
sensation. This procedure may be altered by using Skin-Trac Traction
2. Check for undue pressure: Strips wrapped with Zimmer Premium or Standard
a. Over the outer head and neck of the fibula. Orthopaedic Wrap.*
b. On the dorsum of the foot. 8. Apply weights.
c. On the Achilles tendon.
3. Check to see that bandages, boots, etc., have not slipped and * See page 50 on application of Skin-Trac Traction Strips.
become bunched around the toes or ankles.
24
Prod. No. Components Qty.
00-0640-008-00 Pulleys 4
Weight Carriers 2
Traction Cord
25
Cervical Traction
26
TRACTION SETUP #1 TRACTION SETUP #2
Basic Frame Setup (See pages 14-17 or page 82) Basic Frame Setup (See pages 14-17 or page 82)
00-0640-004-00 9in. (23cm) Single Clamp Bar 1 00-0619-000-00 Zimcode Buck’s Extension 1
00-0640-005-00 18in. (46cm) Single Clamp Bars 2 00-0640-006-00 27in. (69cm) Single Clamp Bar 1
00-0640-008-00 Pulleys 3 00-0619-001-00 9in. (23cm) Single Clamp Bar with Pulley 1
Traction Cord
* See page 72 for a complete selection of head halters. Weights: As ordered by physician
27
Traction On Humerus-
Overhead (90-90)
INDICATIONS skin breakdown as well as to relieve the general discomfort
Immobilization or stabilization of fractures, dislocations, resulting from remaining in the supine position for an
and other pathology of the upper arm and shoulder. extended period.
11. Since the patient has the use of only one hand (and frequently
REQUIREMENTS not the one normally used), he or she may require help with
The establishment of an angle of pull which produces the best eating to ensure adequate dietary and fluid intake. These
possible alignment for reduction of the fracture. patients also will need help with other self-care procedures
such as teeth brushing, hair combing, etc. Also keep items
such as water, tissues, etc., within easy reach.
POSITION OF BED AND PATIENT
12. Remember to turn off overhead lights when not needed.
If possible, the bed should be level with the patient flat
A light shining directly in patient’s eyes is irritating.
on back.
13. Patients in 90-90 traction will need prism glasses for reading
and watching TV.
TIPS AND PRECAUTIONS 14. Be sure to stand where the patient can see you!
1. Remember, traction is applied to the humerus only. The
forearm is only in balanced suspension.
TRACTION SETUP
2. An overhead frame and trapeze will facilitate patient care and
1. Attach basic frame setup to bed. (See pages 14-17 or
enable the patient to be more active and help himself.
page 82)
3. Exposed adhesive sides of Skin-Trac Traction Strips should be
2. Attach 40in. (100cm) bar with cross clamps to overhead bar
covered near hand and other bony prominences to prevent
above the patient’s arm.
sticking and skin irritation.
3. Attach 5in. (13cm) single clamp bar on each upright bar at foot
4. Countertraction can be increased by:
of bed. Add cross clamp to each 5in. (13cm) single clamp bar.
a. Placing a rolled blanket between the mattress and spring
Connect the two sides together with a 40in. (100cm) plain bar.
on the traction side of the bed.
4. Attach two pulleys to 40in. (100cm) bar overhead of patient,
b. Placing bed elevation or shock blocks under the bed on
one on each side.
the traction side of the bed to tilt the patient away from
5. Attach one pulley to 40in. (100cm) plain bar at the foot
the traction.
of the bed.
c. Using a body or jacket restraint to keep the patient away
6. Apply Skin-Trac Traction Strip smoothly to arm.*
from the traction side of the bed.
7. Wrap Zimmer Premium or Standard Orthopaedic Wrap
5. Encourage active and passive exercises especially to the wrist
around arm.
and fingers of the affected arm.
8. Tie traction cord to spreader block, thread through pulleys,
6. The bed linen is most easily changed from top to bottom.
then attach to weight carrier.
7. Make sure bandage wrappings are not tighter at the proximal
9. Place patient’s forearm and hand in large polyester pile knee
rather than distal end of arm otherwise swelling may occur.
sling, attach traction cord to spreader bar, tie other end of rope
8. Make sure bandage wrappings are not cutting at the elbow or
to an “S” hook and place over the pulley.
wrist. This can be prevented by placing a piece of felt padding
10. Apply weights.
in these areas.
9. Due to its elevated and immobile position, the hand may feel
* See page 50 on application of Skin-Trac Traction Strips.
cold to the patient even though circulation is adequate. A light
covering, such as with a towel, can relieve this problem.
10. Frequent and thorough back care is essential to prevent
28
Prod. No. Components Qty.
00-0640-008-00 Pulleys 3
Weight Carriers 2
Traction Cord
29
Pelvic Traction With Pelvic Belt
POSITION OF BED AND PATIENT NOTE: One 9in. (23cm) single clamp bar may be placed on the
The attending physician may prescribe countertraction either by: upright bar at the foot of the bed for attachment of one
1. Elevation of the foot of the bed using shock blocks. 36in. (91cm) center clamp bar to provide greater clearance
2. Gatching of the bed at the knees. for weights.
3. Placing pillows under the knees.
4. Placing the bed in the semi-Fowler’s (jackknife) position. 3. Attach two pulleys to 36in. (91cm) center clamp bar.
Whichever countertraction the physician prescribes, the 4. Measure patient’s girth at the crest of the ilium to ensure
patient should be flat on back. correct size of belt.
5. Apply pelvic traction so that the lower portion of the belt is
TIPS AND PRECAUTIONS at or slightly below the greater trochanter. (Belt is not to be
1. Check and adjust pelvic belt straps so they are unrestricted applied like an abdominal binder.)
and equal in length. It is a good idea to secure the straps with 6. Attach traction cords to straps of pelvic belt, thread through
adhesive tape or a safety pin. pulleys then tie to weight carriers.
2. Make sure the angle of pull is correct. 7. Apply weights.
3. Since the pelvic belt is applied directly to the skin, check
frequently for skin irritation, especially on the iliac crests. NOTE: The above procedure may be altered using a 22in. (56cm)
Powder and other skin care measures can help prevent skin spreader bar and a single traction cord, pulley and weight
irritation and breakdown. carrier. The 36in. (91cm) center clamp bar can be deleted,
4. Pelvic belts should be changed and laundered when they and a 9in. (23cm) single clamp bar with pulley can be
become soiled, or at least every three days. attached at an angle to the upright bar at the foot end of
5. Constipation will add to patient discomfort. Measures should the bed. (See photo on p. 31)
be taken to prevent this condition and patients should be
taught why these measures are necessary.
6. A footboard will help prevent foot drop.
7. Back pain is often hard to define and relieve, but it is very real.
Moral support is essential for these patients. They also should
be instructed on proper body mechanics and care of the back
to prevent future disorders.
30
Prod. No. Components Qty.
00-0640-008-00 Pulleys 2
Weight Carrier 1
Traction Cord
31
Buck’s Unilateral Leg Traction
(One Leg)
INDICATIONS TRACTION SETUP
1. Trial treatment of nerve root disorders. 1. Attach basic frame setup to bed. (See pages 14-17 or
2. Sciatica. page 82)
3. Muscle spasms. 2. Attach one 5in. (13cm) single clamp bar to upright bar
4. Minor fractures of the lower spine. at foot of bed. NOTE: A 9in. (23cm) single clamp may
5. Temporary stabilization of fractured hips or fractures of the be used for greater clearance of the weights.
femoral shaft. 3. Attach on 9in. (23cm) single clamp bar to 5in. (13cm) single
6. Degenerative arthritis and knee injuries. clamp bar.
4. Attach pulley to 9in. (23cm) single clamp bar.
POSITION OF BED AND PATIENT 5. Apply Deluxe Convoluted Zim-Trac Traction Splint to leg.
The patient should be flat on back with the foot of the 6. Tie traction cord to splint, thread through pulley, then tie to
bed elevated. weight carrier.
7. Apply weights.
TIPS AND PRECAUTIONS
NOTE: The above procedure may be altered by using Skin-Trac
1. Pulley bars must be placed so that the line of pull aligns distal
Strips wrapped with a Zimmer Premium or Standard
to proximal.
Orthopaedic Wrap.
2. Cover exposed adhesive side of Skin-Trac Traction Strips (if
used) near ankles with strips of felt or sheet wadding to help
* See page 50 on application of Skin-Trac Traction Strips.
prevent the Skin-Trac Traction Strips from sticking onto the foot
and ankle.
3. Make sure wrappings are not too tight across the dorsum of
the foot. Excess pressure can cause severe complications.
4. Pressure on the heels can cause irritation and skin
breakdown. Make sure heels are not digging into the mattress.
If necessary, place small foam pads, folded blankets, etc.,
under full length of the calf to keep heels off the bed.
5. Make sure pressure is kept off the peroneal nerve or foot drop
may occur.
6. A bed cradle may be used to keep bed covers from resting
on the feet.
7. Encourage activity as tolerated, including active and passive
exercises. The patient should use the trapeze for moving about
in bed.
32
Prod. No. Components Qty.
00-0640-008-00 Pulley 1
Weight Carriers 1
Traction Cord
33
Unilateral Leg Traction Using
Böhler-Braun Frame
34
Prod. No. Components Qty.
Weight Carriers 2
Traction Cord
35
Russell’s Traction
36
Prod. No. Components Qty.
00-0640-008-00 Pulleys 3
Weight Carrier 1
Traction Cord
37
Split Russell’s Traction
38
Prod. No. Components Qty.
Weight Carrier 2
Traction Cord
39
Balanced Suspension and Traction with Thomas
or Brady Leg Splint (Utilizing Skin Traction)
40
18. Apply weights.
19. Distribution of the weight through the various elements
should be arranged so that a delicate balance of
traction and countertraction is maintained.
00-0640-008-00 Pulleys 5
Weight Carriers 3
Traction Cord
41
Balanced Suspension and Traction with Thomas
or Brady Leg Splint (Utilizing Skeletal Traction)
INDICATIONS 11. For skeletal traction, refer to your own institution’s policies
Fractures of the femoral shaft, hip, and lower leg, or any regarding care of the pin site.
combination of these.
TRACTION SETUP
GENERAL INFORMATION 1. Attach basic frame setup to bed. (See pages 14-17
The difference between the Thomas and Brady systems is that or page 82).
the Brady system is universally sized, whereas the Thomas is 2. Attach one 9in. (23cm) single clamp bar to upright
sized to fit individual patients. bar at head of bed on the injured limb side at a 45
degree angle.
POSITION OF BED AND PATIENT 3. Attach pulley to 9in. (23cm) single clamp bar.
Elevate foot of bed with patient flat on back. (In certain 4. Attach two 9in. (23cm) single clamp bars to upright bar
instances, the head of the bed may be elevated, but only at foot of bed.
at the discretion of the attending physician.) 5. Attach one cross clamp to each 9in. (23cm) single clamp bar.
6. Attach the two cross clamps together with a 40in. (100cm)
plain bar.
TIPS AND PRECAUTIONS
7. Attach one pulley to the top 40in. (100cm) plain bar on the
1. Padding the ischial ring with sheepskin enhances patient
side with the injured leg.
comfort. The sheepskin can be easily removed when soiled
8. Attach one pulley to the bottom 40in. (100cm) plain bar
without affecting the balance of the setup.
on the side with the injured leg.
2. Meticulous skin care and decubitus prevention measures
9. Attach Pearson Attachment to Thomas or Brady Leg Sling
must be carried out routinely.
with point of attachment at patient’s knee joint.
3. Active and passive exercises should be done at least four
10. Form cradle for leg by attaching polyester pile slings to splints
times a day.
and Pearson Attachment.
4. Make sure the leg does not rotate externally and place
11. Lift leg and move splint and Pearson Attachment under leg
pressure on the peroneal nerve. Check the neuro-
with ring resting loosely against ischial tuberosity.
vascular status of the limb at least every two hours.
12. Tie one end of traction cord to the proximal lateral end of the
5. If elastic bandages are used, they should be checked
splint. Wrap cord three times around spreader bar and tie on
frequently for excessive pressure at the site of the fibular
opposite side of splint.
head and the dorsum of the foot.
13. Tie another traction cord to center of spreader bar thread
6. Slings should be positioned so that the heel and Achilles
through pulley above chest, then through pulley at head
tendon do not carry the weight of the lower leg.
of bed, and tie to weight carrier.
7. Patients in this type of suspension and traction initially
14. Thread another cord through rope locators at distal end
experience much discomfort and are very apprehensive. The
of splint. Tie loose end of traction cord back on to itself to
nurse needs to explain all procedures as well as enlist the
form a triangle. Next, thread traction cord through pulley
cooperation of the patient in helping with his or her care.
on 40in. (100cm) bar overhead bed at knee, and then through
8. The patient generally finds a fracture bed pan more
pulley on 40in. (100cm) top bar at end of bed. Finally, tie to
convenient.
weight carrier.
9. It is easier to make the bed from the head to the foot. The
15. Tie third traction cord to end of Pearson Attachment, and tie
patient can lift his head and shoulders by using the trapeze.
to distal end of splint.
10. In most cases, the patient should wear an antiembolism
stocking on the unaffected leg.
42
16. Tie traction cord to Böhler Steinmann Pin Holder or Kirschner SINGLE FRAME SETUP
Wire Tractor, thread through pulley on lower 40in. (100cm) bar
Prod. No. Components Qty.
at end of bed, and tie to weight carrier.
17. Apply weights. Basic Frame (See pages 14-17 or page 82)
18. Distribution of the weight through the various elements 00-0640-004-00 9in. (23cm) Single Clamp Bars 4
should be arranged so that a delicate balance of traction and
00-0640-005-00 18in. (46cm) Single Clamp Bars 2
countertraction is maintained.
00-0640-008-00 Pulleys 8
Weight Carriers 3
Traction Cord
The above photo shows how this traction system may be set up
using a single frame setup. FOUR-POSTER (BALKAN) FRAME SETUP
Prod. No. Components Qty.
00-0640-008-00 Pulleys 5
The above photo shows how this traction system may be set Weight Carriers 3
43
Patient Exercises Utilizing Traction Equipment
SETUP INSTRUCTIONS
1. Attach basic frame setup to bed.
2. Attach one 9in. (23cm) single clamp bar to upright bar
at foot of bed.
3. Attach one 36in. (91cm) center to 9in. (23cm) single
clamp bar.
4. Attach one 36in. (91cm) center clamp bar to overhead bar.
5. Attach one pulley to each side of both 36in. (91cm)
center clamp bars.
6. Attach traction cord to weight carrier, thread through pulleys
and tie to Nelson Finger Exerciser (hand grip).
7. Apply weights.
44
Prod. No. Components Qty.
00-0640-008-00 Pulleys 4
Weight Carriers 2
Traction Cord
45
ARM AND SHOULDER EXERCISE
WITHOUT WEIGHTS
INDICATIONS
1. Post-radical mastectomy.
2. Shoulder injuries involving loss of range of motion or strength.
3. Bursitis and other inflammatory conditions.
4. Strengthening of anterior shoulder muscles and the deltoid
muscle using the unaffected arm to provide a counterbalance
to assist motion. This exercise is primarily for the patient who
has a weakened shoulder and requires a counterbalance to
lift his or her arm weight.
SETUP INSTRUCTION
1. Attach basic frame setup to bed.
2. Attach one 36in. (91cm) center clamp bar to overhead
bar above patient. Prod. No. Components Qty.
3. Attach one pulley to each side of 36in. (91cm) center Basic Frame (See pages 14-17 or page 82)
clamp bar.
00-0640-011-00 36in. (91cm) Center Clamp Bar 1
4. Tie traction cord to one Nelson Finger Exerciser (hand grip),
thread through pulleys and tie to other Nelson Finger Exerciser. 00-0640-008-00 Pulleys 2
5. Adjust to patient’s needs.
00-0920-000-00 Nelson Finger Exercisers 2
Traction Cord
46
LOWER EXTREMITY EXERCISE
INDICATIONS
Any post-surgical or post-injury condition in which the
following goals are desired:
47
KNEE EXERCISE WITH THOMAS SPLINT
INDICATIONS SETUP INSTRUCTIONS
1. Following knee surgery in which an increase in flexion and/or 1. Attach basic frame setup to bed.
extension is desired. 2. Attach one 9in. (23cm) single clamp bar with one pulley
2. Conditions as above which also require increased strength of to overhead bar above patient’s upper extremity.
quadriceps and/or knee flexors (hamstrings, gastrocnemius). 3. Attach one 9in. (23cm) single clamp bar with one pulley
3. Beginning pattern for increased range of motion and/or to overhead bar above patient’s thigh.
strengthening hip flexion, knee flexion, and dorsi-flexion. 4. Attach one 9in. (23cm) single clamp bar with three pulleys
to overhead bar above patient’s foot.
5. Attach one 9in. (23cm) single clamp bar to upright bar
at foot of bed.
6. Attach one 18in. (46cm) single clamp bar with two pulleys
to 9in. (23cm) single clamp bar.
7. Attach one 18in. (46cm) single clamp bar with one pulley
to upright bar at head of bed at 45 degree angle.
8. Position Thomas Splint and Pearson Attachment under
patient’s leg.
9. Tie traction cord to one side of traction splint, wrap around
spreader bar and tie to other side of splint.
10. Tie traction cord to spreader bar; thread through pulley above
thigh then through pulley at head of bed. Tie to weight carrier.
11. Tie traction cord to distal end of Pearson Attachment, thread
through pulley above foot; thread through pulley at foot end;
then tie to weight carrier.
12. Tie traction cord to distal end of leg splint, thread through
pulley above foot; thread through pulley at foot end; then tie
to weight carrier.
13. Tie traction cord to distal end of leg splint; thread through
pulley above foot; thread through pulley above patient’s upper
extremity; then tie to Nelson Finger Exerciser.
14. Apply weights.
15. Distribution of the weight through the various elements
should he arranged so that the system is balanced.
NOTE: A short piece of traction cord also tied to the Nelson Finger
Exerciser and then tied to the bed frame may also be used
to keep the grip within easy reach.
48
Prod. No. Components Qty.
00-0640-008-00 Pulleys 8
Weight Carriers 3
Traction Cord
49
How To Apply Skin-Trac Skin
®
Traction Straps
Use a Skin-Trac Skin Traction Strip size which permits covering
as much skin as possible, thereby distributing the tension force AVOID TIGHT WRAPPING AT Styloid Process
over as much skin as possible. However, since the objective THESE PRESSURE POINTS
of Ulna
in fracture treatment is to apply tension on the tissues around
the fracture, the Skin-Trac Skin Traction Strip should not extend
proximally beyond the line of the fracture. Care must be taken
that the strips do not overlap; that is, at least a 1in. (2.5cm)
space must be maintained between the strips, otherwise the Lateral
Olecranon
Epicondyle
elastic bandage may cause soft tissue damage. Deltoid Process
Tuberosity
Hospital policy and/or physician preference determines the type
of skin preparation required prior to the application of Skin-Trac
Skin Traction Strips. Hospital policy and/or physician preference
will also determine skin care, usually checked at least every Medial
Ulnar Nerve Epicondyle
eight hours.
VERTICAL
(FOREARM)
TRACTION
Begin wrapping at
small end of limb.
50
AVOID TIGHT WRAPPING AT THESE PRESSURE POINTS
Tuberosity of Tibia
Dorsal Prominence
Head of Fibula
Superficial Peroneal
Nerve
Application completed.
51
Universal Brady Balanced
Suspension System
OPTIONAL ACCESSORIES
Prod. No. Accessory
52
Complete Set
00-1231-011-00
Pearson Attachment
00-1231-015-00
Splint Assembly
00-1231-005-00
53
Radiolucent Thomas Leg Splint
Strap Clamps
00-1232-010-00
Heel Rest Foot Support
00-1232-137-00 00-1232-017/020-00
00-1232-021/024-00 00-1232-136-00
Prod. No. Size Leg Splint Pearson Foot Heel Slings* Strap Clamps
Attachment Support Rest (Set of 3) (Set of 16)
54
Assembly Components for
Radiolucent Thomas Leg Splint Leg Splint
00-1232-001-00
00-1232-002/105-00
LEG SPLINTS
Prod. No. Size Width Inner Length
Polyester Pile
00-1232-001-00 Pediatric 5 1/ in. (13cm) 26 1/ in. (67cm) Slings
4 2
00-1232-007-00
00-1232-002-00 Small 7in. (18cm) 33in. (84cm)
COMPONENTS
Size Foot Foot Support Heel Ring Strap Clamps Ring Polyester Pile
Supports Sling* Rests Straps (Set of 16) Pads Ring Pads*
* Optional accessory 55
Thomas Leg Splint
• For fractures of the femoral shaft, hip or lower leg.
• Applicable to either leg.
• Meets specifications of the Fracture Committee of
the American College of Surgeons.
• Choice of sizes.
• 3/8in. (9.5mm) steel rod diameter.
Full-Length Sling
• Provides soft cradle for leg in Thomas Splint System.
• Offers greater comfort than supports utilizing towels.
• Adjustable to all splint sizes.
Pearson Attachment
• Converts Thomas Splint to balanced suspension.
• Allows passive motion of knee without disturbing
alignment of fracture.
• Used with either skin or skeletal traction.
56
Foot Support and Heel Rest
• Foot support helps prevent peroneal paralysis. Heel rest
reduces heel irritation from friction contact with mattress.
• Both accessories are compatible with Neufeld
Splint System.
• Non-removable thumb screws cannot become lost.
Canvas Slings
• Replacement Slings for Böhler-Braun Frame.
• Canvas material.
00-0113-002-00 Box of 5
57
Böhler-Braun Frame
Developed for comminuted fractures extending into the knee
joint; unstable fractures of the tibia; open fractures associated
with severe soft tissue damage.
58
Stephan Spreader Bar
Utilized in Bryant’s Traction to achieve abduction and
angulation of legs for infants with femoral fractures or
congenital hip dislocation.
59
Zimmer Serrated Clip
• Provides firm attachment.
• Plated steel to retard rust.
• Autoclavable.
Zim-Clip
• Wide serrated gripping edge.
• Numerous uses.
• High-impact plastic, autoclavable.
Mini-Clip
• Useful for applying draping, and holding cautery wire.
• High-impact plastic, autoclavable.
60
Zimcode Traction Cord
• Strong, durable polyester braided fibers.
• Packaged in convenient dispenser carton.
00-0967-001-00 3/ in.
16 (5mm) 100ft. (30m)
00-0967-002-00 3/ in.
16 (5mm) 100yds. (91m)
00-0967-003-00 3/ in.
16 (5mm) 250yds. (229m)
61
Weight Carriers for Cast Iron Weights
Prod. No. Length
Prod. No. Bag Weight Bag Hooks Single Bag Hooks Multiple
00-1600-051-00
62
Zimcode Traction Weight Bags
• Twenty gauge polyvinyl chloride with steel rivets.
• Can be filled with water or sand.
• Calibrated to indicate water weight (sand must be
weighed before filling).
• Single bag hook included with each bag.
Contraindications:
Abrasion, lacerations, superficial infections of immediate skin
areas or compromised circulation.
Individual Dispenser
Strips Carton Qty Size. Dimensions
63
Flex-Foam Traction Strips
Contraindications:
Abrasions, lacerations, superficial infections of immediate skin
areas or compromised circulation.
Single Strips
00-3860-001-00 2in. x 42in. (5cm x 107cm) 12 per carton
25-yard Rolls
00-3861-001-00 2in. x 25yds. (5cm x 23m) 1
64
Nelson Finger Exerciser
Helps alleviate numbness and tingling sensation in fingers and
arm for patients in side arm traction. Reduces risk of circulatory
embarrassment.
Zimcode Footrest
Helps prevent peroneal paralysis (foot drop) and prevents
patient from sliding toward end of bed.
65
Zimcode Footrest Set with Bed Attachment
66
Kirschner Wire Tractor
Affixed to Kirschner Wire in skeletal traction to exert
longitudinal pull on extremity in conjunction with traction
weights. K-wire is secured in the clamps and tensions applied
by spreading the tractor.
• Easily applied.
• Grips finger securely and comfortably.
• Stainless steel mesh.
00-0325-001-00 Small
(Individual Finger Grips)
00-0325-002-00 Medium
00-0325-003-00 Large
00-0325-004-00 Pediatric
67
Patient Helpers
• Offset design for optimum placement in hospital rooms.
• Reinforced octagonal tubing for dependable support.
965 Patient Helper • Heavy duty trapeze for patient safety.
• Adjustable height.
• Attaches to trapeze bracket available from Hill-Rom.
• 200lbs. weight limit.
00-0640-067-00 Trapeze
00-0640-067-00 Trapeze
00-0640-067-00 Trapeze
68
Zimmer Mobile Traction Unit-Extra Long
• Lengthened version of 1036 Compact Zimmer Mobile
Traction Unit.
• Two pegboards (both sides of cart), five storage shelves
and trays below each pegboard conveniently bring two
complete traction frames and assorted accessories to
patient’s bedside.
• Two fixed and two swivel casters provide easy maneuverability
through hospital corridors and doorways.
• Pegboard areas allow orderly arrangement of components.
• Molded rubber corner bumpers reduce marring of hospital
walls and door frames.
• One Traction Cart Hook Kit (00-1015-002-00) included with
each cart. Provides variety of types and lengths of hooks
for holding various traction equipment.
Products shown not included.
69
Traction Cart Hook Kit
Fifty-six hooks in five different styles are attached to pegboard in
traction storage room or traction cart for orderly arrangement of
traction equipment. Seventy-six plastic protective tips included.
70
Zimmer Orthopaedic Wraps
• Knit construction for durability and conformability.
• Cotton content absorbs moisture and is smooth
and non-irritating.
• Choice of premium and standard style.
• Premium style also available sterile.
71
No. 7 Head Halter
• Designed for intermittent overhead traction.
• No spreader bar needed.
• Ideal for clinic or home use.
• Universal size.
• Fully adjustable.
Prod. No.
00-2700-007-00
Prod. No.
00-2700-003-00
00-1778-001-00 Small
00-1778-002-00 Medium
00-1778-003-00 Large
72
Universal Traction Boot
• Universal size for inventory convenience.
• Medial and lateral stays may be positioned anywhere
on boot.
• Excess material may be trimmed for proper fit.
73
Zimcode Pelvic Traction Belts
• Contact closure strap.
• Wide range of sizes.
• Belt width 8 1/2in. (22cm).
• Double strap.
74
Universal Double Strap Pelvic Belt
• Straps with contact closure attachments can be positioned
anywhere on belt to achieve most effective line of pull.
• Universal size for inventory convenience.
• Belt width 8in. (20cm).
75
Zimcode Traction Components
76
Component Prod. No. Zimcode Length Diameter
Bar-Short
63 1/2in. x 88in. (161cm x 224cm)
Bar-Long
74 1/2in. x 101in. (189cm x 257cm)
Overhead Bar-Short
63 1/2in. x 88in. (161cm x 224cm)
Bar-Long
74 1/2in. x 101in. (189cm x 257cm)
77
Component Prod. No. Zimcode Length
78
Component Prod. No. Zimcode Length Diameter
TotalCare
I.V. Post Brackets 00-2700-022-00 (1 each)
(head of bed)
TotalCare
I.V. Post Brackets 00-2700-023-00 (1 each)
(foot of bed)
VersaCare
I.V. Post Bracket 00-2700-027-00 (Set)
(foot of bed)
CareAssist
I.V. Post Bracket 00-2700-024-00
(head of bed)
CareAssist
I.V. Post Bracket 00-2700-025-00 (Set)
(foot of bed)
79
Component Prod. No. Zimcode
80
Component Prod. No. Zimcode
Note: On the Heavy Duty Pulley, the eyelet on the pulley attachment is welded closed.
81
Traction Frames For Specific
Bed Models
The following is a listing of Zimcode Traction Frames for hospital 800-348-2759. Also see page 21 in this Handbook for
bed models. These are the most popular beds used today, instructions on frame measurements for beds not listed below
but do not necessarily represent all bed manufacturers. For on the bed frame specifier. The components for these frames
a complete listing of all hospital beds and their respective must be ordered individually. The components are shown on
Zimcode Frames, call Zimmer Customer Service at pages 76-81.
STRAIGHT FRAME
82
STRAIGHT FRAME
KEY TO ABBREVIATIONS Abbr. Product Description Length Min.-Max. Abbr. Product Description Length Min.-Max.
ABL Adjustable Bar—Long(Telescoping) 741/2”-101” STL Smooth-Trac Overhead Bar—Long 741/2”-101”
ABS Adjustable Bar—Short (Telescoping) 631/2”-88” STL Smooth-Trac Overhead Bar—Long 741/2”-101”
83
OFFSET FRAME
84
OFFSET FRAME
top
BED MANUFACTURER horz
dbl swivel horz I.V. post
cross
curved
clamp clamp plain with clamp double trapeze
plain clamp
MODELS bar
bar bar bar head foot clamp
KEY TO ABBREVIATIONS Abbr. Product Description Length Min.-Max. Abbr. Product Description Length Min.-Max.
ABL Adjustable Bar—Long(Telescoping) 741/2”-101” STL Smooth-Trac Overhead Bar—Long 741/2”-101”
ABS Adjustable Bar—Short (Telescoping) 631/2”-88” STL Smooth-Trac Overhead Bar—Long 741/2”-101”
85
OFFSET FOUR-POSTER
I.V.
BED MANUFACTURER top dbl horz post curved
horz swivel clamp cross
clamp plain with double trapeze
plain bar clamp
MODELS bar bar clamp clamp
bar head foot
Manufactured since July ‘93 BASIC FRAME
Hill-Rom COMPONENTS ABS 31-0 48 36 133/4 133/4 CC CDC -
Advance** Models 115, 1125, 1135, 1145 QUANTITY 2 2 2 5 2 2 8 2 1
(four motor beds) DIMENSIONS – 31” 48” 36” 133/4 133/4 – - -
86
OFFSET FOUR-POSTER
KEY TO ABBREVIATIONS Abbr. Product Description Length Min.-Max. Abbr. Product Description Length Min.-Max.
ABL Adjustable Bar—Long(Telescoping) 741/2”-101” STL Smooth-Trac Overhead Bar—Long 741/2”-101”
ABS Adjustable Bar—Short (Telescoping) 631/2”-88” STL Smooth-Trac Overhead Bar—Long 741/2”-101”
87
NOTES
88
NOTES
89
NOTES
90
BIBLIOGRAPHY WARRANTY
1. Anderson, Merline G: Orthopaedic Traction and Nursing Care. All Zimmer traction frame components are unconditionally
ONA Journal 2:304-307, December 1975. guaranteed against defects in materials and workmanship.
2. Asher, R: The dangers of going to bed: Critical Care Update.
May 1983, pp 40-41, 51. This warranty does not cover normal wear and tear inherent
3. Brooker, Andrew F., Schmeisser, Gerhard: Orthopaedic Traction in day-to-day use, nor consequential or incidental damages
Manual. Baltimore, Williams and Wilkins, 1955. or damage caused by misuse, abuse, accident or neglect.
4. Carini G., Birmingham J.: Traction Made Manageable, A Self
Learning Module. New York, McGraw-Hill 1980. This warranty also does not cover damage to any traction
5. Donahoo, Clara, Dimon, Joseph H.: Orthopaedic Nursing. component resulting from repairs not performed by Zimmer.
Boston, Little Brown and Co., 1977.
6. Farrell J.: Care of the patient in traction: Illustrated Guide to
Orthopaedic Nursing. Philadelphia, JB Lippincott Co., 1977,
pp 97-141.
7. Holder, CEA: The Pathology and Prevention of Volkmann’s
lschaemic Contracture. Journal of Bone and Joint Surgery 61:
296-300, August 1979.
8. Iverson, LD , Clawson, DK: Manual of Acute Orthopaedic
Therapeutics. Boston, Little Brown and Co., 1977.
9. Kerr, Avice H.: Orthopaedic Nursing Procedures, ed. 2.
New York, Springer-Verlag Publishing Co., 1969.
10. Larson, Carol B., Gould, Marjorie: Orthopaedic Nursing,
ed. 8. St. Louis, C.V. Mosby Inc., 1976.
11. McCann V.: The prevention of depression in the immobilized
patient: ONA Journal 1979, pp 433-438.
12. Morris L., Krafgt S.: Nursing the patient in traction: RN. January
1988, pp 26-31.
13. National Association of Orthopaedic Nurses: Core Curriculum
for Orthopaedic Nursing. Pitman, NJ, National Association of
Orthopaedic Nurses, 1986.
14. Osborne L., DiGiacomo I.: Traction: A review with nursing
diagnoses and interventions: Orthopaedic Nursing 1987,
pp 13-19.
15. Rubin M.: The physiology of bedrest. Am J Nurs, January 1988,
pp 50-57.
16. Schneider, Richard F.: Handbook for the Orthopaedic
Assistant, ed. 2. St. Louis, C.V. Mosby Inc., 1976.
17. Schoen D.: The Nucsing Process in Orthopaedic Nursing.
E. Norwalk, CT, Appleton, Century, Crofts, 1986.
18. The Dos and Don’ts of Traction Care. Nursing 74: 35-41.
November 1974.
19. Valbona C.: Bodily responese to imobilization: Krusen’s
Handbook of Physical Medicine and Rehabilitation.
Philadelphia, W.B. Saunders Co., 1982, pp 963-975.
91
97-2000-805-00 Rev. 1 10ML ©2005, 2006 Zimmer Orthopaedic Surgical Products, Inc.