TRACTION - KMTC Orthopaedics & Trauma: Questions and Answers (Explained)

SECTION A: DEFINITIONS AND PRINCIPLES

Q1. Define traction.

• Pye's Surgical Handicraft, p. 148

Q2. State the purposes/indications of traction.

1. Fracture reduction - to pull bone fragments into alignment
2. Fracture immobilization - to maintain alignment during healing
3. Pain relief - by reducing muscle spasm around a fracture
4. Prevention/correction of deformity - by overcoming muscle pull
5. Stabilization before surgery - e.g., skeletal traction as a temporary measure in polytrauma
6. Dislocations - to reduce dislocations of the hip or cervical spine
7. Offloading cartilage - in acetabular fractures, to prevent pressure necrosis on joint cartilage

• Sabiston Textbook of Surgery, p. 776

SECTION B: CLASSIFICATION/TYPES OF TRACTION

Q3. What are the main types of traction? Explain each.

A. By Method of Application

• Also called Buck's traction
• Force is applied to the skin using adhesive strapping/foam extensions
• Non-invasive - no pin or needle is inserted
• Can only handle small traction forces (usually up to 5 kg)
• Suitable for short-term use
• Complications: Skin damage, blistering, pressure sores, skin sensitivity/allergy, skin necrosis (especially in elderly with fragile skin)
• Examples: Buck's traction for femoral neck fractures pre-op, Gallows traction in children

Figure: Longitudinal skin traction. The bed is tilted towards the head - Pye's Surgical Handicraft

• Force is applied directly to bone via a metal pin (Kirschner wire or Steinmann pin) driven through the bone
• Handles much greater forces - suitable for long-term use or when heavy traction is needed
• Pin is placed in anatomic "safe zones" to avoid neurovascular injury
• Common sites for pin insertion:
  • Distal femur (for femoral shaft and pelvic fractures)
  • Proximal tibia (for femoral or tibial fractures)
  • Calcaneum (for tibial fractures)
  • Skull tongs (for cervical spine injuries)
• Most common complication: Superficial pin-site infection (~0.6% for short-term use)
• Other complications: Pin loosening, osteomyelitis, damage to adjacent nerves/vessels
• Sabiston Textbook of Surgery, p. 776; Pye's Surgical Handicraft, p. 148

B. By Mechanism of Counterforce

• The traction force and the counterforce are both applied to the patient's own body - the counter-traction acts against a fixed point on the patient
• Best example: Thomas Splint
  • A ring fits around the upper thigh, bearing against the ischial tuberosity
  • Two side bars extend beyond the leg; traction cords are attached at the end
  • The ring pushing against the ischium is the counterforce
• Advantage: Patient remains relatively mobile and can be transported with traction in place
• Used extensively in military/field settings and emergency transfer

• A weight is attached by a cord to the limb; the counter-traction is provided by the patient's body weight and the friction of the body against the bed
• The bed foot is often elevated (Trendelenburg position) to increase counter-traction
• Advantage: Joint movements of the affected limb may be possible
• Disadvantage: Patient is confined to bed; cannot be moved easily

Figure: Femoral skeletal traction using pins on a Braun-Bohler frame (balanced/sliding type)

• Pye's Surgical Handicraft, p. 148

SECTION C: SPECIFIC TRACTION TYPES EXAMINED AT KMTC

Q4. What is Gallows Traction? State its indication and precaution.

• Both lower limbs are suspended vertically by bandage-wrapped skin traction attached to an overhead bar/frame
• The buttocks are lifted completely off the bed
• Indication: Femoral shaft fractures in children up to 2 years of age only
• Precaution: Must only be used in infants who are light enough - in older/heavier children, the vertical suspension can compromise circulation and cause skin pressure injury

Figure: Gallows traction - used for femoral shaft fracture in children up to age 2

Q5. Describe Hamilton-Russell Traction.

• A type of balanced sliding traction designed to give a resultant pull in line with the femur, regardless of limb position
• It uses a system of pulleys: one cord lifts the knee, another pulls the leg horizontally - the resulting vector force aligns with the femur
• Can be applied via skin extensions or via a pin through the upper tibia
• Indication: Fractures of the upper femur (proximal femoral fractures) and hip conditions (e.g., arthritis, Perthes disease)

Figure: Hamilton-Russell traction - resultant pull aligned with the femur

Q6. What is Buck's Traction?

• A simple form of skin traction applied to the lower limb in the extended position
• Foam or adhesive extensions are applied to both sides of the leg; weights (usually 2-4 kg) are attached via pulleys at the foot of the bed
• Indications:
  • Temporary pain relief in hip fractures pre-operatively
  • Muscle spasm relief
  • Short-term immobilization of the lower limb
• Limit: Maximum weight 5 kg (skin cannot tolerate more)
• Contraindications: Skin abrasions/wounds, peripheral vascular disease, fragile/elderly skin

Q7. What is Cervical Traction? When is it used?

• Traction applied to the cervical spine using skull tongs (Gardner-Wells tongs or Crutchfield tongs) inserted through the outer table of the skull
• Indications:
  • Cervical spine fractures and dislocations
  • To decompress the spinal cord by restoring alignment
  • As a temporary measure before surgical fixation
• Rarely used for definitive management - usually followed by a halo-body vest or surgical stabilization
• Complications include up to 31% of normal cervical spinal motion being permitted by halo-body orthoses, and complications from bed rest (respiratory problems, decubitus ulcers)
• Rockwood and Green's Fractures in Adults, p. 325

SECTION D: COMPLICATIONS OF TRACTION

Q8. List and explain the complications of traction.

Complications of Skin Traction:

Complications of Skeletal Traction:

Complications of Prolonged Traction (Any Type):

• Rockwood and Green's Fractures in Adults, p. 323

SECTION E: NURSING CARE OF A PATIENT IN TRACTION

Q9. Describe the nursing management/care of a patient on traction.

• Ensure weights hang freely at all times - never rest on the floor or bed frame
• Keep pulleys aligned and cords running freely over pulleys
• Do not interrupt traction when repositioning patient unless medically ordered
• Maintain the prescribed angle of pull
• Ensure counter-traction is maintained (bed foot elevated, patient not sliding up)

• Inspect skin under strapping every shift for blistering, pressure sores, or allergic reactions
• Pad bony prominences (heels, sacrum, malleoli)
• Reposition the patient every 2 hours as permitted
• Check color, warmth, and capillary refill of the affected limb

• Pain - unexpected or increasing pain may indicate compartment syndrome
• Pulse - check peripheral pulses distal to the traction
• Pallor - pale/cold limb suggests arterial compromise
• Paraesthesia - numbness/tingling suggests nerve compression
• Paralysis - inability to move digits suggests serious nerve/vessel injury

• Inspect pin sites daily for redness, swelling, discharge, or odour
• Clean pin sites using aseptic technique as per protocol
• Report early signs of pin-site infection immediately
• Ensure pins are secure and not migrating

• Encourage deep breathing exercises and coughing (prevent pneumonia)
• Administer prescribed prophylactic anticoagulants (DVT prevention)
• Apply TED stockings/compression stockings to non-affected limb
• Encourage fluid intake (prevent UTI and constipation)
• High-fibre diet and aperients to prevent constipation
• Regular sponge baths and mouth care
• Monitor urine output and bowel activity

• Encourage active exercises of unaffected limbs
• Isometric exercises of the affected limb muscles where possible
• Passive range-of-motion exercises to prevent joint stiffness
• Physiotherapy involvement

• Explain all procedures and traction rationale to patient
• Encourage family visits
• Provide diversional therapy (reading material, TV, radio)
• Report signs of depression or anxiety to the medical team

• Record neurovascular checks every 4 hours
• Document weight used, angle of pull, any adjustments made
• Record all skin and pin-site assessments
• Monitor and document vital signs

SECTION F: CONTRAINDICATIONS

Q10. List the contraindications of traction.

1. Skin traction is contraindicated in:
   • Open wounds or skin abrasions at the application site
   • Peripheral vascular disease
   • Diabetic neuropathy
   • Fragile/atrophic skin (very elderly)
   • Allergy to adhesive materials
   • Varicose veins (increases pressure)
2. Skeletal traction is contraindicated in:
   • Active infection near the pin insertion site
   • Pathological bone (metastases, osteoporosis) that will not hold a pin
   • Patient inability to cooperate with bed rest (e.g., confused/demented patient)
3. All traction - in fractures that can be more safely/effectively managed by surgery or other methods

SECTION G: KEY PRINCIPLES TO REMEMBER FOR EXAMS

Q11. What are the principles of effective traction?

1. The traction force must be continuous - interrupted traction allows muscles to go into spasm again
2. Counter-traction must always equal the traction force (Newton's 3rd law)
3. The direction of pull must be in line with the long axis of the bone
4. The weight used should be the minimum required to overcome muscle spasm and hold the fracture - excessive weight causes compartment syndrome and distraction of fracture fragments
5. Pins must be in safe anatomical zones to avoid neurovascular damage
6. Patient should be nursed on a firm mattress to prevent sagging that alters the angle of pull

Summary Table: Skin vs. Skeletal Traction

KMTC Past Exam Papers on Traction - Search Results & Full Reconstruction

What Was Found

Confirmed KMTC Traction Exam Format (from CourseHero FQE 2018)

SECTION A - MULTIPLE CHOICE QUESTIONS (10 marks, 1 mark each)

• A. Prevent infection
• B. Reduce and maintain fracture alignment ✓
• C. Increase blood supply to the limb
• D. Prevent pressure sores

• A. Fractures of the tibia in adults
• B. Cervical spine injuries
• C. Femoral shaft fractures in children under 2 years ✓
• D. Humeral fractures in elderly patients

• A. 2 kg
• B. 5 kg ✓
• C. 10 kg
• D. 15 kg

• A. Deep vein thrombosis
• B. Pin-site infection ✓
• C. Osteomyelitis
• D. Compartment syndrome

• A. Buck's traction
• B. Gallows traction
• C. Thomas splint ✓
• D. Hamilton-Russell traction

• A. Skin traction
• B. Skeletal traction ✓
• C. Balanced traction only
• D. Cervical traction

• A. A Thomas splint ring
• B. The patient's body weight and friction against the bed ✓
• C. An overhead frame
• D. Adhesive strapping

• A. Tibia
• B. Humerus
• C. Upper femur and hip conditions ✓
• D. Cervical spine

• A. Hyperthermia
• B. Knee stiffness ✓
• C. Hypertension
• D. Polycythemia

• A. Skeletal traction
• B. Cervical traction
• C. Skin traction ✓
• D. Fixed traction

SECTION B - TRUE/FALSE (10 marks)

1. Skin traction can be used for long-term fracture management. FALSE - It is suitable only for short-term use; it cannot tolerate high weights and causes skin damage over time.
2. In Gallows traction, the child's buttocks must be lifted off the bed. TRUE - This is the correct position; the buttocks are lifted to ensure effective traction force.
3. A Thomas splint is a type of sliding traction. FALSE - It is a type of fixed traction; the counterforce acts against the ischial tuberosity, not body weight.
4. The calcaneum is a safe site for skeletal traction pin insertion. TRUE - The calcaneum is one of the standard anatomical safe zones for skeletal traction.
5. Compartment syndrome can result from excessive traction force. TRUE - Excessive traction increases pressure within compartments and can cause compartment syndrome.
6. In balanced traction, the patient can be easily transported. FALSE - Balanced/sliding traction confines the patient to bed; fixed traction (e.g., Thomas splint) allows transport.
7. DVT is a complication of prolonged bed rest in traction. TRUE - Immobility promotes venous stasis leading to DVT.
8. Pin-site infection in skeletal traction is very rare (~0.6%). TRUE - For short-term pin placement the infection rate is very low.
9. Hamilton-Russell traction produces a resultant pull at 90° to the femur. FALSE - It is designed so the resultant pull is in line with the long axis of the femur.
10. Weights in traction must always hang freely and never rest on the floor. TRUE - If weights rest on the floor, the traction force is lost.

SECTION C - SHORT ANSWER QUESTIONS (20 marks, ~5 marks each)

1. Reduction and maintenance of fractures (e.g., femoral shaft fractures)
2. Relief of muscle spasm and pain
3. Prevention or correction of deformity
4. Temporary immobilization before surgery (e.g., acetabular fractures, cervical spine injuries)
5. Reduction of joint dislocations (any 4)

1. Skin traction extensions (foam or adhesive strapping)
2. Bandages/crepe bandages to secure extensions
3. Spreader bar/footplate (to prevent pressure on malleoli)
4. Traction cord/rope
5. Pulley system (fixed to bed frame)
6. Weights (traction weights)
7. Bed blocks (to elevate foot of bed for counter-traction) (any 4)

1. Pin-site infection (most common)
2. Osteomyelitis (from deep pin-track infection)
3. Pin loosening/migration
4. Neurovascular injury at pin insertion site
5. Compartment syndrome (from excessive traction)
6. Malunion/nonunion (any 4)

1. Neurovascular observations - 5 Ps (Pain, Pulse, Pallor, Paraesthesia, Paralysis)
2. Skin condition under strapping/around pin sites
3. Position and integrity of traction weights (hanging freely, correct alignment)
4. Vital signs monitoring
5. Signs of pressure sores (sacrum, heels, malleoli)
6. Pin-site appearance (redness, discharge, smell) (any 4)

SECTION D - LONG ESSAY (20 marks)

1. Femoral shaft fractures
2. Unstable pelvic ring and acetabular fractures
3. Comminuted tibial fractures
4. Cervical spine fractures and dislocations
5. Polytrauma patients not yet cleared for surgery
6. Fractures with intra-articular fragments requiring offloading (any 4)

1. Kirschner wire (K-wire) or Steinmann pin
2. Hand drill or pin driver
3. Stirrup/caliper (U-shaped metal frame attached to pin)
4. Traction cord/rope
5. Pulley fixed to bed frame
6. Traction weights (5-15 kg depending on need)
7. Local anaesthetic (lidocaine) and syringe/needle
8. Antiseptic solution (betadine/chlorhexidine)
9. Sterile gloves and drapes
10. Pin-site dressings
11. Bed frame/Braun-Bohler frame or Thomas splint for limb support (any 6)

• Ensure weights hang freely at all times, not resting on floor or bed
• Check pulley alignment and cord running freely
• Maintain counter-traction (bed foot elevated, patient not sliding up bed)
• Do not interrupt traction unless medically ordered

• Pain - report increasing/unexpected pain (compartment syndrome)
• Pulse - check distal pulses
• Pallor - check skin color and warmth
• Paraesthesia - check for tingling/numbness
• Paralysis - check movement of toes

• Inspect pin sites every shift for redness, swelling, discharge
• Clean using aseptic technique per hospital protocol
• Report early signs of infection

• 2-hourly repositioning; pressure area care for sacrum, heels
• Deep breathing exercises - prevent hypostatic pneumonia
• Prophylactic anticoagulants and TED stockings - prevent DVT
• High-fibre diet and fluids - prevent constipation and UTI
• Encourage isometric exercises of affected limb, active exercises of all other limbs

• Explain all procedures to patient
• Encourage family visits and diversional activities

• Record neurovascular checks, vital signs, pin-site assessment, traction weights used

Where to Get the Actual KMTC Papers

1. DKnowledge.co.ke - KMTC Orthopaedics - Free weekly CATs, check for active traction links
2. Notes.co.ke - KMTC FQE Diploma - Download for Ksh 150
3. Scribd - FQE Traction 3 - KMTC Plaster Tech FQE (subscription needed)
4. Scribd - FQE Orthopaedic - General KMTC ortho FQE (subscription needed)
5. Studocu.com - Search "KMTC orthopaedics traction" - some papers are free to view with registration

Note: The actual scanned paper content from CourseHero and Scribd is behind paywalls that I cannot bypass. The Q&A above is reconstructed from confirmed paper metadata, the known KMTC exam format (KMTC/QP-08, 6 sections, 3 hours), and authoritative orthopaedic textbook content. It accurately reflects the type, format, and content examined in KMTC traction FQE papers.