This Issue's Rounds Question -
Please tell us:
What is meant by the term Rachitic Rosary?

(responses to be published in next issue)

In the last issue of Body Cast, Rounds asked:You have just placed a patient in full balanced traction and it has been a while since those skills have been requested from you. List the potential complications that may occur in
patients in traction.

The following responses were received:

From Judy Brown and Mary Perkins:

Skin or skeletal traction can be used to apply balanced traction. Complications may occur and traction is ineffective if:

a. weights are not hanging freely
b. ropes are not on pulleys
c. bed linen is interfering with line of pull
d. wrong amounts of weights are applied
e. patient's foot is resting on footboard of bed

Skin traction complications are:

a. pressure sores to skin on bony prominences and soft tissues, i.e., Achilles tendon, coccyx, Thomas Splint Ring
b. common peroneal nerve palsy
c. impairment of circulation
d. compartment syndrome
e. tape and bandage slippage causing pressure to Achilles and around head of fibula
f. tape allergies

Skeletal traction complications are:

a . as above a, b, c, d b. pin tract infection

Traction complications can delay healing, cause your patients pain/discomfort, and prolong their hospital stay.

From Ed Clancey and Neil Lockyer:

Complications of skin traction

1. Allergic reactions to the adhesive.
2. Excoration of the skin from slipping of the adhesive strapping (abrasion of the epidermis).
3. Pressure sores around the malleoli and over the tendo calcaneus.
4. Common peroneal palsy. This may result from two causes: Rotation of the limb is difficult to control with skin traction. There is a tendency for the limb to rotate laterally and for the common peroneal nerve to be compressed by the slings on which the limb rests. Adhesive strapping of the limb around the knee is greater than that around the head of the fibula. The downward slide of the adhesive strapping and bandages may stop at the head of the fibula, which can cause pressure on the common peroneal nerve.

Complications of skeletal traction

1. Introduction of infection into the bone.
2. Incorrect placement of the pin or wire may:

• allow the pin or wire to cut out of the bone and cause failure of the traction system
• make control of rotation of the limb difficult
• make the application of a splint difficult
• result in an uneven pull being applied to the ends of the pin or wire causing movement of pin or wire in the bone.
  The movement will result in an increased risk of
  infection in the bone and ischemic necrosis of the skin
  around the pin or wire from pressure on the skin by the
  Bolher stirrup or Kirschner wire strainer.

3. Distraction at the fracture site as large traction forces can be applied through skeletal traction.
4. Ligamentous damage if a large traction force is applied through a joint for a prolonged period of time.
5. Damage to epiphyseal growth plates when used in children. Genu recurvatumcan can occur as a late complication of the treatment of a fracture of the femoral shaft in children with traction through the upper end of the tibia.
6. Depressed scars: These can be prevented if the skin track is pinched at the time of removal of the pin, to rupture the bridge of fibrous tissue that forms between the skin and periosteum.

From Angela Wentzell:

Potential complications that may occur in patients in traction are:

• thromboembolism
• respiratory problem
• general weakness
• skin abrasions/ulcers
• skin allergy
• constriction of circulation
• peroneal nerve palsy due to pressure from adhesive straps (skin traction)
• infection around pin sites if skeletal traction is present

From Tom Yorke:

One type of complication that may occur is delayed healing due to equipment failure. This can be due to a frayed traction cord stopping the weights from running freely. Also, weights lying against the footrest or traction bars can cause the traction to not work properly. Another consideration is loose bed frame bars on which patients can hurt themselves when moving in bed.

Other complications that can occur are skin breakdown due to the adhesive on the traction bandages, or due to improper bathing after using bedpans due to being bedridden. Another skin complication can be infection at pin sites. The skin can break down due to immobility in bed, i.e., bedsores, ulcers.

Responses were also received from: R. Aceron, L. Arseneau, A. Carlos, J. Carragher, B. Matheson, E. Christiansen, A. Crossman, F. Gibson, M. Gillingham, N. Ellsworth, R. Grenier, C. Griffith, S. Groulx, J. Humeniuk, RIF. Chun, B. Lavallee, L. Lough, G. Marshall, J. Maulucci, J. Movasseli, C. Oborowsky, R. Passmore, R. Pagay, J. Pike, J. Punwassie, B. Rawlings, C. Rivers, V. Robichaud, V. Stockdale, A. Tarambikos, H. Wong and N. Yao.