PROFORMA FOR REGESTRATION OF SUBJECT FOR DISSERTATION

MR. SYAMPRASAD.R.K1ST YEAR M.Sc NURSING

MEDICAL SURGICAL NURSINGYEAR 2009-2011

PADMASHREE COLLEGE OF NURSINGGURUKRUPA LAYOUT, NAGARBHAVI

BANGALORE-560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

0

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS

Mr. SYAMPRASAD.R.K

I YEAR M.sc. NURSING

GURUKRUPA LAYOUT

NAGARBHAVI

BANGALORE-560072

2 NAME OF THE INSTITUTE Padmashree College of Nursing

Bangalore

3 COURSE OF THE STUDY AND

SUBJECT

I Year M.sc Nursing

Medical Surgical Nursing

4 DATE OF ADMISSION 10-06-2009

5 TITLE OF THE TOPIC A Study to Assess the Knowledge and

Attitude of Caregivers Regarding Care of

Clients on Traction Admitted in Selected

Hospital, Bangalore.

1

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“If you can’t pin it or cast it, the best way is to hang it”

An orthopedic surgeon

Musculoskeletal disorders are the most common cause of severe long-term pain and

physical disability affecting hundreds of millions of people around the world. Joint diseases

and back pain is the second leading cause of sick leave. With the burden of musculoskeletal

disease at the forefront of health care worldwide, the World Health Organization (WHO)

declared 2000-2010 the Bone and Joint Decade.1

The musculoskeletal system includes the bones, joints, muscles, tendons, ligaments,

and bursae of the body. The common musculoskeletal disorders are musculoskeletal

infections, tumors, musculoskeletal trauma and metabolic bone disorders.2Among the

musculoskeletal disorders fracture is the most common and important disorder.

Fracture is the (local) separation of an object or material into two or more, pieces

under the action of stress. The word fracture is often applied to bones of living creatures.

Depending on the part which is fractured, a fracture reduces strength . A bone fracture

(sometimes abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a break

in the continuity of the bone. Although broken bone and bone break are common

colloquialisms for a bone fracture, break is not a formal orthopedic term.3

An article reveals the prevalence and incidence statistics of fracture as follows

Incidence (annual) of Fractures: 1.5 million fractures. Incidence Rate: approximately 1 in

181 or 0.55% or 1.5 million people Incidence extrapolations for Fractures: 1,499,999 per

year, 124,999 per month, 28,846 per week, 4,109 per day, 171 per hour. Deaths from

2

Fractures: 4.3 per 100,000 cases. In country vice analysis; Incidence extrapolations for

Fractures in India is 5,873,551 in 1,065,070,6072 estimated population.4

Trauma is the leading cause of death for those aged 1-34 years, and causes more

years of lost productivity before age 65 years than coronary artery disease, cancer, and

stroke combined.5

Since bone healing is a natural process which will most often occur, fracture

treatment aims to ensure the best possible function of the injured part after healing. Bone

fractures are typically treated by restoring the fractured pieces of bone to their natural

positions (if necessary), and maintaining those positions while the bone heals. Often, a

physician will align the bone, called reduction, in good position and verify the improved

alignment with an X-ray. This process is extremely painful without anaesthesia, about as

painful as breaking the bone itself.

A fractured limb is usually immobilized with a plaster or fibreglass cast or splint

which holds the bones in position and immobilizes the joints above and below the fracture.

When the initial post-fracture oedema or swelling goes down, the fracture may be placed in

a removable brace or orthosis. If being treated with surgery, surgical nails, screws, plates

and wires are used to hold the fractured bone together more directly. Alternatively,

fractured bones may be treated by the Illizarov method which is a form of external fixator.

Surgical methods of treating fractures have their own risks and benefits, but usually surgery

is done only if conservative treatment has failed or is very likely to fail. Occasionally a

surgeon uses bone grafting to treat a fracture.6

Orthopaedic surgery or orthopaedics is the branch of surgery concerned with

conditions involving the musculoskeletal system. Orthopaedic surgeons use both surgical

and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative

diseases, infections, tumors, and congenital conditions.7

3

Jean-Andre Venel established the first orthopedic institute in 1780, which was the

first hospital dedicated to the treatment of children's skeletal deformities. Antonius

Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. Many

developments in orthopedic surgery resulted from experiences during wartime. On the

battlefields of the Middle Ages the injured were treated with bandages soaked in horses'

blood which dried to form a stiff, but unsanitary, splint. Traction and splinting developed

during World War I. The use of intramedullary rods to treat fractures of the femur and tibia

was pioneered by Gerhard Küntscher of Germany. This made a noticeable difference to the

speed of recovery of injured German soldiers during World War II and led to more

widespread adoption of intramedullary fixation of fractures in the rest of the world.

However, traction was the standard method of treating thigh bone fractures until the late

1970s when the Harborview Medical Center in Seattle group popularized intramedullary

fixation without opening up the fracture. External fixation of fractures was refined by

American surgeons during the Vietnam War but a major contribution was made by Gavril

Abramovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look

after injured Russian soldiers in Siberia in the 1950s. His Ilizarov apparatus is still used

today as one of the distraction osteogenesis methods. Modern orthopaedic surgery and

musculoskeletal research has sought to make surgery less invasive and to make implanted

components better and more durable.7

In orthopaedic medicine, traction refers to the set of mechanisms for straightening

broken bones or relieving pressure on the skeletal system. There are two types of traction:

skin traction and skeletal traction.8 Traction can either be applied through the skin (skin

traction) or through pins inserted into bones (skeletal traction). Skin traction is generally

less desirable due to the fact that skin can be injured when pressure is applied for extend

periods of time. Skin traction called Buck's traction is commonly used in patients who have

a hip fracture. 9

Skeletal traction (also referred to as distraction), is one of the most ancient (as well

as one of the most modern) medical treatments known.  The Egyptian papyri (circa 3,000

B.C.), uncovered by Edwin Smith in 1862  identify the use of axial traction for the purpose

4

of reducing spinal fracture dislocations as well as the treatment of many other less serious

conditions.10

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.

Some of the commonly used tractions in present day orthopaedics are Bryant's

traction, Buck's traction, Dunlop's traction, Russell's traction and Milwaukee brace. Traction is used to manage fractures in an effort to realign broken bones; it is most often

used as a temporary measure when operative fixation is not available for a period of time. 11

Skeletal traction does have the disadvantage of complications associated with pin

insertion, and infections can come from the sites of pin insertion. 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).12

Family members or caregivers play a very important role in providing a holistic

care to the patient with traction and associated complications, therefore the investigator felt

a need to conduct a study in caregivers of traction patients.

6.2 NEED FOR THE STUDY

5

When a limb is painful as a result of a joint or a fracture of one of the bones, the

controlling muscles go in to spasm. The antagonistic muscle in a limb are not all equally

powerful, with the result that when muscle spasm is present, the action of the more

powerful muscle can produce a deformity which may seriously impair the future function

of the limb.13

Traction, when applied to an injured limb, can overcome the effect of the original

deforming force, and thus can be used to reduce a fracture or a dislocation of a joint. In

addition by overcoming muscle spasm and, in certain traction systems, the effect of gravity,

traction can relieve pain and allow the limb to be rested in the best functional position.

Traction also controls movement of an injured part of the body and thus aids in the healing

of bone and soft tissues.14

The purpose of traction is to regain normal length and alignment of involved bone,

to reduce and immobilize a fractured bone, to lessen or eliminate muscle spasms. to relieve

pressure on nerves, especially spinal, to prevent or reduce skeletal deformities or muscle

contractures.15

An experimental study conducted to detect the rate of infection in patient with

Illizarov external fixation. In control group the skin around each pin site was cleaned daily

with 0.9% saline solution and dry dressing. And in experimental group; daily shower,

cleanse with saline, gauze dressing soaked with polyvinylpyrrolidone-iodine. The rate of

infection in control group was 66.7% and in experimental group was 47.7%. It indicates

that not only the aseptic technique but the cleansing solution is also playing a major role in

preventing infection.16

Another study conducted to detect the rate of infection in 20 patients requiring

skeletal pins for acute injury from a hospital in Australia. At 72 hours of surgery,

participants were randomized to cleansing with normal saline and application of white

6

paraffin ointment daily or twice daily cleansing with normal saline and 10% of povidone

iodine solution. The rate of infection in first group is 34.1%and 2nd group is 18.1%17

An article reveals that compartment syndrome is a possible complication for every

patient with a fracture, sprain, or orthopaedic surgery. Complete evaluation of the patient is

necessary on a continual basis to determine any deviation from the normal range of the

neurovascular parameters. Early identification of the symptoms will prompt immediate

treatment and prevent the loss of a limb. So the care giver’s knowledge is very important in

early identification of symptoms and complications.18

All these statistical studies provide strong support for conducting the present

research. The researcher’s own personal experiences while working in the clinical side, has

seen that many patients on skeletal traction developed pin site infection and other

complications mainly because of lack of knowledge regarding care of traction among

caregivers.

All these motivated the researcher to conduct this study to assess the caregiver’s

knowledge and attitude regarding care of clients on traction

6.3 STATEMENT OF THE PROBLEM

A Study to Assess the Knowledge and Attitude of Caregivers Regarding Care of

Clients on Traction Admitted in Selected Hospital, Bangalore.

6.4 OBJECTIVES

1. To assess the knowledge of caregivers regarding care of clients on traction.

2. To assess the attitude of caregivers regarding care of clients on traction

7

3. To correlate knowledge and attitude of caregivers regarding care of clients on

traction.

4. To associate the knowledge and attitude of caregiver with their selected

demographic variables.

6.5OPERATIONAL DEFINITIONS

1. Knowledge: Knowledge refers to awareness and understanding of caregiver

regarding care of clients on traction such as general information about traction,

indication, types, prevention of complication and care of traction including

monitoring the skin integrity, hygiene, monitoring for peripheral vascular system,

pin site care, neurovascular checks, exercise, pain assessment and management,

positioning, monitoring symptoms of infection and monitoring the integrity of

traction as measured by structured questionnaire.

2. Attitude: It refers to opinion, belief or feelings expressed by the caregiver

regarding care of clients on traction such as skin care personal hygiene, activities of

daily living and complications.

3. Caregivers: An individual between the age group of 20 to 55 years and who is in

close relationship with the client either spouse or children or siblings or in-laws or

grand children attending to the needs of the clients who is on traction admitted in

orthopedic ward of selected hospitals.

4. Client: An adult who is admitted in orthopedic wards with skin or skeletal traction

5. Care: It is the process of looking after the client’s needs by the caregiver who is on

traction and preventing further complications.  

8

6. Traction: It refers to the set of mechanisms for straightening broken bones or

relieving pressure on the skeletal system, in which the pulling force is used to treat

muscle and skeletal disorders.

i. Skin traction: It is the application of tape, boots, and splints directly

to the skin to maintain alignment, assist in reduction and help

diminish muscle spasm.

ii. Skeletal traction: It is the surgical installation of pins, screws or

wires in to the bone, either partially or completely, to align and

immobilize body part. In this the weight (11to 18kg) is directly

applied to the bone.

6.6 ASSUMPTIONS

1. Clients on traction may experience major problems or discomforts due to their

prolonged immobility where the caregiver or family member play a vital role in

meeting their self care needs and alleviating their discomforts.

2. Caregivers may not have adequate knowledge to give care to their clients who are

on traction.

3. Caregiver’s level of existing knowledge may have an influence on their attitude in

taking care of client’s needs on traction.

6.7 HYPOTHESES

H1 : There is a significant relationship between knowledge and attitude of caregiver

regarding care of clients on traction.

H 2 : There is a significant association of knowledge and attitude of caregivers

regarding care of clients on traction with their selected demographic variables.

9

6.8 REVIEW OF LITERATURE

The term literature review refers to the activities involved in identifying and

searching information on a topic and developing an understanding of the state of

knowledge on topic.

Also review of literature is a written summary of the state and the art of a research

problem. Literature review is an essential step in the whole process of research. Therefore

the researcher has reviewed literature with regard to the problem by referring books,

journals, thesis, etc.

Traction is the use of a system of weights and pulleys to gradually change the

position of a bone. 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 19

An article states that, approximately 66% of all physical injuries involve the

musculoskeletal system like fractures, dislocations, and related injuries to soft tissue. So

musculoskeletal injuries are commonly seen in the health care setting and are a major part

of the nursing profession which lights towards the thought that nurses and caregivers are

having an important role in patient care. 20

An article reveals that, traction has been the mainstay of orthopaedic management

for thousands of years, with its use recorded by the ancient Egyptians. In more recent

times, however, the advances in surgical reductions of fractures and musculoskeletal

disruptions, coupled with the economic imperatives of reducing hospital bed stay days has

seen a reduction the use of prolonged periods of traction.21

Another article reveals that traction is a treatment modality used for the reduction or

immobilization of fractures or dislocations. It is used to maintain alignment, decrease

muscle spasms, relieve pain, correct, lessen or prevent deformities, expand joint spaces

10

prior to surgery, promote rest to diseased or injured body parts and to promote exercise.

Caregivers need a working knowledge of the various types of traction along with its

rationale, correct setup, and maintenance. They must become familiar with potential

complications related to traction and prolonged bedrest.22

A study conducted to find out the effectiveness of external fixation, use of

percutaneous orthopaedic pins (metal rods or wires used to support an external device) and

research found that the advantages of external fixators are early mobilization, axial loading

of the fracture (along the normal line of the limb), easy observation of the limb and access

to the skin for wound care.23

A study conducted on treatment modalities of fracture including, combination of

external fixation with internal fixation (where wire and plates are used to hold bone

fragments together beneath a surgical wound), traction or plaster cast. The study concluded

that the process of bone healing is higher compared to other therapeutic measures. 24

A study conducted on safe handling of patients on cervical traction, the caregiver

often have to care for patients with unstable vertebral column damage and spinal cord

injury which is being treated by cervical traction. The risk of causing further vertebral or

spinal cord damage is always present, but it can be minimized through tuition and correct

handling techniques. Friction will need to be prevented or reduced, as it can interfere with

the therapeutic effects. Complications of cervical traction can occur therefore meticulous

pin-site observation is critical.25

A study was conducted on care of clients with traction and role of traction in

alleviating the pain. Traction can help to overcome the effects of the original deforming

force of a limb, the effects of muscle spasm and gravity, and it can relieve pain. Traction

pulls the whole body in the direction of the weights, and counter-traction is used to create

the desired traction. Types of traction include manual, skin traction and skeletal traction.

Caregivers need to provide traction patients with regular skin and pressure-area

management and skin monitoring.26

11

A study was to identify factors that may affect the occurrence of ulceration in

patients immobilised with a Thomas splint and specifically to investigate different

frequencies of pressure care in preventing skin changes associated with ulceration. Thomas

splints are often used to immobilise patients who have a fractured femur. Skin ulceration

may occur in the area under and around a Thomas splint causing considerable discomfort to

the patient. The effects of other factors including the patient’s weight, leg circumference,

type of fracture, traction ring size and traction weight on the incidence of skin changes

were also investigated. Data were collected from 33 children in three different hospitals.

Results suggest that the duration between pressure cares may be reduced from 2 to 6 h

(possibly 4 h). Thus reducing the risks associated with movement of the fractured leg.27

In UK, a study conducted on pin site care. Thirty females aged 11 to 18 years with

120 pin sites who were undergoing leg lengthening surgery had daily pin site care

according to a specified protocol and were randomised to either cleansing with 0.9% saline,

with 70% alcohol or no cleansing. Crust removal, gentle massage, spraying with dry

povidone iodine and dressing with dry gauze was undertaken at all sites. The majority of

sites were in the femur or tibia. The rate of infection was 25% in those patients cleansed

with saline, 17.5% in pin site care with alcohol and patients who are not received daily

cleansing has only 7% of infection. The above findings shows that the caregivers have a

less knowledge regarding aseptic technique to be followed while cleaning the pin site.28

A retrospective, descriptive study examined the clinical manifestations of pin

reactions in adults with extremity fracture, treated with skeletal traction and routine pin

care. Data were collected from 12 case study records relative to fracture injury

characteristics, pin site appearance and reaction incidence, pin care treatments, health

deviation history, and routine medication therapy. Results showed that consistent

application of routine pin care with hydrogen peroxide did not prevent pin reactions in

those subjects with external fixators. Findings also suggested that factors such as fracture

type, kind of traction, length of time pins were present and proper caring may have had an

impact on pin reaction development.29

12

An article explains about the fitness and exercise to the patient with orthopaedic

traction. Even more than the general population, orthopedic patients suffers from multiple

consequences of immobility. Fortunately, most of these patients are physically able to

participate in some degree of moderately intense exercise. Helping the orthopedic patient

initiate and adhere to a moderately intense exercise routine is a challenge to the caregiver.

Understanding the health-related benefits that can be derived from participation in

moderately intense exercise routines and the recommended guidelines for exercise

frequency and intensity is a first step toward initiating a fitness routine. Using information

acquired from research, caregivers can assess for specific facilitators and barriers to

exercise participation. This assessment data can then be used to individualize plans for

exercise that meet the fitness needs of the patients. And these exercise programmes helps

the patient to prevent the complications related to immobility. 30

A descriptive study aimed to describe the body image and self-esteem of patients

with external fixation devices. Fifty patients with external fixation devices who came for

follow-up to the Illizarov Outpatient Clinic of a university hospital in Turkey were

included in this study. The study highlighted that body image disturbance and threats to

self-esteem are common with the use of external fixation and need to be assessed by

caregivers and family members.31

An article reveals about Traction Intolerance Syndrome, which is a behavioural

and/or emotional reaction related to skeletal traction severe enough to require psychiatric

consultation and/or the use of major psychiatric medication for prolonged periods in the

absence of pre-existing major psychiatric illness. Patients often attribute these reactions to

the predicament of traction. This syndrome was present in five of nine patients between the

ages of sixteen and forty-five who underwent traction for more than three weeks.

Moreover, all the patients were between sixteen and twenty-six years of age, and all the

patients in that age range developed the syndrome. The article concluded that family

support is mandatory for the patient to cope up with the condition.32

13

A study conducted to assess the caregiver’s knowledge about the psychological

impact of handling patients (especially adolescents) with external fixation devices (EFDs).

The study reported psychological and behavioural changes after EFD treatment. Pain and

pin-site infections were the most problematic physical findings. Depression was universally

evident to varying degrees, with some suicidal ideation and self-destructive behaviours,

although mostly reported as transient. This retrospective cohort of studies reported social

isolation as well as eating and sleeps disturbances. Family and nursing support, a multiple

disciplinary approach, and better preoperative preparation were crucial to patient’s

psychological health after EFD treatment. Adolescents treated with EFDs require

significant psychosocial support. The findings reveal major gaps in the knowledge on

adolescents treated with external fixation for traumatic injury and none focused on EFD

treatment in the acute period.33

A study conducted to investigate the efficacy and safety of home traction in the

treatment schedule of overhead traction method (OHT) for developmental dysplasia of the

hip (DDH). Department of Orthopaedic Surgery introduced an overhead traction method

into the treatment protocol for developmental dysplasia of the hip. They compared 20

patients who underwent home traction in the OHT treatment schedule (Home T group)

with 20 patients who underwent hospital traction for the entire period (Hosp. T group).

There was no significant difference in the total duration of treatment between the two

groups. Home traction in the OHT schedule is safe and useful because it can shorten the

hospitalization period with a traction effect equal to that of hospital traction and without

significant differences in complications.34

14

7. MATERIAL AND METHODS

7.1 SOURCE OF DATAThe data will be collected from the caregivers of the client with traction admitted in

orthopedic ward of selected hospital.

7.2 METHODS OF COLLECTION OF DATA

I. Research design

Non experimental, descriptive correlational design

II. Research variables

Study variables:

The dependent variables are knowledge and attitude of caregivers

regarding care of clients on traction.

Demographic variables:

The demographic variable of the caregivers of clients such as age,

gender, relationship with the client, educational status, occupation, type of

family and previous exposure to information.

The demographic variable of the clients such as diagnosis, duration

of hospitalization, types of traction and duration of traction.

III. Setting

The study will be conducted in orthopaedic ward of selected hospitals,

Bangalore.

IV. Population

Caregiver of all clients admitted in orthopaedic wards of selected hospital.

15

V. Samples:

Caregivers of client who fulfill the inclusion criteria and Sample size will be

90

VI. Criteria for selection of the sample

Inclusion criteria:

The Study includes

1. Caregiver of client with skin or skeletal traction admitted in

orthopedic ward.

2. Significant family member who is closely related to the client such

as spouse or children or sibling or in-laws or grand children

3. Caregiver who is in the age group of 20-55 years.

Exclusion criteria:

The study excludes

1. The caregiver who are not willing to participate in the study.

VII. Sampling technique:

Non probability purposive sampling technique will be adopted for selecting the

sample.

VIII. Tool for data collection:

Data will be collected in following sections:

Section A: Interview schedule will be used to assess the demographic variables of a

caregivers consisting of age, gender, relationship with client, educational status,

occupation, type of family and previous exposure to information. And

demographic variables of client such as diagnosis, duration of illness, types of

traction and duration of treatment.

16

Section B: Structured interview schedule will be used to assess the knowledge of

caregivers regarding care of client on traction.

Section C: Likert scale (3 point) will be used to assess the attitude of caregivers regarding

clients on traction.

IX. Methods of data collection:

Phase 1: After obtaining the permission from concerned authorities and informed consent

from the samples, the investigator will collect the baseline demographic data.

Phase 2: The investigator will administer the structured interview schedule to assess

caregiver’s knowledge regarding clients on traction admitted in orthopaedic ward of

selected hospitals.

Phase 3: The investigator will administer Likert scale to assess the attitude of caregivers

regarding clients on traction admitted in orthopaedic ward of selected hospitals.

The duration of data collection will be 4 weeks.

X. Plan for data analysis

Descriptive statistics:

Frequency, percentage distribution, mean and standard deviation will be used to

analyse the level of knowledge and attitude.

Inferential statistics:

Correlation co-efficient will be used to correlate knowledge and attitude among

caregivers regarding care of traction.

Chi square test will be used to analyse the association of knowledge and attitude

among caregivers regarding care of clients on traction.

17

XI. Projected out come

The investigator will assess the level of existing knowledge and attitude of the

caregiver on care of clients with traction. Based on the finding obtained, instructional

module will be developed and distributed to the subjects, which will be beneficial in

enhancing the level of knowledge and attitude of caregivers regarding care of client on

traction and caregiver can provide better care for their client.

7.3 Does the study require any investigations or interventions to the

patients or other human beings or animals?

Yes, the study requires a minimum investigation on knowledge and attitude of

caregivers because the investigator is planning only for descriptive study and no active

manipulation is involved in the study.

7.4 Has ethical clearance obtained from your institution?

Yes, Formal permission will be obtained from the concerned authorities of the

hospital and the informed consent will be obtained from the research subjects.

18

8. LIST OF REFRENCES

1. Weinstein SL. The Bone and Joint Decade 2000-2010. American Journal of Bone

and Joint Surgery. 2000 Jan; 82(3): 1-3.

2. Suzane C Smeltzer, Brenda G Bare, Janice L Hinkle, Kerry H Cheever. Text Book of

Medical Surgical Nursing. Brunner & Suddarth. 10th ed. Philadelphia: Lippincot

William &Wilkins Publishers; 2008; 2026-2030.

3. Fracture and Dislocation Compendium. Orthopaedic Trauma Association

Committee for Coding and Classification. J Orthop Trauma. 2007 Nov; 10 (1):

1–154. Available from http://www.ota.org/compendium/intro.pdf

4. Wrong Diagnosis. Available from

http://www.wrongdiagnosis.com/f/fractures/prevalence.html

5. Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E. Incidence and Lifetime

costs of Injuries in the United States. In J Prev. 2006 Aug; 12(4): 212-8 

6. Bone healing, BestBets: Do Non-steroidal Anti-Inflammatory Drugs cause a

Delay in Fracture Healing. The Free Encyclopedia. Available from

http://www.bestbets.org/bets/bet.

7. Ranawat CS. History of orthopedics. J South Orthop Assoc. 2008 Apr; 11 (4):

218–226

8. Traction Guidelines. 2007 Jul. Available from

http://www.kaleidoscope.org.au/docs

9. Skin Traction: Buck’s Traction. Available from http://www.answers.com

19

10. Skeletal Traction. Available from http://www.burtonreport.com/topic/skeltal

traction-orthopedics.

11. Skeletal Traction-Types. Available from http://www.answers.com/topic/traction-

orthopedics

12. Overly MD. Frank Dale W, Steele. Common Pediatric Fractures and Dislocations.

Clinical J Ped Emrgncy Med. 2002 Jun 3(2):12-14.

13. Mathew Hudson. Wound healing in orthopedic traction, In J Orthop 2007 Mar; 45:

24-30.

14. John M Stewart, Traction and Orthopedic Appliances. 2nd ed New Delhi :BI Churchill

Livingstone; 2001;1

15. Purposes of Traction. Available from http://en.wikipedia.org/wiki/Traction_

%28orthopedics%29

16. A.M. Camilo and J.C. Bongiovanni. Skeletal Traction Pin Site Care. Available from

http://linkinghub.elsevier.com/retrieve/pii/S1361311106000999

17. Grant. Skeletal Traction Pin Site Infection. Available from

http://www.cochrane.org/contact/ccsgcont.htm#7539

18. Altizer, Linda. Orthopedic Nursing; Orthopedic Essentials. 2004 Nov; 23 (6): 391-

396

19. Definition-Traction. Available from

http://www.thefreedictionary.com/traction+orthopedic

20

20. Altizer, Linda, Robinson. Fracture. Orthopedic Nursing. Orthopedic Essentials. 2002

Nov; 21 (6):51-60. Available from

http://journals.lww.com/orthopaedicnursing/Abstract/2002/11000/Fractures.11.aspx

21. Osmond T. Principle of traction. Aust Nurs J. 1999 Feb; 6(7): 11-14.

22. Styrcula, Laurie. Traction basics- Part II Traction Equipment. Orthopedic Nursing.

1999 May; 13(3):55-59

23. Edward Scott. Effectiveness of External Fixation; Medical Perspectives. International

Journal of Orthopedic. 2006 Mar 2; 29(4):33-38

24. Peterson R, Alex J, Andria Ann T. Treatment Modalities of Fracture - Combination

of External Fixation with Internal Fixation. J Orthop surg. 2001Mar; 23(4): 67-72

25. McCarthy. Health ISSN Complications and Side effects of Cervical Traction.

Nursing Times.1998 Apr; 62(2) 312-14

26. Mellett. Care of the Orthopedic Patient with Traction- Traction Helps Correct not

only the Original injury to a Limb, but also Alleviate any Pain. Nursing Times. 1998

Apr; 62(2): 318-20

27. Skin ulceration: Thomas splint. Available from

http://linkinghub.elsevier.com/retrieve/prefs/displayPrefs

28. Henry. Skeletal Traction- Pin site care. Available from

http://www.cochrane.org/contact/ccsgcont.htm#7539

21

29. Jones-Walton, Peggy. Effects of Pin Care on Pin Reactions in Adults with Extremity

Fracture Treated with Skeletal Traction and External Fixation. Orthopedic Nursing.

1999 Aug; 7(4):29-33

30. Konradi, Donna B, Anglin Linda T. Moderate-Intensity Exercise: For Our Patients.

Orthopedic Nursing. 2001 Jan; 20 (1): 47-57

31. Büyükyilmaz, Funda, Sendir, Merdiye, Salmond, Susan. Evaluation of Body Image

and Self-Esteem in Patients With External Fixation Devices: A Turkish Perspective.

Orthopaedic Nursing. 2009 Jul 28 (4 ):169-175

32. Putnam N, Yager J. Traction Intolerance Syndrome: A Psychiatric Complication of

Femoral Fractures. Int J Psychiatry Med. 1977-1978; 8(2):133-43

33. Patterson M, Miki. Impact of External Fixation on Adolescents: An Integrative

Research Review Orthopedic Nursing. 2006 Oct; 25 (5):300-308.

34. Kitakoji T, Kitoh H, Katoh M, Kurita K, Nogami K, Ishiguro N. Home Traction

in the Treatment Schedule of Overhead Traction for Developmental Dysplasia of the

Hip. J Orthop Sci. 2005 Sep; 10(5):475-9.

22

9. Signature of the candidate :

10. Remark of the guide : The study is beneficial in assessing and also

enhancing caregivers knowledge and attitude

of clients on traction and has an implication in

orthopedic nursing.

11. Name of designation of

11.1 Guide : Mrs. Fathima.L

Vice Principal

11.2 Signature :

11.3 co-guide (if any) : Miss. Shoba G,

Asst.Professor.

11.4 Signature :

11.5 Head of the department : Mrs. Fathima.L

Vice Principal

11.6 Signature :

12.

12.1 Remark of the principal : The study is relevant, feasible and

appropriate for the specialty chosen.

12.2 Signature :

23