Skeletal Traction
Purpose: application of pull to injured extremity while counter force (patient weight) pulls in opposite direction to reduce or re-align fracture
Primarily used short term and in older or larger children.
Care of the Child in Skeletal Traction
- Educate patient & family – purpose of traction, ability & methods of movement in traction
- Encourage use of Trapeze to assist with movement
- Child can raise himself/herself off bed with trapeze, provided other traumatic injuries are not contraindications (e.g. upper extremity fractures)
- Pain Control – provide pain control measures, keeping in mind that the fracture, while in better alignment with traction, still requires fixation for proper healing.
- Muscle spasms – anticipate muscle spasms as the traction weights pull/hold the fracture in proper alignment.
- Documentation – neurovascular assessments, skin & pin site assessments, and (per hospital policy) number of pounds of traction
- Turning & Positioning
- Nurses can support weights gently during patient movement, ensuring smooth movement and free hanging of weights (e.g. preventing weights getting caught in foot board of bed)
- Bed sheets can be changed top to bottom, with child’s assistance lifting off bed (rather than moving side-to-side)
- Trendelenburg positioning can be used to help keep child from sliding to foot of bed
- Lower extremity with traction may be positioned on the bed (with pillow) provided weights are free hanging and extremity is aligned with the pull AND the heel of the foot is elevated off the bed to prevent skin breakdown
- If child’s feet are against footboard, child needs to be moved up in bed
- For larger or multiply injured children, consider using Tortoise positioning system
Pin Care
- Should be PRN only
- Needed for the following devices:
External Fixator**
Halo traction'
Skeletal traction
PRN Pin Care
with gauze in place
Remove 4X4’s from pins
Gently cleanse skin
Replace Chlor-prep soaked 4X4’s
Without gauze in place
Gently Cleanse skin using chlor-prep (Hibiclens)
Do NOT aggressively push skin away from pin sites
**for Ilizarov devices, see specific pin care instructions.
