Type of Intervention
Bryant’s Traction
Description and Use
Both legs are extended vertically,
with child’s weight serving as
countertraction. Skin traction is
applied to both legs. Used to reduce
femur fracture in children younger
than 2 years or with developmental
dysplasia of the hip
Nursing Considerations
Maintain appropriate position.
Ensure heels and ankles are free
from pressure. Assess condition and
position of elastic bandages every
shift and rewrap elastic bandages as
ordered.
Buck’s Extension Traction
Skin traction for hip and knee
contractures, Legg–Calvé–Perthes
disease, slipped capital femoral
epiphysis. Used to rest an injured
limb or to prevent spasms of injured
muscles or joints
Traction force delivered in straight
line
Remove traction boot every 8 hours
to assess skin. Leg may be slightly
abducted.
Russell’s Traction
Skin traction for femur fracture,
hip, and specific types of knee
injuries or contractures. Uses a knee
sling. In split Russell traction, a
portion of the traction weight may
be redistributed via a pulley from
the sling to the head of the bed
(used for femur fracture, Legg–
Calvé–Perthes disease, slipped
capital femoral epiphysis)
Wrap bandages from ankle to thigh
on children younger than age 2
years, from ankle to knee on
children older than 2 years. Use a
foot support to prevent foot drop.
Ensure heel is free from bed.
Assess popliteal region for skin
breakdown from the sling. Mark leg
to ensure proper replacement of
sling.
Cervical Traction
Skin traction applied with a skin
strap (head halter). Used for neck
sprains/strains, torticollis, or nerve
trauma
Ensure that head halter or skin strap
does not place pressure on ears or
throat. Limit of 5–7 lb of weight.
Halo Traction
Metal halo attached to skull via
pins. Used for cervical or high
thoracic vertebrae fracture or
dislocation and for postoperative
immobilization following cervical
fusion
Refer to nursing implications for
cervical tongs.
Tape small wrench to front of brace
so that front panel can be quickly
removed in an emergency. May
become ambulatory in this type of
traction; will be top-heavy so may
need assistance with balance
Assess pin sites and provide pin
care as ordered.
Type of Intervention
Description and Use
Nursing Considerations
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Balanced Suspension Traction
Used for femur, hip, or tibial
fracture. Thomas splint suspends
the thigh while the Pearson
attachment allows knee flexion and
supports the leg below the knee
Avoid pressure to popliteal area.
90/90 Femoral (knee) Traction
For femur fracture reduction when
skin traction is inadequate. Skeletal
traction with force applied through
pin in distal femur
A foam boot may be used for
suspension of the lower leg. Force
of traction applied to femur via the
pin. The amount of weight used is
just enough to hold lower limb
suspended.
Skeletal Traction Pin Care
Keeping the pin sites clean is
important to prevent infection.
Cleaning of the pin sites prevent
infections from promoting comfort
and preventing healing skin from
adhering to the metal pin.
Assess frequently for increased
pain, respiratory distress, and spinal
cord, cranial nerve, or brachial
plexus injury. Place on Stryker
frame or specially equipped bed to
ease positioning without disruption
of alignment.
Actual Pin Care Perform pin care weekly after the
first 48 to 72 hours.
Perform earlier if large amounts of
drainage are present.
Use chlorohexidine in alcohol for
cleaning.
Use a non-shedding material for
cleaning.
Cover pin sites with a non-shedding
dressing.
External Fixation Devices
Surgical reduction of a fracture or
skeletal deformity with an internal
or external pin or fixation device
Fractures, skeletal deformities
Plaster of Paris Cast
Plaster casts are made up of a
bandage and a hard covering,
usually plaster of paris. They allow
broken bones in the arm or leg to
heal by holding them in place, and
usually need to stay on for between
4 and 12 weeks.
No additional care for internal
fixation.
External fixation: perform pin care
as prescribed by the surgeon.
Assess for excess drainage or pin
slippage, notifying physician or
nurse practitioner if this occurs.
Velcro or snaps on sleeves and pant
legs help with dressing.
Plaster requires 24 to 48 hours to
dry.
Take care not to cause depressions
in the plaster cast while drying, as
those may cause skin pressure and
breakdown.
Instruct the child and family to keep
the cast still, positioning it with
pillows as needed.
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Plaster casts require special
treatment of the cast edge to
prevent skin rubbing.
Assess frequently for neurovascular
compromise, skin impairment at
cast edges.
Protect cast from moisture.
Teach family how to care for cast at
home.
Fiberglass Cast
Fracture reduction, dislocations,
correction of deformities
Application of fiberglass material to
form a rigid apparatus to
immobilize a body part
Assess frequently for neurovascular
compromise, skin impairment at
cast edges.
Protect cast from moisture.
Teach family how to care for cast at
home.
usually take only a few minutes to
dry and will cause a very warm
feeling inside the cast, so warn the
child that it will begin to feel very
warm.
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