Feethical fractures are often managed utilizing skin tractivity prior to their definitive surgical administration. Some call for brief term traction ie. 24 hrs whereas others require it for a variety of weeks ie. 6 weeks. Traction borders motion and also reduces the fracture to aid decrease pain, spasms and also swelling. It aims to regain and preserve straight alignment and size of bone complying with fractures.

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Aim

This clinical exercise pointer intends to encertain that the application and management of skin traction is continuous and that potential complications are established early on and also controlled properly.

Definition of terms

Fracture: Any form of break in a bone. Traction: Traction is the application of a pulling pressure toan injured part of the body or extremity. Skin Traction (BucksTraction): Skin traction isused by strapping the patient’s affected reduced limb and attaching weights. Counter Traction: Application of force in the opposite direction usedto oppose/balance out tractivity. Compartmentsyndrome: Increased push within one of the bodies compartments which contain muscles and also nerves.

Management

Acute management

Encertain Order for Skin traction is documentedby the Orthopaedic Team-(including weight to be applied in kgs)Preparation of equipment Hospital Traction bed through bar at the finish of the bedTraction kit paediatric OR adult size (foam stirrup with rope and also bandage)Overhead tractivity framePulleyTractivity weight bagWaterSleek

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Picture 1 - Traction Kit; Picture 2 - Foam brace via rope; Picture 3 -Tractivity weight bag 

Pain relief

A femoral nerve block is the wanted pain management strategy and need to be administered in the emergency department before being admitted to the ward.Diazepam and also Oxycodone have to always be charted and used in conjunction via the femoral nerve block.

Distractivity and education

Exordinary the procedure to the paleas and patient before commencing.Plan correct distractivity from play therapy, parents or various other nursing staff. 

Application of traction

Ensure the correct amount of water has actually been included to the tractivity weight bag as per clinical orders. (Formula to calculate weight in kgs to come)Fold foam stirrup about the heel, ankle and reduced leg of influenced limb. Apply bandage, founding at the ankle, up the lower leg using a number 8 technique, secure via sleek tape.Place rope over the sheave and connect traction weight bag. If vital trim rope to ensure traction weigh bag is suspfinished in air and also does not sit on the floor.

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Picture – Foam stirrup and bandage. 

Ongoing management

Maintain skin integrityPatient’s legs, heels, elbows and buttocks may build pressure locations because of remaining in the exact same place and also the banderas.Position a rolled up towel/pillow under the heel to relieve potential press.Encourage the patient to replace themselves or finish push area care 4 hourly.Rerelocate the foam brace and also bandage when per shift, to relieve potential press and observe problem patients skin. Keep the sheets dry.Document the condition of skin throughout treatment in the development notes and also care planEnsure that the push injury prevention score and also setup is assessed and also recorded. Tractivity careEnsure that the traction weight bag is hanging freely, the bag should notrest on the bed or the floorIf the rope becomes frayed relocation themThe rope need to be in the pulley-block tracksEnsure the bandperiods are complimentary from wrinklesTilt the bed to keep respond to tractionObservationsCheck the patient’s neurovascular monitorings hourly and record in the medical document. If the bandage is as well tight it can reason blood circulation to be slowed. Monitoring of swelling of the femur must also take place to monitor for compartment syndrome.If neurovascular weaken is detected remove the bandage and also reapply bandage not as tight. If circulation does not enhance inform the orthopaedic team. Pain Assessment and also ManagementAssessment of pain is essential to encertain that the correct analgesic is administered for the wanted effect Paracetamol, Diazepam and also Oxycodone have to all be charted and administered as necessary.Pre-emptive analgesia ensures that the patient’s pain is sufficiently controlled and need to be thought about prior to press location treatment.Assess and record outcomes of pain monitoring strategies employedActivityThe patient is able to sit up in bed and also participate in quiet activities such as craft, board games and watching TV. Play treatment will certainly be useful for patients in tractivity long term. Non-pharmacological distractivity and activity will certainly enhance patient comfort. The patient is able to move in bed as tolerated for hygiene to be completed.Patients that are in traction for a number of weeks may require a referral to the education and learning department/kinder.  Theatre timeThe patient need to be transported to theatre in tractivity to minimize painand also keep alignment.

Special considerations

Thefoam brace, bandage and rope are single patient use only.

Potential complications

Skin breakdown/pressure areas Neurovascular handicap Compartment syndromeJoint contractures Constipation from immobility and analgesics

Companion documents

References

Ahmed, A., Beaupre, L., Rashiq, S., Dryden, D.,Hamm, M., Jones, A. (2011). Comparative performance of pain managementinterventions for hip fracture: a methodical evaluation. Annals of internalmedicine, 155(4), 234-246.Anglen, J. & Choi, L. (2005). Treatment optionsin Paediatric Feethical Obelisk Fractures. Journalof Orthopaedic Trauma, 19 (10),724-733.Bailey, J. (2003). Orthopaedic treatment. Nursing Center, 33(6), 58-63.Parker, M. Handoll,P. (2009). Pre-operative traction for fractures of the proximal femur inadults. The Cochrane Collaboration, 1-30.Hedin, H., Bderekwadsworth.comquist, L. & Larskid, S. (2004). Acost evaluation of 3 approaches of treating femoral shaft fractures in kids.Acta Orthopaedic Scand, 75 (3), 241-248.Orthopaedic Traction: Care and monitoring (2014).The Children’s Hospital Westmead Practice Guideline. Pressure area prevention administration clinicalexercise tip (2014). Royal Children’s Hospital. Split Russell’s/Bucks Tractivity (2012). CincinnatiChildren’s Health Topics. Saygi, B., Ozkan, K., Eceviz, E., Tetik, C. &Sen, C. (2010) Skin traction and also placebo result in the preoperative painregulate of patients through collum and also intertrochanteric femur fractures. Bullentin of the NYU Hospital for jointconditions, 68(1) 15-17.Smith, C. (1994). Nursing the patient in tractivity. Nursing Times, 36-39. Stewart, J. & Hallett, J. (1994). Tractivity andorthopaedic appliances 2nd edition. 4-14. Styrcula, L. (1994). Traction Basics. Orthopaedic Nursing, 13(2), 71-74. Trompeter, A. & Newguy, K. (2013). Femoral shaftfractures in adults. Orthopaedics andTrauma, 27(5), 322-331.Wilson, D., Curry, M. & Hockenberry, M.(2009). The boy with musculoskeletalor articular dysattribute. In Hockenberry, M.J., & Wilboy, D. Wong’s Essentials of pediatric nursing.(8th ed.). (pp 1106-1173).

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