Types of Traction

1
Types of Traction

• Bryants traction used for children younger than
  3 years and weighing less than
• 35 pounds who have a fractured femur or
  congenital hip dyplasia
• Bucks traction used for knee immobilization or
  for short-term immobilization of a fracture
• Dunlops traction used for supracondylar
  fractures of the humerus
• Russells traction used for fractures of the
  femur and lower leg

2
Types of Traction
3
Types of Traction
4
Disadvantages of Traction

• Need for hospitalization
• Prolonged immobility
• Always assume that traction is continuous unless
  the physician states otherwise

5
Physiologic Effects of Immobilization

• Directly or indirectly relate to decreased muscle
  activity and have an impact on all systems
• Integumentary
• Red or irritated skin
• Presence of ulceration or drainage
• Gastrointestinal
• Decreased mobility leads to constipation

6
Physiologic Effects of Immobilization

• Respiratory
• Lying supine for prolonged periods leads to
  altered respirations
• Genitourinary
• Decreased urinary output from stasis or retention
• Musculoskeletal
• Significant loss of muscle strength, endurance,
  and muscle mass
• Bone demineralization
• Loss of joint mobility

7
Psychologic Effects of Immobilization

• Immobilization narrows the amount and variety of
  environmental stimuli a child receives through
  the senses
• Physical interference with the activities of
  infants and young children gives them a feeling
  of helplessness and has been found to affect
  speech and language development
• Sensory deprivation in the school-age child and
  adolescent leads to feelings of isolation,
  boredom, and being forgotten, especially by peers

8
Psychologic Effects of Immobilization

• The struggle for independence in each of
  Eriksons phases is thwarted by imposed
  immobility
• Toddlers need exploration and the ability to
  imitate behaviors to develop a sense of autonomy
• Preschoolers expression of initiative is
  evidenced by their need for vigorous physical
  activity

9
Psychologic Effects of Immobilization

• School-age industry is influenced by physical
  achievement and competition
• Adolescence rely on mobility to achieve
  independence, one of the steps in creating their
  identity

10
Behavioral Changes in Immobilized Children

• Changes related to high levels of anxiety
• Restlessness
• Depression
• Regression
• Egocentrism
• Difficulty with problem solving
• Inability to concentrate on activities

11
Behavioral Changes in Immobilized Children

• Changes related to monotony
• Hallucinations
• Disorientation
• Dependence
• Depression
• Acting-out behavior
• Increased fantasizing
• Sluggish intellectual responses
• Sluggish psychomotor responses
• Decreased communication skills

12
Nursing Considerationsfor the Child in a Cast or
in Traction

• Monitor for complications of fracture reduction
• Infection
• Nerve compression syndrome
• Kidney stones
• Pulmonary emboli
• Circulatory impairment
• Fat embolism (pulmonary embolism)

13
Nursing Considerationsfor the Child in a Cast or
in Traction

• Keep cast or other appliance clean and dry
  (especially from urine or feces)
• Monitor bowel sounds
• Assess for abdominal distention
• Provide optimal nutrition for bone healing,
  growth, and development

14
Nursing Considerationsfor the Child in a Cast or
in Traction

• Neurovascular assessment every 1 to 2 hours
  after application of device
• Assessment of strength of pulse distal to the
  site
• Assessment of capillary refill
• Assessment of five Ps
• Reposition every 2 hours encourage mobility
  within the confines of traction or cast
• Prevent skin breakdown

15
Nursing Considerationsfor the Child in a Cast or
in Traction

• Maintain hydration
• Encourage or provide range of motion exercises as
  appropriate for cast or traction
• Provide opportunities for therapeutic play
• Encourage and provide opportunities for
  school-age child and adolescent to keep up with
  school work and friends

16
Soft Tissue Injuries

• Contusions damage to the soft tissue,
  subcutaneous structures, and muscle
• Dislocations bone ends displaced from their
  normal position

17
Soft Tissue Injuries
Sprains occur when trauma to a joint is so severe
that a ligament is either stretched or partially
or completely torn by the force created as a
joint is twisted or wrenched
18
Soft Tissue Injuries

• Clinical manifestations
• Pain
• Swelling
• Localized tenderness
• Limited range of motion
• Poor weight bearing
• Popping or snapping sound (sprains)
• Diagnostic evaluation
• Clinical picture and history
• Radiographs to rule out fracture

19
Soft Tissue InjuriesNursing Considerations

• Ice
• Compression
• Elevation
• Support

• Rest
• Ice
• Compression
• Elevation

• Analgesics for pain management in combination
  with distraction as well as age-appropriate play
  activities
• Review principles of RICE/ICES with parents

20
Congenital Musculoskeletal Health Problems

• Clubfoot
• Developmental dysplasia of the hip
• Osteogenesis imperfecta

21
Clubfoot

• Congenital malformation of the lower extremity
  that affects the lower leg, ankle, and foot
• Clinical manifestations
• One or a combination of four deformities
• Plantar flexion
• Dorsiflexion
• Varus deviation (foot turns in)
• Valgus deviation (foot turns out)

22
Clubfoot

• Involves bone deformity and malposition with soft
  tissue contraction
• May be unilateral or bilateral
• Affected foot is usually smaller and shorter,
  with an empty heel pad and transverse plantar
  crease
• Easily recognized at birth
• Therapeutic management
• Serial manipulation and casting
• If sufficient correction not achieved within 3 to
  6 months, surgery is performed
• Long-term follow-up

23
Clubfoot

• Postoperative nursing considerations
• Neurovascular checks at least every 2 hours
• Observe for any swelling around cast edges
• Elevate ankle and foot on pillows apply ice
• Monitor drainage in cast
• Pain management (analgesics as ordered,
  distraction)
• Education for home management (discharge
  teaching)

24
Developmental Dysplasia of the Hip

• Also called congenital dislocation of the hip
• Refers to a variety of conditions in which the
  femoral head and acetabulum are improperly
  aligned
• May be unilateral or bilateral

25
Developmental Dysplasia of the Hip

• Predisposing factors
• Twins
• Breech delivery
• Maternal hormones relaxin and estrogen
• Large infant
• Clinical manifestations in the neonate
• Displaced femoral head from the acetabulum on
  manipulation (positive Ortolanis maneuver)

26
Developmental Dysplasia of the Hip

• Clinical manifestations in the infant
• Asymmetry of the gluteal skin folds
• Limited range of motion in the affected hip
• Asymmetric abduction
• Femur on affected side appears short

• Clinical manifestations in the child
• Clinical manifestations in the infant plus
• Minimal to pronounced variations in gait, with
  lurching toward affected side

27
Developmental Dysplasia of the Hip

• Diagnostic evaluation
• Screening at birth with Ortolanis and Barlow's
  maneuvers
• Ultrasound is useful between 4 and 6 weeks of
  age
• Radiography in older infants and children

28
Developmental Dysplasia of the Hip

• Therapeutic management in the neonatal period
• Splinting the hips with a Pavlik harness to
  maintain flexion, abduction, and external
  rotation