Pediatric Nursing Demystified

Crepitus

Reduced range of motion

Unable to bear weight on the injured bone

Test Results

Radiograph: Confirms the fracture and confirms realignment of the sur-

face area of the bone.

Decreased hematocrit may indicate blood loss either from the injury or

from surgical reduction of the fracture, if performed. This might result

in low hemoglobin and reduced oxygenation of blood, which might

inhibit tissue repair.

Treatment

Closed reduction realigns the surface area of the bone by manipulating

the bones or by applying tractionto encourage healing.

Open reduction is a surgical procedure performed when a closed reduction

is not possible or when repair must be made to torn muscle and ligaments

to encourage healing. Pins, screws, plates, or rods might be used to

realign the bone.

Immobilize the bone to prevent further injury and to keep the bone

realigned.

Apply traction to realign bones, reduce muscle spasms, and to immobilize:

• Skin traction: Adhesive material, straps, or foam boot are used to
  pull the surface of the skin to cause traction on the bone. Types of
  skin traction are
  Buck extension: For knee immobilization
  Bryant traction: For hip dysplasia and fractured femur for children
  <3 years of age and weighing <17.5 kg
  Russell traction: For fractures of the femur and lower legs


• Skeletal traction: Pins, wires, and tongs are surgically placed in the
  bone applying direct traction to the bone. Types of skeletal traction
  are
  Skeletal cervical traction (Crutchfield tongs): For cervical spine
  injuries.
  Halo traction: For immobilizing the head and neck following a
  cervical injury.
  90/90 femoral traction: For femur or tibia fractures.
  Dunlop (sidearm) traction: For humerus fractures where the arm is
  suspended.
  External fixators: Pins or wires are transfixed percutaneously to the
  extremity.
  Provide adequate fluid to increase hydration and prevent renal calculi
  (rare condition for children).

3

(^284) Pediatric Nursing Demystified