What activities can a patient in Buck's traction perform in bed and what are the recommendations for head of bed elevation and turning?

Patient Activities in Buck's Traction: Guidelines for Bed Positioning

Patients in Buck's traction should maintain a flat supine position with minimal head of bed elevation (no more than 30°) and should be turned using proper logrolling technique with adequate personnel to maintain traction alignment.

Positioning Considerations for Buck's Traction

Head of Bed Elevation

• Keep head of bed flat or at minimal elevation (≤30°) to maintain proper traction alignment and effectiveness 1
• Higher elevations can compromise the longitudinal traction force and reduce therapeutic benefit
• If elevation is necessary for respiratory function, limit to the minimum required angle while monitoring traction effectiveness

Turning and Repositioning

• Implement regular repositioning every 2-4 hours to prevent pressure ulcers 1
• Use proper logrolling technique that maintains spinal alignment when turning patients
• Require 2-3 healthcare providers to coordinate the turn while maintaining traction integrity
• Avoid 90° lateral positioning due to high pressure over trochanters and increased pressure ulcer risk 2

Prevention of Complications

Pressure Ulcer Prevention

• Perform visual and tactile checks of all pressure areas at least once daily 1
• Pay particular attention to heels, sacrum, and other bony prominences
• Use pressure-relieving devices such as air-loss mattresses and foam cushions 1
• Place cushions between knees to avoid interosseous pressure points 1

Skin Care with Modern Traction Equipment

• Modern foam boots for Buck's traction have significantly lower complication rates (0.7%) compared to older methods using adhesive tapes directly on skin (11%) 3
• Inspect skin under traction boot daily for signs of irritation or breakdown
• Ensure proper fit of traction boot to avoid excessive pressure or friction

Activity Limitations and Permitted Movements

Permitted Activities

• Upper body exercises that don't disrupt traction alignment
• Isometric exercises for uninvolved extremities
• Gentle range of motion exercises for uninvolved joints
• Use of overhead trapeze for upper body strengthening and repositioning assistance

Restricted Activities

• Sitting upright beyond recommended head of bed elevation
• Independent turning without proper assistance
• Any movement that disrupts traction alignment or weight

Special Considerations

Spinal Precautions

• For patients with concurrent spinal concerns, follow spinal precautions during all positioning 4
• Maintain proper spinal alignment during all movements and position changes
• Consider anti-Trendelenburg position rather than head of bed elevation if both traction and upper body elevation are required 1

Monitoring Requirements

• Regularly assess neurovascular status of the affected limb
• Monitor skin integrity, especially at pressure points and under traction equipment
• Evaluate traction effectiveness and alignment after any position change

By following these guidelines, healthcare providers can maintain effective traction while minimizing complications and promoting patient comfort and safety during Buck's traction therapy.