Management of Skeletal Traction with Knee Pin
The best management plan for a patient with skeletal traction and a knee pin includes daily pin site care, regular neurovascular checks, proper weight maintenance, and prevention of complications through a structured protocol.
Pin Site Care
Perform daily pin site care following a standardized protocol 1
- Clean around pin sites with sterile technique
- Use antiseptic solution (chlorhexidine or povidone-iodine)
- Keep pin sites dry and uncovered unless drainage is present
- Monitor for signs of infection (redness, warmth, increased pain, purulent drainage)
Inspect pin sites daily for:
- Loosening of the pin
- Pin site irritation or infection
- Proper pin position
Traction Maintenance
Ensure proper weight application and maintenance 1
- Verify weights are hanging freely without touching the floor
- Maintain continuous traction (weights should not be removed without physician order)
- Check that the line of pull is appropriate for the specific injury
Bed positioning:
- Maintain proper body alignment
- Use a firm mattress with minimal head elevation (unless contraindicated)
- Ensure traction frame is secure and properly assembled
Neurovascular Assessment
- Perform neurovascular checks every 2-4 hours 1, 2:
- Distal pulses (dorsalis pedis, posterior tibial)
- Capillary refill
- Sensation (light touch in all nerve distributions)
- Motor function (toe and foot movement)
- Temperature and color of extremity
- Pain assessment (new or worsening pain may indicate compartment syndrome)
Skin and Comfort Care
Implement pressure injury prevention measures:
- Reposition patient regularly within traction constraints
- Use pressure-relieving devices for bony prominences
- Perform skin assessment every shift, particularly at pressure points
Pain management:
- Administer analgesics as prescribed
- Position patient for comfort while maintaining proper traction
- Consider use of temporary manual traction during position changes 1
Mobility and Exercise
- Implement an individualized exercise program 3, 4:
- Active range of motion exercises for uninvolved joints
- Isometric exercises for involved extremity as permitted
- Strengthening exercises for upper extremities and core
- Breathing exercises to prevent respiratory complications
Complication Prevention
- Monitor for and prevent common complications:
- Deep vein thrombosis (use prophylaxis as prescribed)
- Constipation (ensure adequate hydration, fiber intake, stool softeners)
- Urinary tract infections (maintain adequate hydration)
- Respiratory issues (encourage deep breathing exercises)
- Muscle atrophy (implement appropriate exercise program)
Documentation and Communication
- Document the following in the medical record:
- Pin site condition
- Neurovascular status
- Weight and line of pull verification
- Patient comfort level
- Interventions performed
- Any complications or concerns
Discharge Planning
- Begin early discharge planning:
- Assess home environment and support system
- Determine need for assistive devices 3
- Coordinate with physical and occupational therapy
- Educate patient and caregivers on home management
When to Notify the Physician
- Immediately report:
- Changes in neurovascular status
- Signs of pin site infection
- Pin loosening or displacement
- Significant increase in pain
- Equipment failure or traction disruption
The management of skeletal traction requires specialized nursing knowledge and consistent application of evidence-based protocols. A standardized approach significantly improves care quality and reduces complications 1. Regular education of healthcare staff on proper traction management techniques is essential for optimal patient outcomes.