What is the proper technique for turning a patient in skeletal traction for a hip fracture?

Proper Technique for Turning a Patient in Skeletal Traction for Hip Fracture

When turning a patient in skeletal traction for a hip fracture, a coordinated team approach with at least 2-3 healthcare providers is required to maintain proper alignment and prevent complications that could increase morbidity and mortality.

Understanding Skeletal Traction for Hip Fractures

While skeletal traction is now rarely used as definitive treatment for hip fractures due to increased morbidity and mortality 1, it may occasionally be necessary in cases where surgery must be delayed. The AAOS guidelines strongly recommend against preoperative traction for hip fracture patients 1, as evidence shows it provides no benefit for pain relief or fracture reduction 2, 3.

Proper Turning Technique

Pre-Turning Assessment and Preparation

• Ensure adequate pain control before attempting to turn the patient
• Administer multimodal analgesia including peripheral nerve blocks if available 1
• Gather a team of at least 2-3 healthcare providers
• Explain the procedure to the patient to reduce anxiety
• Check that all traction components are secure and properly aligned

Step-by-Step Turning Procedure

1. Position team members strategically:

   • One provider at the head/shoulders
   • One provider at the hips/pelvis
   • One provider at the legs/feet to monitor traction apparatus

2. Maintain traction alignment:

   • The provider at the legs must ensure the traction weights remain freely hanging
   • Traction line must stay in proper alignment throughout the turn

3. Execute coordinated log roll:

   • On a synchronized count, turn the patient as a unit (log roll)
   • Move the patient's body as one piece, maintaining spinal alignment
   • Turn only to approximately 30° to avoid disrupting traction alignment
   • Use pillows to support the patient in the new position

4. Post-turn assessment:

   • Immediately check traction alignment and weights
   • Ensure the affected limb maintains proper position
   • Assess patient comfort and pain level
   • Document the procedure and patient response

Critical Considerations

Complications to Avoid

• Displacement of fracture fragments
• Increased pain and soft tissue damage
• Pressure injuries (particularly important in elderly patients with thin skin) 1
• Neurovascular compromise

Special Precautions

• Extracapsular fractures require extra care during turning due to:

  • Greater periosteal disruption causing more pain 1
  • Higher blood loss (may exceed 1 liter) 1
  • Increased risk of displacement

• For patients with comminuted or unstable fractures:

  • Use more personnel during turning
  • Consider smaller degrees of rotation
  • Monitor for signs of fracture displacement

Post-Turning Care

• Reassess pain level and provide additional analgesia if needed
• Ensure proper body alignment and support with pillows
• Check pressure points and apply preventive measures for pressure injuries
• Document the procedure, patient tolerance, and any complications

Important Clinical Reminders

• Most hip fractures should undergo surgical fixation within 24-48 hours of admission 1, making prolonged skeletal traction unnecessary
• For unstable intertrochanteric, subtrochanteric, and reverse obliquity fractures, cephalomedullary nail fixation is strongly recommended 1
• Maintain active thermoregulation strategies as elderly patients are susceptible to hypothermia 1
• Continue regular assessment of neurovascular status of the affected limb

By following this structured approach to turning patients in skeletal traction, healthcare providers can minimize complications and optimize outcomes while the patient awaits definitive surgical management.