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🦴 Fracture & Trauma Care series: 1 · Fracture 2 · Buck's Traction & Post-Op 3 · Fat Embolism & Osteomyelitis 4 · Cast Care
Nursing Field Notes / Musculoskeletal · Fracture & Trauma Care Series · Page 2 of 4

Buck's Traction 🛏️

& Postoperative Musculoskeletal Surgery Care

NG-058 Musculoskeletal ADHD-friendly visual edition

Buck's traction is a temporary skin traction device used before hip/femur surgery to realign the bone and stop muscle spasms. This page covers setting it up safely, then follows the same patient through hip/femur surgery — ORIF or external fixation — and the postoperative priorities: bleeding, infection, positioning, and mobility. Uses the 6 P's from the Fracture page for every neurovascular check.

📄 Simple Nursing original — opens in Drive →

⚖️ Weights hang FREENever let traction weights rest on the bed or floor.
🛏️ Stay flatSupine, HOB not elevated over 25° while in Buck's traction.
🦵 Abduction pillowPost-hip-surgery: legs apart, never crossed, never flexed past 90°.
🩸 Bleeding > InfectionPost-op priority order: hemorrhage first, then infection.
🛏️

BEFORE

STEP 1 · SET UP TRACTION

Buck's traction buys time before surgery — it pulls, it doesn't fix. Setup errors lose the whole point of the device.

⚙️ Buck's traction anatomy — what's actually pulling on what

HOB ≤ 25° BOOT pulley ⚖️ weight hangs FREE never touches bed or floor ropes stay TIGHT / taut not resting on the footboard supine, flat short-term · pre-op · realigns hip/femur fx, stops muscle spasm
🧠 Kaplan trap: "Most important nursing action to maintain effective traction?" → allow weights to hang freely at all times. Everything else (taut ropes, flat position, alignment) supports that one non-negotiable rule.

🔍 What Buck's traction is for

  • 🦴 Short-term, used before surgery
  • 🎯 Realigns hip & femur fractures
  • 😖 Stops muscle spasms that would otherwise pull bone fragments out of place
  • 🩹 It is skin traction — a boot/foam sleeve on the skin, no pins into bone
🧠 Skin vs skeletal traction: Buck's = skin traction (boot/foam, lighter pull). Skeletal traction uses pins placed directly into the bone for heavier, longer-term pulling — those pin sites need sterile pin care (see the card to the right).

📏 Positioning rules while in traction

  • 🛏️ Client stays supine, flat
  • ❌ Do NOT elevate the HOB over ~25° (commonly taught as 20–30°; follow facility/provider orders) — raising it pulls the line of traction off-axis
  • ↔️ Keep the limb in neutral alignment — don't let it rotate
  • 🚫 Ropes must not rest against the footboard or bed frame
🧠 “Flat line, straight pull.” Traction only works if the rope runs in a straight line from limb to weight — raise the head, bend the line, lose the pull.
⚙️

DURING

STEP 2 · MONITOR THE LIMB

Same 6 P's you learned on the Fracture page — now applied to a limb under continuous pulling force.

🖐️ Neuro checks in traction — P.M.S.C.

P — Pulses distal to the boot — not weak, not absent M — Movement wiggle toes/fingers, no new weakness S — Sensation no tingling, burning, or numbness C — Color/Temp warm, pink — not pale, dusky, or cool = the same 6 P's (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) grouped for a quick bedside check
🧠 Same skill, new device. Whether it's a splint, a cast, or traction — the neurovascular check never changes. If any P is abnormal, loosen nothing on your own — notify the HCP.

🩹 Skin integrity — the #1 traction complication

Skin traction pulls on skin, not bone — so skin breakdown under the boot/foam is the priority thing to monitor.

  • 👀 Assess boot/foam contact points for redness, blistering, or breakdown
  • 🧴 Reposition the client (not the limb out of alignment) to offload pressure
  • 🦶 Check weights are hanging free and off the floor at every round
🧠 Saunders: priority monitoring for a client in skin traction = signs of skin breakdown at the traction interface.

💉 If it becomes skeletal traction: pin site care

Skeletal traction and external fixation use pins through the bone. Typical care includes pin care with sterile technique — frequency varies by facility protocol (a commonly taught example is 3×/day).

Thick, yellow drainage from a pin site is the finding that worries the nurse most — it signals infection, not normal serous ooze.

🧠 Clear/serous ooze = expected. Thick yellow = infected. Compare color every shift.
🩹

AFTER

STEP 3 · POST-OP PRIORITIES

The traction comes off for surgery — ORIF or external fixation — then the priorities shift to bleeding, infection, positioning, and getting the patient moving.

🔧 Two ways to fix the fracture surgically

ORIFExternal fixation
Open Reduction Internal Fixation — plates/screws/rods placed inside via surgical incision Pins placed through skin into bone, connected to an external frame outside the body
🧠 ORIF = fixed on the inside. External fixation = frame on the outside. Both stabilize the same fracture, different approach.

🚨 Post-op priority order: bleeding, then infection

1️⃣ Bleeding — hypotension & tachycardia, monitor pulses distal to the surgical site
▼
2️⃣ Infection — elevated WBC, wound pain/color/amount/odor of drainage
🧠 HESI: the priority post-op assessment for a hip fracture repair includes wound assessment with special attention to pain, and to color/amount/odor of exudate — plus positioning and education.

🦵 Total hip arthroplasty precautions — protect the new joint

✅ Abduction pillow legs kept apart · toes point up ❌ Crossing legs risk of dislocation ❌ Bending past 90° no low chairs, no tying shoes, no leaning forward
  • ✅ Abducted legs — pillow between the legs while turning/lying
  • ✅ Toes pointing upward, neutral rotation
  • ❌ No crossing legs
  • ❌ No leaning forward (no tying shoes)
  • ❌ No sitting in low chairs or bending the hip past 90°
🧠 “HESI: interventions after hip fracture repair” → positioning + education. Kaplan/Saunders: after internal fixation, position the leg abducted with toes pointing upward — a pillow between the legs while repositioning.

🧪 Labs to prioritize reporting

Hemoglobin (adult, approx.) <7 g/dL = report — transfusion often needed ~12–18 g/dL normal range WBC count normal ~5,000–10,000/mm³ (varies by lab) 17,000 = infection, report
🧠 Kaplan: which lab value should the nurse report post-op THA? A hemoglobin below 7 or a markedly elevated WBC (e.g., 17,000) — both are call-the-provider numbers.

✅ General postoperative musculoskeletal surgery priorities

1
Pain control — around-the-clock scheduling, reassess after every intervention
2
Early mobilization — dangle, then ambulate with an assistive device (e.g., walker) as ordered; turn q2h if not yet ambulating
3
DVT prevention — sequential compression devices, anticoagulation per order, ankle pumps, early ambulation
4
Neurovascular checks — the 6 P's, every scheduled round
🧠 DVT prevention here matters twice: it protects the patient and reduces the risk of the fat embolism/PE picture covered on the next page in this series — immobility is a shared risk factor for both.
⚡

QUICK RECALL

SAY IT OUT LOUD
⚖️ Weights free-hangingnever on the bed or floor — the #1 traction rule
🛏️ Flat, HOB ≤25°keeps the traction line straight
🦵 Abducted, toes uppillow between legs, never crossed, never >90°
🩸 Bleed first, then infectionhypotension/tachycardia before elevated WBC
🎯 Cover & check — 4 rapid-fire questions
Q1: What is the single most important nursing action to maintain effective Buck's traction?
Allow the weights to hang freely at all times — never resting on the bed or floor.
Q2: Why must the HOB stay under 25° in Buck's traction?
Raising the head pulls the traction line off a straight axis, reducing its effectiveness — the client stays supine and flat.
Q3: How should the leg be positioned after total hip arthroplasty?
Abducted, with toes pointing upward — a pillow between the legs, never crossed, never flexed past 90°, no leaning forward.
Q4: A pin site has thick yellow drainage. What does that mean?
Infection — report it. Clear/serous drainage is expected; thick and yellow is not.