Monitoring for Compartment Syndrome in a Child with 90-90 Skeletal Traction

QUESTION

The practical nurse (PN) is caring for a child in a 90-90 skeletal traction. Where should the PN monitor the child for signs of compartment syndrome?

ANSWER

Monitoring for Compartment Syndrome in a Child with 90-90 Skeletal Traction

Introduction

Skeletal traction is a therapeutic technique used to immobilize and manage fractures, dislocations, and certain orthopedic conditions. When a child is placed in 90-90 skeletal traction, it is essential for the practical nurse (PN) to closely monitor the child for any signs or symptoms of compartment syndrome, a potentially serious and limb-threatening complication. This essay outlines where the PN should monitor the child for signs of compartment syndrome to ensure early detection and timely intervention.

Understanding Compartment Syndrome

Compartment syndrome occurs when there is increased pressure within a muscle compartment, leading to reduced blood flow, nerve compression, and potentially severe tissue damage. In the case of a child in 90-90 skeletal traction, the risk of developing compartment syndrome is heightened due to the potential compression of blood vessels and nerves.

Monitoring Sites for Compartment Syndrome

The PN should conduct regular and thorough assessments, paying close attention to specific sites where compartment syndrome is most likely to manifest. These sites include:

Lower Extremities

Most commonly, compartment syndrome occurs in the lower extremities, making it crucial for the PN to closely monitor the child’s legs.
Pay special attention to the areas where traction pins or wires are inserted into the bone. In 90-90 skeletal traction, these pins are usually located in the femur.
Examine the skin and underlying tissues around the pin sites for signs of compartment syndrome.

 Extremities Distal to the Traction

Check the extremities, particularly the toes and feet, that are distal to the site of traction.
Compartment syndrome can affect the areas below the level of the traction, and any signs of diminished blood flow, such as pale or cool skin, numbness, tingling, or weakness, should be noted.

Pain Assessment

Continuous pain or discomfort disproportionate to the expected level can be an early indicator of compartment syndrome.
Encourage the child to express any pain or unusual sensations and document their pain scores regularly.

Range of Motion

Observe the child’s range of motion in the affected extremity, paying attention to any limitations or resistance. Difficulty moving the limb can be a sign of compartment syndrome.

Neurovascular Checks

Perform neurovascular checks regularly, which involve assessing the child’s circulation, sensation, and motor function.
Document capillary refill, pulses, skin temperature, sensation, and muscle strength.

Swelling and Firmness

Examine the affected limb for signs of significant swelling, which can cause increased pressure within the compartments.
Palpate the muscles to detect firmness or tension.

Conclusion

Monitoring a child in 90-90 skeletal traction for signs of compartment syndrome is a critical aspect of nursing care. Early detection and intervention are essential to prevent further complications and preserve limb function. By closely assessing the aforementioned sites and involving healthcare providers when necessary, the PN can contribute to the child’s safety and well-being while undergoing skeletal traction.