Which of the following types of skin traction is usually used in the treatment of femoral shaft fracture in children up to the age of two years?

1. A

   Tulloch Brown Traction

2. B

   Dunlop Traction

3. C

   Hamilton Russel Traction

4. D

   Bryant's Traction

Appeared in: PGICH Noida NO-2025

Explanation

• Bryant's traction is a specific type of skin traction designed for infants and young children, typically under the age of two or weighing less than 15 kg.
• It is primarily indicated for the treatment of femoral shaft fractures and for developmental dysplasia of the hip.
• The mechanism involves suspending both of the child's legs in a vertical position at a 90-degree angle to the torso.
• The child's body weight provides counter-traction, which is achieved by ensuring the buttocks are lifted just slightly off the surface of the bed.

Why Other Options Were Wrong

• Option A: Tulloch Brown traction is a modification of a Thomas splint used for lower limb fractures, but it is not the standard or specific traction method for infants with femoral fractures.
• Option B: Dunlop traction is used for fractures of the upper extremity, not the lower extremity.
• Option C: Hamilton Russel traction is used for femoral fractures, but it is designed for a different patient population.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Pediatric Orthopedic Traction Methods helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• A critical nursing responsibility for a child in Bryant's traction is performing frequent neurovascular checks (monitoring color, temperature, capillary refill, sensation, and movement) of the feet and legs to prevent ischemic injury (Volkmann's contracture), a serious complication.
• Maintaining skin integrity is paramount. The nurse must inspect the skin under the traction straps regularly for signs of pressure, irritation, or breakdown.
• What if the child was 4 years old? Bryant's traction would be contraindicated due to the increased risk of vascular compromise and compartment syndrome in larger children. A 90-90 skeletal traction, spica cast, or flexible intramedullary nails would be more appropriate treatment options.

How to Approach the Question

• First, identify the key elements in the question stem: the specific injury (femoral shaft fracture), the patient's age (up to two years), and the type of intervention (skin traction).
• Next, systematically review your knowledge of common orthopedic traction methods.
• Evaluate each option based on its primary indication and target patient population.
• Eliminate Dunlop traction as it is used for upper arm fractures.
• Eliminate Hamilton Russel traction as it is used for older children and adults.
• Between the remaining options, recognize that Bryant's traction is specifically designed for treating femoral fractures in infants and very young children, making it the most accurate answer.

Concept Tested & Keywords

• Concept Tested: Pediatric Orthopedic Traction Methods
• Stem keywords: skin traction, femoral shaft fracture, children, two years
• Lead-in keywords: Which

Question ID

Qj0ECd0u8ia4gRFgnEIilI

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 2092-2094