# Situation: A 30-year-old construction worker has a closed midshaft fracture of the right femur after a fall from scaffolding. He is placed in balanced skeletal traction with a pin through the distal femur while awaiting internal fixation. He has no other injuries and no significant medical history. During a traction check, the nurse reviews four observations. Which one requires correction?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630431  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 30-year-old construction worker has a closed midshaft fracture of the right femur after a fall from scaffolding. He is placed in balanced skeletal traction with a pin through the distal femur while awaiting internal fixation. He has no other injuries and no significant medical history.

During a traction check, the nurse reviews four observations. Which one requires correction?

## 보기

1. Foot plate clear of the end of the bed
2. Body lying in line with the pull of traction
3. Weights hanging about 15 cm above the floor
4. Knot in the rope caught against a pulley **✔ 정답**

**정답: 4**

## 해설

Skeletal traction works only when the ropes run freely on the pulleys, the weights hang freely off the bed and floor, and the body is aligned to provide counter-traction. A knot caught at a pulley stops the pull even though the weights appear to hang, so it must be corrected, without removing the weights.

## 심화 해설

What makes skeletal traction work
Balanced skeletal traction applies a steady pull to the femur through a pin in the distal bone. The pull works only when four conditions are met: the ropes run freely over the pulleys, the weights hang freely off the bed and floor, the body is aligned with the line of pull, and the feet are clear of the end of the bed. Counter-traction comes from the client's own body weight in line with the pull. Anything that catches the rope or rests the weight cancels the pull, even when the weights still appear to hang.

The finding that needs correction
A knot caught against a pulley is the problem. The rope can no longer slide, so the force transmitted to the pin changes or is lost, and the fracture fragments may override or angulate. The nurse repositions the rope so the knot sits well away from the pulley and the rope runs freely. The correction is made without removing or lifting the weights, because releasing traction allows muscle spasm to pull the fragments out of alignment and causes severe pain.

Why the other observations are correct
Three observations describe traction set up properly.

| Observation | Correct? | Reason |
| --- | --- | --- |
| Foot plate clear of the end of the bed | Yes | A foot pressing against the bed would cancel the pull |
| Body in line with the pull | Yes | Alignment provides counter-traction |
| Weights about 15 cm above the floor | Yes | Weights must hang freely, not rest on the floor or bed |
| Knot caught at a pulley | No | The rope cannot run freely, so the pull is lost |

Watch out! The question asks which finding requires correction, so the answer is the one abnormal finding. Options that describe correct practice are distractors here even though they are true statements.

Routine traction checks
On each check the nurse follows the line from the pin to the weights: pin sites for redness or drainage, frame and pulleys secure, ropes on the pulley tracks and free of knots near pulleys, weights hanging freely, and the client pulled up in bed with feet clear. The nurse also performs neurovascular checks of the leg. Key point! Weights must hang freely and ropes must move freely; a knot at a pulley must be fixed without taking off the weights.

## 임상 시나리오

Skeletal Traction CheckKeeping the pull effective
Effective traction needs free-running ropes, freely hanging weights, alignment with the line of pull, and feet clear of the bed end.

A knot caught against a pulley stops the rope from sliding, so the pull is lost even though the weights look correct. The nurse moves the knot away from the pulley.

Weights about 15 cm above the floor, a clear foot plate, and body alignment are all signs of correct setup.

CautionNever remove or lift traction weights to fix a problem; releasing the pull lets muscle spasm displace the fracture.

## 핵심 개념

- **Skeletal traction** — Traction applied directly to bone through a pin or wire to align and immobilize a fracture.
- **Counter-traction** — An opposing force, usually the client's body weight, that balances the pull of traction.
- **Balanced suspension** — A traction setup with a frame and splint that supports the limb so the client can move without changing the line of pull.
- **Pin site** — The skin opening where a traction pin enters the bone, monitored for infection.

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