Perioperative, Procedural, and Traction/Cast Care
Preoperative essentials
Informed consent, correct-site verification with marking, and a formal time-out before incision. Prophylactic antibiotics are given within 60 minutes of incision (within 120 minutes for vancomycin or fluoroquinolones). Screen for anticoagulants, allergies, and NPO status. Teach before surgery, not after: incentive spirometry, leg exercises, device use, and the expected pain plan.
Cast care
Keep the cast dry, elevate to limit swelling, apply ice over the cast, check the 5 Ps regularly, never insert objects to scratch, and never cover a drying cast with plastic. Report increasing pain, numbness, tingling, discoloration, or a cast that is too tight, cracked, or soiled. Plaster dries in 24–72 hours and is heavy; fiberglass dries in about 30 minutes and is lighter. Bivalve or trim a cast that is too tight - never pad it tighter.
Traction
Traction realigns and rests tissue and reduces muscle spasm. Skin traction (Buck's, Russell's) typically uses 5–10 lb; skeletal traction (90-90, Dunlop, balanced suspension) uses pins and greater weight. Tested rules: weights hang free and never touch the floor or bed, ropes sit in pulley grooves, weights are never removed or lifted by staff, countertraction is maintained, and repositioning must not change the line of pull. Assess pin sites and neurovascular status each shift.
Rule of thumb
Any cast or traction complaint becomes a neurovascular assessment first and a call to the provider second.