Gallows traction, also known as Bryant's traction, is a specialised skin traction technique used almost exclusively in infants and young children. The primary aim is to treat femoral shaft fractures or correct congenital hip dislocations. In this setup, both of the child's lower limbs are suspended vertically at a 90-degree angle to the body from an overhead frame. The child's body weight naturally acts as the counter-traction force, lifting the buttocks just slightly off the mattress.
This method is restricted to infants under the age of two years or children weighing less than 12 to 14 kilograms. Beyond this weight limit, the child's body mass becomes too heavy for safe counter-traction, risking compromised circulation or tipping the bed.
Selecting the correct patient for gallows traction ensures safe orthopaedic recovery and prevents avoidable complications. The procedure is indicated for specific paediatric conditions involving the lower extremities.
Applying gallows traction requires precise preparation of both equipment and the infant's skin. The nurse gathers an overhead traction frame, ropes, pulleys, weights, and adhesive or foam skin traction strips.
First, the nurse washes and dries the infant's legs, ensuring no open wounds or rashes are present where adhesive will touch. Next, foam or adhesive traction strips are applied along the lateral and medial aspects of both lower legs, leaving the ankles and heels free from direct pressure. Soft bandages wrap around the strips in a spiral fashion without wrapping too tightly, which would obstruct blood flow. Finally, the ropes attached to the leg bandages are threaded through the pulleys and connected to hanging weights. The weights must hang freely above the floor, and the infant's buttocks should hover just clear of the bed mattress.
Frequent neurovascular assessments are vital because skin traction bandages can easily compromise circulation and nerve function in an infant's tiny limbs. Nurses evaluate the five Ps—pain, pallor, pulselessness, paresthesia, and paralysis—every two to four hours.
Maintaining skin integrity under traction is challenging because the infant remains in a fixed, suspended position. Nurses perform meticulous skin care by inspecting the heels, ankles, and sacral area during bath times and linen changes. Since the buttocks float just above the mattress, the diaper area requires special attention. Diapers must be checked frequently and changed promptly; sliding a small diaper underneath without lowering the legs prevents urine and stool from soiling the traction tapes and irritating the skin.
Bed linen changes are done from top to bottom rather than side to side, as rolling the infant disrupts the vertical alignment of the fracture. Keeping the skin dry and applying barrier creams to vulnerable pressure points prevents moisture-associated skin damage.
Although gallows traction aids healing, it carries specific risks that demand vigilant nursing oversight.
An infant in gallows traction cannot understand why their legs are tied up in the air, leading to distress, crying, and restlessness. Parents often feel anxious, guilty, or overwhelmed seeing their baby suspended. Nurses play a crucial role in providing emotional reassurance and explaining that the traction is temporary and necessary for proper bone healing.
Involving parents in daily care—such as feeding, gentle stroking, and diaper changes—strengthens their bond with the baby. Nurses also teach parents how to spot danger signs like discoloration, cold toes, or slipping bandages. Providing toys that hang within the infant's visual field helps keep the child distracted and calm.