Place the patient supine on the bed.
Position the stirrup of the traction set with the strings for weight attachment at the foot leaving space for ankle movement. Use an assistant to apply slight traction and provide stability when applying the bandage.
Apply the long adhesive bandages from ankle to hip to distribute the skin tension forces over a large area to prevent blisters and skin necrosis. Wrap a bandage over the adhesive bandage to further reduce shear forces.
Apply the sling just above the knee and place the leg on a support, eg a pile of towels, to produce 30° knee flexion.
This neutralizes the muscle forces, controls rotational deformities, and maintains the femoral bow, which may require a small pillow or towel under the thigh.
The resulting traction direction should be in line with the femoral axis.
The traction weight is determined by the age and weight of the child and should be sufficient to maintain length and alignment. 500 g per year of age is a good initial weight to use. The foot of the bed should be raised, tilting the bed, to stop the child being pulled down the bed.
Perform regular neurovascular observations and check for loosening of the bandage.