3. History
Hippocrates- treated fracture shaft of femur and of leg with
the leg straight in extension
Guy de chauliac- introduced continuous isotonic traction in
the fracture of femur
4. General Considerations
Safe and dependable way of treating fractures for more
than 100 years
Bone reduced and held by soft tissue
Less risk of infection at fracture site
No devascularization
Allows more joint mobility than plaster
5. Indications
To reduce the fracture or dislocation
To maintain the reduction
To correct the deformity
To reduce the muscle spasm
6. Types Based On Method Of
Application
Skin traction
The traction force is applied over a large area of skin
• Adhesive
• Non-adhesive skin tractions
Skeletal traction
Applied directly to the bone either by a pin or wire through the
bone. (eg- Steinmann pin, Denham pin or Kirschner wire)
7. Types Based On Mechanism
Fixed Traction
By applying force against a fixed point of body.
Sliding Traction
By tilting bed so that patient tends to slide in opposite
direction to traction force
8. Advantages of Traction
Decrease pain
Minimize muscle spasms
Reduces, aligns, and immobilizes fractures
Reduce deformity
Increase space between opposing surfaces
9. Disadvantages of Traction
Costly in terms of hospital stay
Hazards of prolonged bed rest
Thromboembolism
Decubiti
Pneumonia
Requires meticulous nursing care
Can develop contractures
10. The Traction Suspension
System
• Bed and Balkan beam
• Splints- Thomas splint, Bohler-Braun frame, Fisk Splint
• Slings and padding
• Skin traction
• Skeletal traction- Steinmann pin, Denham pin or Kirschner wire
• Bohler Stirrup
• Cord
• Pulleys
• Weights
11. Knots
Ideal knots can be
tied with one hand
while holding weight
Easy to tie and untie
Overhand loop knot
will not slip
12. Knots
A slip knot tightens
under tension
Up and over, down
and over, up and
through
15. Buck’s Traction or Extension
Used in temporary
management of
fractures of
Femoral neck
Femoral shaft in older children
Undisplaced fractures of the
acetabulum
After reduction of a hip
dislocation
To correct minor flexed
deformities of the hip or knee
In place of pelvic traction in
management of low back pain
Can use tape or pre-
made boot
Not more than 4.5 kgs
Not used to obtain or
hold reduction
16. Hamilton Russell Traction
Buck’s with sling
May be used in more
distal femur fracture in
children
Can be modified to hip
and knee exerciser
17. Bryant’s Traction
Useful for treatment of
femoral shaft fracture in
infant or small child
Combines gallows
traction and Buck’s
traction
Raise mattress for
counter traction
Rarely used currently
18. Forearm Skin Traction
Adhesive strip with Ace
wrap
Useful for elevation in
any injury
Can treat difficult
clavicle fractures with
excellent cosmetic
result
Risk is skin loss
19. Double Skin Traction
Used for greater
tuberosity or proximal
humeral shaft fracture
Arm abducted 30
degrees
Elbow flexed 90
degrees
Risk of ischemia at
antecubital fossa a
20. Dunlop’s Traction
Used for supracondylar
and transcondylar
fractures in children
Used when closed
reduction difficult or
traumatic
Forearm skin traction with
weight on upper arm
Elbow flexed at 45
degrees
21. Finger traps
Used for distal forearm
reductions
Changing fingers
imparts radial/ulnar
angulation
Can get skin
loss/necrosis
Recommend no more
than 20 minutes
22. Head Halter traction
Simple type cervical
traction
Management of neck
pain
Weight should not
exceed 2.3 kg
Can only be used a few
hours at a time
23. Contraindications
Abrasions and lacerations of skin in the area to which
traction is to be applied
Impairment of circulation - Varicose veins, impending
gangrene
Dermatitis
When there is marked shortening of the bony fragments,
the traction weight required will be more then 6.7 kg which
cannot be applied through the skin
24. Complications
Allergic reactions to adhesive
Excortication of skin
Pressure sores around the malleoli and over the tendo
calcaneus
Common peroneal nerve palsy
26. Indications
It should be reserved for those cases in which skin traction
is contraindicated
In patients with lacerated wounds
In patients with external fixator in situ
When the weight required for traction is more then 6.5 kgsObese patients
27. Proximal Tibial Traction
•
Used for distal 2/3rd femoral
shaft fractures
•
Tibial pin allows rotational
moments
•
Easy to avoid joint and growth
plate
•
2cm distal and posterior to
tibial tubercle
•
Pin should be driven from the
lateral to the medial side to
avoid damage to the common
peroneal nerve.
28. Upper Femoral Traction
Lateral traction for
fractures with medial or
anterior force
Stretched capsule and
ligamentum teres may
reduce acetabular
fragments
29. Femoral Traction Pin
•
Lateral surface of femur
(2.5cm) below the most
prominent part of GT midway
between the anterior and
posterior surface of femur
•
A coarse threaded cancellous
screw is used. Must avoid NV
structures and growth plate in
children
30. Distal Femoral Traction
Alignment of traction
along axis of femur
Used for superior force
acetabular fracture and
femoral shaft fracture
Used when strong force
needed or knee
pathology present
31. Distal Femoral Traction
• Draw 1st line from before
backwards at the level of the
upper pole of patella,2nd line from
below upwards anterior to the
head of the fibula, where these
two lines intersect is the point of
insertion of a Steinmann pin
• Just proximal to lateral femoral
condyle. In an average adult this
point lies nearly 3 cm from the
lateral knee joint line
32. Ninety-Ninety Traction
Useful for
subtrochantric and
proximal 3rd femur
fracture
Especially in young
children
Matches flexion of
proximal fragment
Can cause flexion
contracture in adult
33. Perkin’s traction
Treatment of fractures of tibia and of the
femur from the subtrochantric region
distally.
Basis of management is the use of skeletal traction
coupled with active movements of the injured limb
By encouraging early muscular activity, the
development of stiff joint is frequently prevented by
both maintaining extensibility of muscles by reciprocal
innervation, and preventing stagnation of tissue fluid
34. Application of Perkin’s traction
A Hadfield split bed is required
Under General anaesthesia and full aseptic conditions, a Denham pin is
inserted through the upper end of tibia
A Simonis swivel is attached to end of each Denham pin
Two traction cords are connected to each of swivel
4.6 kg weight is attached to each traction cord making a total traction weight of
9.2 kg
Foot end of the bed is elevated by one inch for each 0.46 kg of traction weight
One or more pillow is placed under the thigh to maintain the anterior bowing of
the femoral shaft
Length of the limb is checked with a tape measure and total traction weight is
increased or decreased as necessary
Active Quadriceps exercises are started immediately and continued
36. Balanced Suspension with
Pearson Attachment
Enables elevation of
limb to correct angular
malalignment
Counterweighted
support system
Four suspension points
allow angular and
rotational control
37. Pearson Attachment
• Middle 3rd fracture has
mild flexion proximal
fragment
• 30 degrees elevation with
traction in line with femur
• Distal 3rd fracture has
distal fragment flexed
posterior
• Knee should be flexed
more sharply
• Fulcrum at level of fracture
• Traction at downward
angle
• Reduces pull of
38. Distal Tibial Traction
Useful in certain tibial plateau
fracture
Pin inserted 5 cm above the
level of the ankle joint,
midway between the anterior
and posterior borders of the
tibia
Avoid saphenous vein
Place through fibula to avoid
peroneal nerve
Maintain partial hip and knee
flexion
39. Calcaneal Traction
Temporary traction for
tibial shaft fracture or
calcaneal fracture
Insert about 1.5 inches
(4cms) inferior and
posterior to medial
malleolus
Do not skewer subtalar
joint or NV bundle
Maintain slight elevation
leg
40. Olecranon Pin Traction
Supracondylar/distal
humerus fractures
Greater traction forces
allowed
Can make angular and
rotational corrections
Place pin 1.25 inches
distal to tip
Avoid ulnar nerve
41. Lateral Olecranon Traction
Used for humeral
fractures
Arm held in moderate
abduction
Forearm in skin traction
Excessive weight will
distract fracture
42. Olecranon traction
• Point of insertion:
just deep to the SC border of
the upper end of ulna
(3cms)
This avoids ulnar joint and
also an open epiphysis
• Technique:
Pass K-wire from medial to
lateral side - pass the wire
at right angles to the long
axis of the ulna to avoid
ulnar nerve.
43. Metacarpal Pin Traction
Used for obtaining difficult
reduction forearm/distal
radius fracture
Once reduction obtained,
pins can be incorporated
in cast
Pin placed radial to ulnar
through base 2nd/3rd MC
Stiffness of intrinsics is
common
44. Metacarpal Pin Traction
• Point of Insertion: 2-2.5
cms proximal to the distal
end of 2nd metacarpal
• Technique: push the 1st
dorsal interosseius and
palpate the subcutaneous
portion of the bone. Pass
the K-wire at right angles
to the longitudinal axis of
the radius, the wire
traversing 2nd and 3rd
metacarpal diaphysis
transversely.
45. Gardner Tongs
U shaped tongs, used
for spinal traction
In patients having
cervical injury
Easy to apply
Place directly above
external auditory
meatus
In line with mastoid
process
46. Gardner Tongs
Pin site care important
Weight ranges from2.3
kg to 15.8 kg for c-spine
Excessive manipulation
with placement must be
avoided
Poor placement can
cause flexion/extension
forces
Patient can get occipital
decubitus
47. Crutchfield Tongs
Crutchfield tongs fit into
the parietal bones
A special drill point with
a shoulder is used to
enable an accurate
depth of hole to be
drilled
48. Application of Crutchfield
Tongs
Sedate the patient
Shave the scalp locally
Draw a line on the scalp,
bisecting the skull from
front to back
Draw a second line joining
the tips of the mastoid
processes which crosses
the first line at right angles
Fully open out the tongs
49. Application of Crutchfield
Tongs
With the fully open tongs lying equally on each side of the antero-
posterior line, press the points into the scalp making dimples on the
second line.
Infiltrate the area of the dimples down to and including the periosteum,
with local anaesthetic solution.
Make small stab wounds in the scalp at the dimples.
Using the special drill point, drill through the outer table of the skull in a
direction parallel to the points of the tongs.
Fit the points of the tongs into the drill holes.
Tighten the adjustment screw until a firm grip is obtained, and repeat
daily for the first 3 to 4 days, and then tighten when necessary
Attach a traction cord to the two lugs.
Attach a weight to the traction cord.
Raise the head end of the bed to provide counter traction
50. Recommended Weights in Cervical Traction
(Crutchfield)
Level
Minimum
Weight
Maximum
Weight
C1
2.3 KG
4.5 KG
C2
2.7 KG
4.5 – 5.4 KG
C3
3.6 KG
4.5 – 6.7 KG
C4
4.5 KG
6.7 – 9.0 KG
C5
5.4 KG
9.0 – 11.3 KG
C6
6.7 KG
9.0 – 13.5 KG
C7
8.2 KG
11.3 – 15.8 KG
51. Complications of Skeletal Traction
Introduction of infection into the bone
Incorrect placement of the pin or wire may Allow the pin or wire to cut out of the bone causing pain and the
failure of the traction system
Make control of rotation of the limb difficult
Make the application of splints difficult
Result in uneven pull being applied to the ends of the pin or wire
and thus cause the pin or wire to move in the bone
Distraction at the fracture site
Ligamentous damage if a large traction force is applied through a joint
for a prolonged period of time
Damage to epiphyseal growth plates when used in children
Depressed Scars
52. Management of patients in
traction
Care of the patient
Care of the traction suspension system
Radiographic examination
Physiotherapy
Removal of traction
53. In The Patient
Care of the injured limb-
• Pain
• Parasthesia or Numbness
• Skin irritation
• Swelling
• Weakness of ankle, toe, wrist or finger movement
54. Radiographic Examination
2-3 times in first week
Weekly for next 3 weeks
Monthly until union occurs
After each manipulation
After each weight change
55. Removal Of Traction
Elbow fracture with olecranon pin
- 3 weeks
Tibial fracture with calcaneal pin
- 3-6 weeks
Trochanteric fracture of femur
- 6 weeks
Femoral shaft fracture
with application of cast brace and
partial weight bearing
without external support and
partial weight bearing
- 6 weeks
- 12 weeks
