What are characteristics of skeletal traction?

Traction is a technique for realigning a broken bone or dislocated part of the body using weights, pulleys, and ropes to gently apply pressure and pull the bone or injured body part back into position. After a fracture, traction can restore the position of a bone during the early stage of healing or temporarily ease the pain while you are waiting for further corrective surgery. There are two main types of traction: skeletal traction and skin traction. A third kind, cervical traction, is used to help stabilize fractures in the neck.

Purpose of Traction

The purpose of traction is to stabilize a fracture or injury and restore tension to the surrounding tissues, muscles, and tendons. Traction can:

• Stabilize and realign a broken bone or dislocated part of the body (such as the shoulder)
• Help regain the normal position of the bone that's been fractured
• Stretch the neck to reduce pressure on the spine by realigning the vertebrae
• Temporarily reduce pain prior to surgery
• Lessen or eliminate muscle spasms and constricted joint, muscles, and tendons
• Relieve pressure on nerves, especially spinal nerves
• Treat bone deformities

The kind of traction used will depend on the location and severity of the broken bone or injury and the amount of force needed.

Skeletal Traction

Skeletal traction is used for fractures of the femur (thighbone), pelvis, hip, and certain upper arm fractures. It involves inserting a pin or wire directly into the bone, then attaching weights through pulleys or ropes to it that control the amount of pressure applied. Skeletal traction is used for fractures that require a high amount of force applied directly to the bone, as it allows more weight to be added with less risk of damaging the surrounding soft tissues. If you need skeletal traction, it will be done while an anesthetic so you don't experience too much pain.

Skin Traction

Skin traction is less invasive than skeletal traction and uses splints, bandages, and adhesive tapes positioned on the limb near the fracture and is applied directly to the skin. Weights and pulleys are attached, and pressure is applied. When a bone breaks, the muscles and tendons can pull the extremity into a shortened or bent position. The traction can hold the fractured bone or dislocated joint in place. This can cause painful movement at the fracture site and muscle cramping. Buck's traction is a type of skin traction that is widely used for femoral, hip, and acetabular fractures, which are fractures in the socket portion of the "ball-and-socket" hip joint.

Cervical Traction

Cervical traction is used when neck vertebrae are fractured. In this kind of traction, a device circles the head and attaches to a harness that's worn like a vest around the torso. The resulting stretch to the neck reduces pressure on the spine by pulling and aligning the vertebrae. 

Limitations of Traction

Although traction was widely used for more than a century, in recent years it has been eclipsed by more state-of-the-art surgical techniques for correcting broken bones. Today, traction is used primarily as a temporary measure until surgery is performed.

Risks and Contraindications

There are no long-term risks associated with traction. But some people may experience muscle spasms or pain in the treated area.

Risks

Cervical traction is used when neck vertebrae are fractured. In this kind of traction, a device circles the head and attaches to a harness that's worn like a vest around the torso. The resulting stretch to the neck reduces pressure on the spine by pulling and aligning the vertebrae. The potential risks associated with traction include:

• A negative reaction to the anesthesia
• Excessive bleeding from the site of a pin or screw in skeletal traction
• An infection at the point where the pin or screw has been inserted
• Nerve or vascular injury, in some instances due to extreme swelling
• Damage to surrounding tissue or skin in cases of skin fracture

Contraindications

Elderly people are usually not good candidates for skin traction because their skin is fragile and may be injured from the traction. Traction may also be contraindicated if you have:

• Osteoporosis
• Rheumatoid arthritis
• Infection
• Pregnancy
• Respiratory or circulatory problems
• Claustrophobia
• Cardiovascular disease
• Joint problems

These should all be discussed with your healthcare provider if you are considering traction.

Before Traction

Both skin and skeletal traction require X rays prior to application. These may be repeated over the course of treatment to ensure that the bone alignment remains correct.

If you need traction, your healthcare provider will determine:

• Type of traction
• Amount of weight to be applied
• Timing of neurovascular checks if more frequent than every four hours
• Care regimen for inserted pins, wires, or screws used in skeletal traction
• The site and care of straps, harnesses and halters used in skin traction
• The inclusion of any other physical restraints, straps or appliances (such as a mouth guard)
• Length of traction

Timing

The length of time you will be in traction depends on the location, type, and severity of your broken bone or injury. Traction time can vary from 24 hours to six weeks, or more. If you are waiting for corrective surgery, skin traction may be short-term to immobilize the fracture until your healthcare provider can operate.

Location

Traction is usually done in a hospital.

During Traction

The prolonged immobility that you will experience in traction carries with it a number of potential issues including:

• Bedsores
• Possible respiratory problems
• Urinary issues
• Circulatory problems

To maintain movement of your muscles and joints, your healthcare provider will most likely prescribe a physical therapy program. The equipment will be checked regularly to ensure it's positioned properly and that the force is correctly calibrated.

If you have skeletal traction, your healthcare provider will periodically check which may be a sign that foreign material has penetrated the skin near the screw or pin.

Though you will be largely immobile during traction, some of the activities and movements you can generally participate in are:

• Sitting up in bed
• Quiet activities such as crafts, board games, and television watching
• Moving enough to be bathed and have your hygiene needs addressed

Follow-Up

The first few days after being in traction may be physically and emotionally challenging. Your muscles are probably weak from spending a lot of time in bed. Moving around may be painful.

To address these issues, your healthcare provider may recommend physical therapy as a follow-up to traction. This will help you regain your strength and movement after having spent so much time without movement of parts of your body. A physical therapist can also show you how to manage any discomfort, weakness, or paralysis you may have experienced because of your fracture or injury. You may also have occupational therapy to help regain your strength and to relearn skills that may have been affected or impaired by your injury.

It's important to stick with any therapies your healthcare provider recommends in order to maximize your chance for a full recovery.

A Word From Verywell

Traction can be a very challenging treatment—physically, emotionally, and psychologically because you are severely limited in movement and so undoubtedly feeling quite vulnerable. This may be compounded by the pain that you have to deal with associated with a bone fracture or dislocation of some part of your body. Your healthcare provider can play a big role in easing your anxiety by fully explaining the procedure, including what you can expect and how long the traction will be necessary. Communication with the health professionals who care for you during this difficult time can go a long way to assuage your anxiety and help you get through the experience of having traction.

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.

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