Specific Types of
Robert Hamilton Russell wrote "Fracture of the
Traction
Thomas Splint Traction
Hugh Owen Thomas introduced his splint which
he called "The Knee Appliance" in 1875
The method of Hugh Owen Thomas uses fixed
traction with the counter traction being applied
against the perineum by the ring of the splint
This is in contrast to other methods using weight
traction which is countered by the weight of the
body
Backward angulation of the distal fragment can
never be corrected by traction in the axis of the
femur which only results in elongation with
persistence of the deformity
A Thomas splint and fixed traction is only
capable of maintaining a reduction previously
achieved by manipulation
The use of supports enables correction of
angulation caused by muscle tension
Placement of a large pad behind the lower
fragment acts as a fulcrum over which backward
angulation is then corrected by the traction force
The pad should be 6" in width, 9" long and 2"
thick, applied transversely across the splint
under the distal fragment and popliteal fossa
It is the splint which controls alignment and not
the traction
The tension in the apparatus should only be that
sufficient to balance resting muscle tone
Suspension of the splint using an overhead
beam enables the splint to move easily with the
patient when they move in bed
Its use in combination with a Pearson Knee-
flexion piece enables mobilisation of the knee,
while maintaining traction, alignment and
splinting of the fracture
Hamilton Russell Traction
femur: A clinical study" in which he described his
traction in 1924
Sling under the distal 1/3 of the thigh provides
upward lift, as well as longitudinal traction in the
line of the tibia
The sling under the distal fragment controls
posterior angulation and the lifting force is
related to the main traction force through the
medium of pullies
No rigid splinting is used in this method
Combines a means of suspending the lower
extremity and a means of applying traction in the
axis of the femur
Many other varieties of both skeletal and skin
traction result in a similar effect
Buck Traction
Buck introduced simple horizontal traction in
1861
Traction is analogous to Pugh's traction only the
inclination of the bed is replaced by the
application of weights over a pulley.
Bryant's traction
Vertical extension traction was described by
Bryant in 1873 and applied to the management
of femoral fractures
The development of ischemia of the lower leg
through reduced perfusion resulted in limitation
of its application to the short-term management
of a fractured femur
A modification of his traction has been shown to
reduce the risk of limb ischemia and may be
applicable where prolonged traction is required
in an infant
 Braun Frame
This is merely a cradle for the limb
Disadvantage is that the position of the pulleys
cannot be altered and the size of the splint often
does not fit the limb as might be wished
Lateral bowing is common as the splint and the
distal fragment are fixed to the frame, while the
patient and the proximal fragment can move
sideways leaving the frame behind
Perkins Traction
Here no splinting is used at all
The posterior angulation of the thigh is controlled
by a pillow
The alignment and fixation depend entirely on
the action of continuous traction
Fisk Traction
Hinged version of a Thomas splint is arranged to
allow 90o of knee movement
It is particularly attractive as it allows active
extension of the knee joint
Fixation and alignment is dependent entirely on
the weight traction and the splint merely applies
the motive power for assisted knee movement
90 - 90 Traction
The thigh is suspended in the vertical plane by
weight traction pulling vertically upwards
The ill effect of gravity as the cause of backward
angulation of the fragments is thus eliminated
Charnley
Strongly recommends the use of a BK POP
incorporating the Steinmann or Denham pin in
the upper end, in order to reduce pressure on
the soft structures around the knee
Benefits of POP/Traction unit (Charnley) :
Foot supported at right angles to the tibia
Common peroneal nerve and calf muscles
protected from pressure against the slings of the
splint and the splint itself
The tibia is suspended from the skeletal pin
inside the POP, so that an air space develops
under the tibia as the calf muscles loose their
bulk
External rotation of the foot and distal fragments
is controlled
The tendo achilles is protected from pressure
sores
Comfort; The patient is unaware of the traction
when applied through the medium of a nail
Upper Limb
A number of skin traction methods have been
described and a number more utilised without
documentation in the literature
Ingerbrightsen's overhead skin traction (A);
Dunlop's side arm skin traction (B); and
Graham's extension skin traction (C) are but a
few
Skeletal pin traction can also be utilised :
Overhead (A)
Overhead with secondary distal forearm traction
directed cephalad (B)
Side arm pin traction (C)
What Is Traction?
In the medical field, traction refers to
the practice of slowly and gently pulling on a
fractured or dislocated body part. Its often
done using ropes, pulleys, and weights.
These tools help apply force to the tissues
surrounding the damaged area.
The purpose of traction is to guide the
body part back into place and hold it steady.
Traction may be used to:
stabilize and realign bone fractures, such
as a broken arm or leg
help reduce the pain of a fracture before
surgery
treat bone deformities caused by certain
conditions, such as scoliosis
correct stiff and constricted muscles,
joints, tendons, or skin
stretch the neck and prevent painful
muscle spasms
TYPES
The two main types of traction are skeletal
traction and skin traction. The type of
traction used will depend on the location
and the nature of the problem.
Skeletal Traction
Skeletal traction involves placing a
pin, wire, or screw in the fractured bone.
After one of these devices has been
inserted, weights are attached to it so the
bone can be pulled into the correct position.
This type of surgery may be done using a
general, spinal, or local anesthetic to keep
you from feeling pain during the procedure.
The amount of time needed to
perform skeletal traction will depend on
whether its a preparation for a more
definitive procedure or the only surgery
thatll be done to allow the bone to heal.
Skeletal traction is most commonly
used to treat fractures of the femur, or
thighbone. Its also the preferred method
when greater force needs to be applied to
the affected area. The force is directly
applied to the bone, which means more
weight can be added with less risk of
damaging the surrounding soft tissues.
Skin Traction
Skin traction is far less invasive than
skeletal traction. It involves applying splints,
bandages, or adhesive tapes to the skin
directly below the fracture. Once the
material has been applied, weights are
fastened to it. The affected body part is then
pulled into the right position using a pulley
system attached to the hospital bed.
Skin traction is used when the soft
tissues, such as the muscles and tendons,
need to be repaired. Less force is applied
during skin traction to avoid irritating or
damaging the skin and other soft tissues.
Skin traction is rarely the only treatment
needed. Instead, its usually used as a
temporary way to stabilize a broken bone
until the definitive surgery is performed.
Cervical Traction
During cervical traction, a metal
brace is placed around your neck. The
brace is then attached to a body harness or
weights, which are used to help correct the
affected area. Cervical traction is performed
using a general anaesthetic, so youll be
asleep throughout the entire procedure.
Cervical traction might be used in
two different situations. First, it may be done
to gently stretch the neck muscles so
muscle spasms can be relieved or
prevented. It may also be performed to
immobilize the spine after a neck injury.
RECOVERY
What Happens After Traction?
If youre treated with traction, youll
probably need to participate in an inpatient
or an outpatient treatment program. These
programs often consist of physical and
occupational therapy to help you regain
your strength and relearn skills that may
have been affected by your injury. A
therapist can also teach you new skills to
compensate for any pain, weakness, or
paralysis you may have experienced as a
result of being injured.
The first few days after traction is
performed can be difficult. The muscles are
often weak since you must spend a lot of
time in bed after traction is performed.
Moving around and walking may be
challenging and can make you tired.
However, its important to stick with any
rehabilitation program so that you can
improve your chances of making a complete
recovery.
EFFECTIVENESS
Is Traction an Effective Treatment?
Traction used to be considered a
state-of-the-art treatment. In recent years,
however, other surgical techniques have
become more advanced and more effective
in correcting fractures, damaged muscles,
and spinal conditions. Traction also doesnt
allow for much movement after surgery, so
the recovery time is often much longer.
Today, its used primarily as a temporary
measure until the definitive procedure is
done. Traction saved many lives during
World War II by allowing soldiers to be
transported safely without injury to their
surrounding tissues.
However, traction can be beneficial
in treating certain conditions. Its very
effective in providing temporary pain relief in
the early stages of treatment after trauma.
You and your doctor can discuss whether
traction is the best option for your particular
condition.

RISKS
What Are the Risks of Traction?
There are risks involved in all surgical
procedures. These risks include:
an adverse reaction to the anesthesia
excessive bleeding
an infection of the pin site
damage to the surrounding tissue
nerve injury or vascular injury from too
much weight being applied
Its important to contact your doctor if:
the prescribed medications arent
relieving your pain
the skin around the pin site becomes red,
hot, or swollen
theres drainage