Traction

In orthopedic medicine, traction refers to the set of mechanisms for straightening broken
bones or relieving pressure on the spine and skeletal system. Traction is the use of weights,
ropes and pulleys to apply force to tissues surrounding a broken bone. There are two types
of traction: skin traction and skeletal traction.
The purpose of traction is to:

Regain normal length and alignment of involved bone;

Realign and fix bone fractures, such as a broken leg;

Help reduce pain before surgery;

Treat bone deformities caused by conditions such as scoliosis (abnormal curvature of

the spine);

Correct a muscle contracture (shortening of a muscle);

Lessen or eliminate muscle spasms;

Relieve pressure on nerves, especially spinal;

Prevent or reduce skeletal deformities or muscle contractures; and

Provide a fusiform tamponade around a bleeding vessel.

Skin Traction
Skin traction includes weight traction, which uses lighter weights or counterweights to apply
force to fractures or dislocated joints. Weight traction may be employed short-term, (e.g., at
the scene of an accident) or on a temporary basis (e.g., when weights are connected to a
pulley located above the patient's bed). The weights, typically weighing five to seven
pounds, attach to the skin using tape, straps, or boots. They bring together the fractured
bone or dislocated joint so that it may heal correctly.
In obstetrics, weights pull along the pelvic axis of a pregnant woman to facilitate delivery. In
elastic traction, an elastic device exerts force on an injured limb.
Skin traction also refers to specialized practices, such as Dunlop's traction, used on children
when a fractured arm must maintain a flexed position to avoid circulatory and neurological
problems. Buck's skin traction stabilizes the knee, and reduces muscle spasm for knee
injuries not involving fractures. In addition, splints, surgical collars, and corsets also may be
used.
Skin traction is usually carried out while a person is lying in a hospital bed. It uses
equipment such as splints, bandages, adhesive tape and special gloves and boots that are
attached to weights.
A pulling force is applied through soft tissues, such as the skin, muscles and tendons. The
affected area of the body is pulled up using a pulley system attached to the bed.

Skeletal Traction
Skeletal traction requires an invasive procedure in which pins, screws, or wires are surgically
installed for use in longer term traction requiring heavier weights. This is the case when the
force exerted is more than skin traction can bear, or when skin traction is not appropriate for
the body part needing treatment. Weights used in skeletal traction generally range from 25
40 lbs (1118 kg). It is important to place the pins correctly because they may stay in place
for several months, and are the hardware to which weights and pulleys are attached. The
pins must be clean to avoid infection. Damage may result if the alignment and weights are
not carefully calibrated.
Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis, hip, or
femur; and overhead arm traction, used in certain upper arm fractures. Cervical traction is
used when the neck vertebrae are fractured.

Skeletal traction is used when a greater force needs to be applied. The force is applied
directly to the skeleton, which means additional weight can be added without the risk of
damaging the surrounding soft tissues.
The skin can usually support up to 3.5kg (8 lbs), whereas the skeleton can support up to
12kg (25 lbs).
During skeletal traction, pins, wires or screws are surgically implanted into the bone. This
can be carried out using either a local anesthetic or a general anesthetic.
After the pins, wires or screws have been implanted, weights are attached to them so that
the affected body part can be pulled into the correct position.
The length of time skeletal traction needs to be used for will depend on how badly injured
the bones are.

How Does It Work

Despite being used as a treatment for hundreds of years, there's little scientific evidence to
support the use of traction.
Skin or skeletal traction was often routinely applied to the limb of a fractured hip before
surgery. However, recent research has shown this appears to have little or no benefit.
There's also little evidence to show traction is an effective method of treating spinal
conditions such as:

Neck pain;

Back pain; and

Sciatica (pain caused by irritation or compression of the sciatic nerve).

Several studies have either produced inconclusive results or concluded that there are more
effective methods of treating these conditions, such as exercise and physiotherapy.
Although skin and skeletal traction may be used to treat certain types of fracture, traction is
not usually needed for minor fractures.

Preparation
Both skin and skeletal traction require X-rays prior to application. If skeletal traction is
required, standard pre-operation surgical tests are conducted, such as blood and urine
studies. X-rays may be repeated over the course of treatment to insure that alignment
remains correct, and that healing is proceeding.

Normal Results
There have been few scientific studies on the effects of traction. Criteria (such as
randomized controlled trials and monitored compliance) do exist, but an outcome study
incorporating all of them has not yet been done. Some randomized controlled trials
emphasize that traction does not significantly influence long-term outcomes of neck pain or
lower back pain.