5 Traction

Purpose and use

Traction applies a sustained pull to help maintain alignment, limit movement, and reduce pain or muscle spasm. It may be used temporarily while a fracture awaits definitive treatment; for example, Buck’s traction may be used for a femoral fracture while the patient awaits surgery. Traction does not permanently fix a fracture or eliminate complications associated with immobility.

Types of traction

The two types differ in how they transmit force:

• Skin traction transmits force through the skin, often using a boot or straps.

• Skeletal traction transmits force through pins or wires attached to bone and requires pin-site monitoring and care.

The prescribed setup and weight are specific to the patient. Do not independently add, remove, or change weights or otherwise alter the prescribed traction system.

Equipment and setup safety

Check that the patient’s body and affected limb remain aligned with the prescribed pull. The weights should hang freely, and the ropes should run freely in the pulley grooves. Weights resting on the floor, ropes that are obstructed, and frayed ropes can interfere with safe, effective traction and should be addressed promptly.

If weights are pulling against the bed frame, reposition them so they hang freely if this can be done safely without changing the prescribed setup, and report equipment problems. Do not tie weights to the bed frame, remove a weight to reduce discomfort, or disconnect the system as an independent change. Report concerns to the treating team; do not change weights unless directed by the team or required in an emergency.

Monitoring the patient

Regularly assess pain, skin, and the affected limb’s distal neurovascular status. Check distal color, temperature, capillary refill, pulse, sensation, and movement. Compare findings with the other limb and with prior assessments, document them, and promptly report deterioration. Follow the treating team’s directions for how often assessments should be performed.

In skeletal traction, inspect pin sites for changes such as increasing redness, swelling, drainage, or pain. Perform pin care according to the prescribed care plan and facility protocol. Do not rotate pins, apply skin lotion directly to insertion sites, or independently loosen or manipulate the pins or traction assembly.

Responding to complications and immobility

Rapidly worsening pain, increasing swelling, or pain when the toes are passively moved can signal compartment syndrome, a time-critical emergency. Report these findings immediately and obtain urgent clinical assessment. Do not wait for a routine check, rely on elevation and observation alone, or independently remove the traction weights.

For prolonged traction, care extends beyond the equipment. Provide prescribed skin care and repositioning, encourage permitted movement and breathing exercises, and monitor for complications associated with limited mobility. Follow the patient’s individual orders and precautions.