What Is Traction?

Traction is a technique for realigning a broken bone or dislocated part of the body. It uses weights, pulleys, and ropes to gently put pressure on and pull a bone or injured body part back into the right position. 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.

After a fracture, traction can restore the proper position of a bone during the early stage of healing or temporarily ease the pain while you are waiting to have corrective surgery. 

This article explains the types of traction, how they work, and what to expect if you have to be in traction while you are healing from an injury or surgery.

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 (e.g., a shoulder)
• Help a fractured bone get back into a normal position
• Stretch the neck and realign the vertebrae to reduce pressure on the spine
• Temporarily reduce pain before surgery
• Lessen or eliminate muscle spasms and constricted joints, 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 that's needed to fix it.

Skeletal Traction

Skeletal traction is used for fractures of the thighbone (femur), pelvis, hip, and some upper arm fractures. It involves inserting a pin or wire directly into the bone, then attaching weights to it through pulleys or ropes that control the amount of pressure applied.

Skeletal traction is used for fractures that need a lot of force applied directly to the bone. This type of traction allows more weight to be added with less risk of damaging the surrounding soft tissues.

If you need skeletal traction, you will be given an anesthetic so you will not feel too much pain while it is done.

Skin Traction

Skin traction is applied directly to the skin. It uses splints, bandages, and adhesive tapes to position a limb near the fracture. Then, weights and pulleys are attached and pressure is applied. It does not require cuts to get to the bone, like skeletal traction does.

When a bone breaks, the muscles and tendons around it can pull an arm or leg into a shortened or bent position. This can cause painful movement at the fracture site and muscle cramping. Traction can hold the fractured bone or a dislocated joint in place.

Cervical Traction

Cervical traction is used when the neck vertebrae are fractured.

With this type, a device goes around the head and attaches to a harness that's worn like a vest on the torso. The traction stretches the neck and reduces pressure on the spine by pulling and aligning the vertebrae. 

Limitations of Traction

Although traction was widely used for more than a century, it has been replaced by more state-of-the-art surgical techniques for correcting broken bones.

Today, traction is used mostly as a temporary measure until surgery can be done.

Concerns and Contraindications

The major risks of traction are short-term and include muscle spasms or pain in the area being treated. Long-term risks of being in traction, like damage to nerves or your skin, are less likely but can happen.

Risks of Traction

There are risks to being put in any kind of traction. For example, you may have:

• A negative reaction to anesthesia
• Excessive bleeding from the site of a pin or screw
• An infection at the place where the pin or screw has been put in
• Nerve or vascular injury (in some cases, this is caused by extreme swelling)
• Damage to surrounding tissue or skin

The prolonged immobility that you will experience in traction also carries risks, including:

• Bedsores
• Respiratory problems
• Urinary issues
• Circulatory problems

Who Should Not Have Traction

Traction is not an option for every patient. For example, older adults are usually not good candidates for skin traction because their skin is fragile and could be injured by traction.

You also may not be able to have traction if you have:

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

Before Traction

You'll need to have X-rays before skin and skeletal traction. The scans might be repeated over the course of treatment to make sure that the bone realignment stays in the right place.

If you need traction, here are some decisions your provider will need to make:

• Type of traction
• Amount of weight to be applied
• Length of traction
• Timing of neurovascular checks (if more frequent than every four hours)
• Care needs 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 mouthguard)

Timing

How long you will need to be in traction depends on the location, type, and severity of the broken bone or injury. In general, traction time can vary from 24 hours to six weeks or more.

If you are waiting to have corrective surgery, skin traction could be used in the short term to keep the fracture from moving (immobilization) until you can have the operation to fix it.

Location

If you need to be put in traction, it will be done by your provider in a hospital.

During Traction

To maintain the movement of your muscles and joints while you are in traction, your provider will likely prescribe a physical therapy (PT) program for you. The equipment will be checked regularly to make sure it's positioned properly and that the force is calibrated correctly.

If you have skeletal traction, your provider will check on it from time to time to look for any signs that foreign material has gotten under the skin near the screw or pin.

Though you won't be able to move much while you're in traction, some activities and movements you can still do include:

• Sitting up in bed
• Quiet activities (e.g., crafts, board games, and watching TV)
• Moving enough to be bathed and have your hygiene needs taken care of

Follow-Up

The first few days after being in traction can be physically and emotionally challenging. Your muscles will be weak from spending a lot of time in bed, so moving around may hurt.

Your provider may recommend PT as a follow-up to traction. Doing PT will help you regain your strength and movement after having spent so much time immobile.

A physical therapist can show you how to manage any discomfort, weakness, or paralysis you may have experienced because of a fracture or injury. You may also have occupational therapy (OT) to help you regain your strength and relearn skills that may have been affected or impaired by your injury.

It's important to stick with any therapies your provider recommends to maximize your chance of making a full recovery.

Summary

Traction can be used to help a broken or dislocated bone heal. It uses tools like weights and ropes to get the part of the body back into position.

There are different kinds of traction for different parts of the body, and each kind has risks and benefits.