Types of Traction

1. By Mode of Application

A. Skin Traction

• Applied via adhesive or non-adhesive bandages/strapping to the skin surface.
• Transmits a tangential force through the skin to the underlying bone.
• Suitable only for small traction forces (up to ~4-5 kg).
• Prolonged use risks skin breakdown, sensitivity reactions, and infection.
• Examples:
  • Buck's traction - longitudinal pull for femoral/hip fractures; patient lies flat with leg in extension
  • Hamilton-Russell traction - compound pulley system giving a resultant pull in line with the femur; used for upper femoral fractures and hip conditions
  • Gallows (overhead) traction - both legs suspended vertically; used for femoral shaft fractures in children under 2 years, buttocks lifted off the bed
  • Head halter traction - for cervical spine injuries/spasm
  • Collar and cuff - for proximal humeral fractures; the arm's own weight under gravity provides longitudinal traction

B. Skeletal Traction

• A metal pin, wire, or screw is inserted directly through bone, and weights are attached via caliper devices or cords.
• Allows much greater forces to be applied safely without soft tissue damage.
• Common pin sites: proximal tibia, distal femur, calcaneum, olecranon, skull (skull tongs/halo for cervical spine).
• Disadvantage: risk of pin track infection, especially if the pin migrates - threaded pins reduce this risk.
• Pins may be incorporated into plaster casts for added stability.
• Used for: femoral shaft fractures, acetabular fractures, hip fracture-dislocations, cervical spine fractures, comminuted tibial fractures.

C. Manual Traction

• Temporary, hand-applied pulling force along the limb axis.
• Used during fracture reduction maneuvers and in emergency settings before definitive traction is applied.

2. By Mechanism (Fixed vs. Sliding/Balanced)

A. Fixed Traction

• The traction force and its counterforce are both contained within a static system (no free weights or bed dependency).
• Classic example: Thomas splint - a ring fits around the upper thigh against the ischial tuberosity; the traction cord is tightened against the distal end of the splint.
• Advantage: patient is relatively mobile and can be transported with traction in place (historically important in wartime).
• Also: a simple arm sling acts on the same principle.

B. Sliding (Balanced/Dynamic) Traction

• A weight is suspended by a cord from the limb; the counterforce is the patient's own body weight and friction against the bed (or the bed is tilted).
• Advantage: joint movement is often possible if traction is carefully arranged.
• Disadvantage: patient is confined to bed.
• Examples: balanced skeletal traction using a Braun-Bohler frame; longitudinal skin traction with a tilted bed.

3. Common Named Traction Systems

4. By Anatomical Region

• Lower limb: most common; femoral shaft, hip, tibial fractures
• Upper limb: humeral fractures, supracondylar fractures in children
• Cervical spine: skull tongs, halo traction, head halter

Advantages and Disadvantages (Summary)

• Pye's Surgical Handicraft, 22nd Ed., p. 148
• Bailey and Love's Short Practice of Surgery, 28th Ed., p. 449
• Rockwood and Green's Fractures in Adults, 10th Ed. (2025), p. 321