Fixed traction
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Here is a focused summary of fixed traction from the surgical and fracture management literature:
Fixed Traction
Definition
Fixed traction is a method of maintaining a fracture or limb in position by applying a traction force to the limb (through skin strapping or a skeletal pin) and using the patient's own body as the counterforce - specifically a bony prominence or rigid frame - rather than suspended weights.
- Pye's Surgical Handicraft, p. 148
- Rockwood and Green's Fractures in Adults, 10th ed.
How It Works
The traction force is applied distally (via skin adhesive or a transosseous pin through the distal femur or proximal tibia), and the counterforce acts against the patient's body - typically a bony landmark such as the ischial tuberosity.
This is in contrast to sliding (balanced) traction, where hanging weights provide the traction force and the patient's body weight/friction acts as the counterforce.
Classic Example: The Thomas Splint
The most well-known device for fixed traction is the Thomas splint, used primarily for femoral fractures:
- A ring fits around the upper thigh and bears against the ischial tuberosity
- A U-piece (two metal side bars) extends down the sides of the leg and beyond the foot
- Traction cords are attached to the distal end of the splint and tightened, pulling the limb distally against the ring's counterforce
- Historically very important during wartime for emergency stabilization of femoral shaft fractures
A simple arm sling is also a form of fixed traction - the sling suspends the forearm/hand, with the patient's shoulder providing the counterforce.
Skeletal vs. Skin Fixed Traction
| Type | Method | Use |
|---|---|---|
| Skin traction | Adhesive strapping | Lower loads, short duration |
| Skeletal traction | Transosseous pin (distal femur or proximal tibia) | Higher loads, longer duration |
In skeletal fixed traction, the pin is secured to the distal end of the splint (e.g., Thomas splint), locking it in place rather than suspending it from a weight-and-pulley system.
Key Advantage
The patient remains relatively mobile and can be transported with the traction still applied - a major benefit over sliding traction, which confines the patient to bed.
Current Role
Traction (both fixed and sliding) has largely been superseded by internal fixation (intramedullary nailing) for femoral fractures since the 1970s-80s. However, it remains relevant:
- Where internal/external fixation is unavailable
- For acute cervical spine fracture management
- As a temporary measure prior to definitive surgery
(Rockwood and Green's Fractures in Adults, 10th ed., p. 321)
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