Relieve pain

Reduce deformity

Hold fracture reduced

Allow movement while relieving pain








Reduction Principles


1. Apply traction in the long axis of the limb

2. Reverse the mechanism that produced the fracture

3. Align the fragment that can be controlled with the one that cannot


Skin Traction


Applied over large area of skin - spreads load


Never more than 10lb (4.5 kg)



- circulatory impairment

- lacerations or abrasions on skin 

- marked bony shortening - requiring greater reduction force


Skeletal traction



- lower limb fractures 

- cervical spine




Distal femur

- entry medial to prevent injury femoral artery on exit

- just proximal to adductor tubercle

- above intercondylar notch

- below Hunter's canal

- perpendicular to distal femur

- flex knee, insert knife, turn 90o so there is a transverse nick in ITB so knee can flex if needed


Proximal tibia

- 2 cm posterior to crest and 2 cm inferior to tibial tuberosity

- insert laterally to avoid injury to CPN on exit


Distal tibia

- 5cm proximal to ankle joint in middle of tibia on lateral



- 2 cm below and behind tip of lateral malleolus


Skull tongs

- 1.5 to 2 cm above superior tip of pinna



- roll patient and put on back piece

- apply front piece and attach

- apply halo pins x 4

- outer edge of eyebrows

- close eyes tightly to prevent inability to closure

- above and posterior to ears

- 8 pound / sq inch

- ensure below equator of head

- attach to thoracic brace


Fixed traction




Force applied against fixed point of body

- i.e. ischial tuberosity


Thomas splint (1876)

- counter traction

- up against ischial tuberosity

- need 2 cm clearance about thigh

- needs to be 15 cm longer than leg

- need slings to support leg and bandage over top


Balanced traction

- attach Thomas splint

- leg sits on padded slings on splint

- skin traction on calf

- tie to distal aspect of Thomas splint

- this is tensioned by winding about paddle pop stick

- weight hung off end of Thomas splint over pulley on edge of bed to pull away from ischium

- rope tied to Thomas splint and hung from top pulley with weight attached, this pulls the Thomas splint off the bed

- need safety rope attached to weight

- needs daily pressure care and regular oiling


Hamilton Russell traction

- also known as Australian traction

- first described by Dr Hamilton Russell of Melbourne in the 1920's