Skeletal traction is a medical procedure used in orthopedics to manage significant bone and joint injuries. It involves applying a continuous pulling force, known as traction, directly to a bone by inserting pins, wires, or screws. The purpose of this technique is to stabilize, align, and immobilize a fractured bone or a dislocated joint. It also helps reduce muscle spasms around the injured area, which can alleviate pain and prevent further damage, allowing for initial healing or preparation for surgery.
Why Skeletal Traction is Used
Skeletal traction is often employed for severe and unstable fractures where less invasive methods may not provide adequate support. This includes significant fractures of the femur, pelvis, tibia, and sometimes injuries to the cervical spine. It plays a role in managing complex fractures or dislocations by maintaining the injured part in correct alignment.
The technique also prevents further displacement of bone fragments before definitive treatment, such as surgery. While advancements in surgical techniques have reduced its long-term use, skeletal traction remains a valuable temporary measure, especially when immediate surgery is not feasible, ensuring stability for better outcomes.
The Process of Skeletal Traction
The application of skeletal traction is performed in a hospital setting under sterile conditions. It involves the insertion of a metal pin, such as a Steinmann pin or a Kirschner wire, directly into the bone. The insertion site is numbed using a local anesthetic to minimize discomfort. A small incision may be made to facilitate pin placement.
Once the pin is securely in the bone, a device called a traction bow is attached. Ropes are then connected to this bow, routed through a system of pulleys, and attached to weights. The amount of weight applied varies depending on the patient’s body weight and the specific injury, often ranging between 10 to 20 pounds (approximately 4.5 to 9 kilograms). Specialized frames, like a Balkan frame or a halo traction device for spinal injuries, are used to support the limb and facilitate the traction system.
Living with Skeletal Traction
Patients undergoing skeletal traction remain in a hospital bed for the duration of treatment, which can range from several days to weeks. Pain management is an ongoing aspect of care, often addressed through a combination of local anesthetics and systemic pain relief medications. Immobility is a challenge, requiring careful attention to prevent complications such as pressure sores.
Daily care involves pin site maintenance to prevent infection. Nurses clean the areas where the pins enter the skin, often using sterile saline to remove any exudate or crusting. Dressings are regularly changed to keep the sites clean and dry. Maintaining personal hygiene, such as showering, requires specific protocols to protect the pin sites.
The prolonged bed rest and restricted movement can also impact a patient’s emotional well-being, potentially leading to frustration, boredom, or anxiety. Healthcare providers continuously monitor the traction setup to ensure proper alignment and tension.
Transitioning from Skeletal Traction
When the injured bone has achieved sufficient stability or is ready for further surgical intervention, the skeletal traction is removed. The removal of the pins is a procedure performed using local anesthesia. Following removal, the patient transitions to another form of immobilization, such as a cast or a brace, to continue the healing process.
Physical therapy and rehabilitation are important next steps to help the patient regain strength, mobility, and function in the affected limb. While skeletal traction is effective, some potential issues can arise. These can include pin site infections, muscle wasting from prolonged inactivity, or joint stiffness. Nerve damage or deep vein thrombosis (blood clots) are also possibilities associated with extended immobility.