Skeletal traction is an orthopedic method used to stabilize and align bones, particularly after severe injuries. It involves applying a continuous pulling force to an injured body part. This technique helps manage complex fractures by gently guiding bone fragments into a more appropriate position. It often serves as a temporary measure to prepare for further definitive treatment or to facilitate healing.
What Skeletal Traction Is
It stabilizes fractured bones, aligns fragments, and reduces muscle spasms that worsen displacement. Proper alignment also helps relieve pain and prepares the injured area for surgical repair or natural healing.
This technique is often applied in cases of severe fractures, particularly those affecting larger bones in the lower body, such as the femur (thigh bone) or tibia (shin bone). It can also be used for injuries to the hip, pelvis, and certain spinal fractures. Skeletal traction frequently serves as a temporary measure in trauma situations, providing stability and realignment until a patient is stable enough for surgery.
How Skeletal Traction is Performed
Skeletal traction involves the precise insertion of a metal pin or wire directly into the bone. Common pin types include Steinmann pins, Denham pins, or Kirschner wires, chosen based on the specific injury and bone. Before insertion, the area is cleaned, and local anesthesia is administered to numb the skin and bone, ensuring patient comfort. A small incision allows the pin to pass into the bone.
The pin is typically inserted through a specific area of the bone, such as the distal femur (just above the knee) or the proximal tibia (just below the knee), chosen to maximize mechanical advantage and avoid nerve or blood vessel damage. Once the pin is in place, a U-shaped frame, known as a traction bow or stirrup, is attached to its ends. Ropes are then connected to this frame, running over a system of pulleys mounted on a specialized bed or frame.
Weights are then attached to the ropes, providing the continuous pulling force necessary to realign the bone fragments. The amount of weight used varies depending on the patient’s body weight and the specific injury, typically ranging from 10 to 20 pounds, or about 10-15% of the patient’s body weight. Counter-traction, often achieved by tilting the bed or using the patient’s body weight, ensures the pulling force is effective and sustained. This setup maintains constant tension, gradually bringing the fractured bone into proper alignment.
Life with Skeletal Traction
Skeletal traction requires significant adjustments due to prolonged immobility. Patients are restricted to bed rest for several weeks. This prolonged inactivity necessitates diligent monitoring, including regular checks of neurovascular status and respiratory function. Pain management is also a primary concern, often addressed through prescribed medications and by ensuring the traction setup maintains proper alignment, which can itself reduce discomfort.
Maintaining meticulous hygiene around pin insertion sites is important to prevent infection. Nurses or caregivers regularly clean the pin sites, often using sterile saline solution or chlorhexidine. They inspect for signs of infection such as redness, swelling, increased drainage, or warmth. Dressings may be applied to protect the sites, and any crusting around the pins is typically removed to allow for drainage and inspection.
The psychological impact of prolonged immobility and dependence can also be challenging for patients. Medical teams encourage coping strategies and provide support to manage the emotional aspects of recovery. Regular assessment for pressure sores is also performed, and repositioning within the limits of the traction is done to protect skin integrity.
After Skeletal Traction
Once the bone has achieved sufficient stability or is ready for definitive surgical repair, the skeletal traction pins are removed. This process is typically performed with local anesthetic to minimize discomfort. After pin removal, the small puncture sites are cleaned and bandaged to prevent infection.
The transition from skeletal traction often involves moving to another form of immobilization, such as a cast or brace, to continue supporting the healing bone. Rehabilitation then begins, focusing on restoring mobility, strength, and function to the affected limb. Early mobilization, as appropriate for the injury, helps prevent joint stiffness and muscle wasting. Physical therapy exercises are tailored to the individual’s needs, gradually increasing activity levels.
Despite careful management, some potential complications can arise during or after skeletal traction. Pin site infections are a recognized risk due to the direct entry of pins into the bone, though diligent care aims to minimize this. Other potential issues include nerve damage, joint stiffness from prolonged immobility, and muscle wasting. Deep vein thrombosis (DVT), or blood clots, is another concern associated with prolonged bed rest, managed with preventive measures. Regular follow-up appointments with the orthopedic surgeon and imaging studies help monitor the healing process and address any complications that may arise.