70.9 Traction

To exert traction is to pull. You can use traction: (1) to pull fractured bones into place to begin with, or (2) to keep them moderately immobile until they have united, or, (3) to do both these things, one followed by the other. To apply traction successfully you will have to find some way to grasp a patient’s limb safely, for several weeks if necessary. There are two ways you can do this: (1) You can stick adhesive strapping to his skin (skin traction). (2) You can pass a Steinmann pin, a Denham pin, or Kirschner wire through his bone (bone traction). Cord has then to be attached to the strapping, pin, or wire, passed over a pulley, and fixed to a weight. The weight may pull the patient out of his bed, so you usually need to exert countertraction by raising the foot of his bed. One of the main purposes of traction is to allow a patient to exercise his muscles and move his joints, so make sure he does this. Traction takes time to apply and manage, but it can easily be managed by assistants—if you teach them! Traction is mostly useful in the leg. In the arm it is uncomfortable, inconvenient, difficult to maintain, and frustrating for the patient. For all these reasons arm traction is only useful in rather exceptional circumstances. Elaborate kinds of traction, such as that of Hamilton and Russell for the leg, require equipment you are unlikely to have, so we have only described the simpler kinds here.