70.10 Skin traction

The great advantage of skin traction is that there is no need to pass any instrument through the tissues. But: (1) You cannot apply more than 5 kg, and even then not for long, so it is not suitable for Perkins traction. (2) joints which are crossed by the strapping cannot flex and exercise. (3) The patient’s skin may become sensitive to the strapping. (4) Skin traction is poorly tolerated in old patients and easily causes blisters. (5) If it is not carefully managed, the strapping slips off completely. (6) It is very uncomfortable in hot climates. (7) It can occasionally cause ischaemia followed by Volkmann’s contracture (78.2).

Nevertheless, skin traction is particularly useful for treating: (1) elbow fractures in adults and children, (2) fractured femurs in children, (3) fractured femurs in adults where pin traction cannot be used or has caused complications.

SKIN TRACTION

If possible, use special traction strapping. If you use ordinary zinc oxide strapping, help it to stick by applying compound tincture of benzoin (compound tincture of benzoin BPC) to a patient’s skin. This is an alcoholic varnish which becomes sticky as it dries. Let it get sticky and then apply the strapping to it.

If necessary, shave the patient’s skin. Apply strapping to both sides of his limb, up to but not above the fracture line, or it will fail to exert any traction. Finally, wind a crêpe bandage spirally over it. Never wind circular turns of ahesive strapping round a limb, because the strapping can become too tight.

Either fix a piece of wood in a loop of strapping, as in Fig. 78-3, making it slightly wider than the patient’s ankle so that the strapping does not compress his malleoli. Or, fold each end of the strapping, and tie a cord to it.

CAUTION! (1) When you apply skin traction to an adult’s leg, especially a thin, bony, old one, take great care that the strapping does not press on his common peroneal nerve, as it winds round the neck of his fibula. This could paralyse it and cause foot drop. (2) Don’t let the strapping extend above the fracture line onto the proximal fragment, or it will be useless. (3) Don’t let it interfere with his circulation.

If you don’t have any crêpe bandage, take some 2 cm zinc oxide tape and wind it in two long right and left spirals round the limb. The spirals should cross each other twice as in Fig. 78-1. This will be safer than applying circular strapping.