Boyd W. Haynes III, MD
If you are near my age, can you remember how TV showed patients with broken bones? They were all in the hospital, lying in a bed, with pins through their limbs, in traction. That was the reality, too. Forty to fifty years ago, we didn’t have the technology, instrumentation, anesthesia, surgical technique, etc. that we use in today’s Orthopaedics, so we relied on good old traction to treat bone fractures. In this article, walk with me down memory lane as I discuss skeletal traction, what it is, why it was used and the rare circumstances in which it is still used in current Orthopaedic treatment. I’m not going to address traction as a modality in Physical Therapy in this article.
Simply put, traction is the practice of pulling on a broken bone or dislocated body part in a slow, steady manner to realign it into proper position and keep it stable. This is typically done with ropes, weights, and pulleys. Traction can also be used to prevent or control muscle spasms. Skeletal traction uses a pin, wire or screw inserted into the fractured bone to which a weight(s) is attached. The weight will then pull the broken bone into place over time. Skin traction doesn’t use a pin, but instead a splint or an adhesive is used to pull the skin and soft tissues surrounding a bone.
Traction has been in use since at least the time of the ancient Greeks. Galen wrote about using it in the 2nd century A.D to treat spinal issues. It saved many a life in WWII as wounded soldiers needed to be transported safely home for recuperation with broken limbs. However, traction has many drawbacks and inherent complications, such as:
- Infection – from the site of the pin, wire or screw
- Bed sores – (decubitus ulcers) from lying in one position for so long
- Pneumonia – from lying flat and still for so long
- DVT – blood clots from inactivity
- Mechanical malfunction of the pulley system leading to reinjury
- Misalignment of the bone
- Nerve damage from limb suspension
- Stiffened joints – due to inactivity
- Lengthy recovery times
- Patient weakened after long recovery in bed
Often, the physician would have more trouble treating all the complications than the fractured bone…imagine how that was before penicillin was discovered!
Fast forward with me to 2022, where we almost never use traction for those ten reasons I listed above. Even though surgery has risks, today’s advanced and minimally invasive bone reduction technique, antibiotics, superb anesthesia and pain management drugs and the movement to mostly outpatient care has made this possible. It is worth the smaller risk that surgery presents to the patient to avoid all those big risks that are involved with traction and keeping a patient inactive in bed for weeks at a time.
Now, there will be a very rare occasion when we will use traction, but that is typically for a traumatic accident patient who is in bad shape, where we need to buy some time before surgery can be performed AND need to get a fractured bone(s) in better position to do that surgery. The trauma may have been so great that muscles, ligaments and tendons contracted so rapidly that the fractured bone was pulled far away from its broken end. Traction can help me to gently and steadily pull that bone back into position, with the help of some muscle relaxant and pain medications, so that we can permanently repair or reduce it surgically for healing and rehab to occur.