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A Method of Balanced Skeletal Traction for Femoral Fractures


STEVEN T. WOOLSON and LOUIS W. MEEKS
J Bone Joint Surg Am. 1974;56:1288-1289.

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Publisher Information The Journal of Bone and Joint Surgery
20 Pickering Street, Needham, MA 02492-3157
www.jbjs.org
A Method of Balanced Skeletal Traction for
Femoral Fractures
BY STEVEN T. WOOLSON, M.D.*, AND LOUIS W. MEEKS, M.D.t, ANN ARBOR, MICHIGAN

From the Section of Orthopaedic Surgery, Departenent of Surgery.


University of Michigan Medical Center. Ann Arbor

The history of the use of traction in the initial treatment of femoral fractures 2

includes development of various types of splint for support of the extremity, but there are
obvious disadvantages to the use of these splints. A method of skeletal suspension,
introduced at the University of Michigan Affiliated Hospitals in the 1960’s for treatment
of femoral fractures with or without other associated ipsilateral lower-extremity injuries,
eliminates the need for splints. It combines Russell traction :t and the more recent
technique of 90-90 traction ‘, and offers advantages in patient comfort, ease of nursing
care, and simplicity.
The method is illustrated in Figure 1 It consists
. of balanced skeletal traction with a
Kirschner wire or Steinmann pin inserted either in the proximal part of the tibia or the
distal part of the femur and with a short cast to support the leg. A standard cotton-flannel
thigh sling supports the site of fracture. The method requires the use of four weight-ropes
and between 13.6 and 22.7 kilograms of traction for the average adult patient.

FIG. I

Diagram oftraction set-up. Rope A to thigh sling (2.3 to 4.5 kilograms). Rope B to traction pin elevating short
cast (2.3 to 4.5 kilograms). Rope C to foot ofshort cast (0.9 to 3.2 kilograms). Rope D to tibial traction bail (or
to femoral bail if preferred) for longitudinal traction (4.5 to 1 1 .3 kilograms).

* University of Michigan Medical Center, Ann Arbor, Michigan 48104.


t 2301 South Huron Parkway, Ann Arbor, Michigan 48104.

I 288 THE JOURNAL OF BONE AND JOINT SURGERY


BALANCED SKELETAL TRACTION 1289

Under sterile conditions, the Steinmann pin or Kirschner wire is inserted while
longitudinal traction is applied by an assistant. A well padded short cast is applied with the
ankle in a neutral position and special care is taken to pad the heel and Achilles tendon
with a piece of felt. The traction pin, when inserted in the tibia, is incorporated in the cast,
which is contoured posteriorly so that, when the knee is in approximately 30 to 45 degrees
of flexion, there is no popliteal pressure. A thigh sling is applied with its direction of pull
perpendicular to the femur, as in Russell traction. The ropes elevating the short cast may
be adjusted to maintain rotational alignment of the leg and varus-valgus angulation at the
fracture site. Skeletal traction is applied through the long axis of the femur by a fourth
rope attached to the traction bail. All four weights are suspended from the foot of the bed
through separate pulleys. Enough weight is used to elevate the leg from the bed as desired,
to flex the knee to the degree appropriate to the type and location of the fracture, and to
reduce the fracture. The method may easily be convet’. to 90-90 traction by flexing the -

knee to 90 degrees and discarding the thigh sling.


Traction of this type has been used at the University of Michigan for over five years.
There have been no significant complications. Good control has been achieved in over 300
femoral fractures, and in some patients the method was used for extended periods of time.
It has been used for femoral fractures associated with ipsilateral hip, tibial, ankle, and foot
fractures, and with various knee injuries. Bilateral femoral fractures have also been
treated with this method.
There are many advantages to this method of traction. The patient’s comfort in
traction is evident. The method is ideal for open fractures because the thigh is readily
accessible for inspection and changes of dressings. True lateral roentgenograms of the
femur are easily obtained, unobstructed by a metallic splint. An equinus foot deformity is
prevented by the use of the short cast.
This method is applicable to any femoral-shaft fracture in any age group except that
of infants, in whom Bryant traction is indicated. It is especially suitable for femoral frac-
tures associated with ipsilateral fractures distal to the knee, for which a short cast is
needed. It is also appropriate for a patient with a sciatic or peroneal-nerve palsy or for one
in whom an equinus deformity may develop. Obese patients for whom perineal care in a
Thomas splint poses difficulty also benefit from treatment by this method.

References
I . HUMBERGER. F. W. .
and EYRING, E. J. : Proximal Tibial 90-90 Traction in Treatment of Children with
Femoral-Shaft Fractures. J. Bone and Joint Surg. , 51-A: 499-504, April 1969.
2. PELTIER. L. F.: A Brief History of Traction. J. Bone and Joint Surg., 50-A: 1603-1617, Dec. 1968.
3. RUSSELL. R. H.: Fracture of the Femur: A Clinical Study. British J. Surg. . 491-502, 11: 1924.

VOL. 56-A, NO. 6, SEPTEMBER 1974

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