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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
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).
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 -
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.