Skeletal Traction

Indications

  • Temporary control of femoral shaft, acetabular and vertically unstable pelvic fractures
  • Patients unfit for early surgery
  • Cervical traction with tongs or halo for cervical dislocations

Position

  • Supine, local anaesthetic infiltration down to periosteum
  • Image intensifier is rarely needed

Operative Steps

  1. Distal femoral pin at the level of the superior pole of the patella, inserted medial to lateral to avoid the femoral artery
  2. Proximal tibial pin 2 cm posterior and 2 cm distal to the tibial tubercle, inserted lateral to medial to protect the common peroneal nerve
  3. Avoid tibial pins with suspected knee ligament injury
  4. Calcaneal pin inserted medial to lateral to protect the tibial nerve and artery
  5. Use a threaded Denham pin to reduce sliding
  6. Weight about one seventh of body weight for femoral traction
  7. Make a small stab incision and insert the pin by hand drill
  8. Check the pin is parallel to the knee joint

Postoperative Care

  • Daily pin care and neurovascular checks
  • Check films for length and alignment
  • Pressure care and VTE prophylaxis
  • Physiotherapy for knee and ankle motion
  • Skin traction is limited to about 5 kg

Complications

  • Pin tract infection
  • Nerve or vessel injury
  • Pressure sores, VTE and chest infection from immobility
  • Pin tract infection
  • Neurovascular injury
  • Pressure sores and VTE with prolonged traction

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.