Femoral Skeletal Traction

Overview

Femoral traction is accomplished with placement of a pin across the distal femur and attachment to a pulley system secured to a bed.

1.

Do not set up femoral traction until confirming that no “skeletal” injury is present about the knee.
- a.
  
  Confirmation that no skeletal injury is present about the knee can be ascertained via a clinical examination in an alert and oriented patient or with radiographs.
- b.
  
  Note that femoral traction continues to be indicated when a “ligamentous” injury to the knee is present.
2.

The pin must be inserted from the medial aspect to avoid injury to the femoral artery.
3.

Ensure that the pin is placed using the sterile technique. Do not place pins through or near open wounds.
4.

Ensure that the pin is placed perpendicularly to the axis of the limb and is in a straight horizontal plane.
5.

Place traction weights gently!
6.

Once traction has been established, ensure that the traction bow is not in contact with the skin.
- a.
  
  A pressure ulcer can be easily created by the traction bow.
- b.
  
  To ensure that the traction bow does not create a pressure ulcer, the bow should be overwrapped in rolled gauze.
7.

Apply rubber stoppers or similar end caps to the ends of the pin to prevent injury to the patient or healthcare workers.

1.

Close coordination with the operating surgeon is mandatory when placing patients into traction.
2.

Insertion of femoral traction can be completed under a local anesthetic, but conscious sedation is preferred.
3.

If only a local anesthetic is being used, then consider increasing the amount and adding bupivacaine.
4.

If the patient is going to go to the operating room for definitive fixation shortly after placement of femoral traction, then elective intubation prior to placement may be prudent.
5.

Before placement of femoral traction, ensure that the patient is on a bed that is capable of having a traction frame attached to it.
6.

Placement of a femoral pin is easiest when all the equipment are organized. Having two bedside tables facilitates organization and maintenance of a sterile environment.
7.

Having an assistant is not mandatory but is extremely helpful.
8.

A hand drill or a power drill may be used. We prefer using a power drill, especially in younger patients with good bone stock.