Buck’s traction is a type of skin traction that uses a padded boot, a rope, and a hanging weight to pull gently on an injured leg in a straight line. It is most commonly applied before surgery to stabilize hip or femur fractures, reduce muscle spasms, and control pain. The weight used typically does not exceed 4.5 kilograms (about 10 pounds), since the pulling force is transmitted through the skin rather than directly through bone.
How Buck’s Traction Works
The setup is straightforward. A foam boot or padded strap wraps around the lower leg, attaching to a cord that runs over a pulley at the foot of the bed. A weight hangs from the cord, creating a steady pulling force along the length of the leg. This constant pull counteracts the strong thigh muscles that tend to contract and shorten after a fracture, which is the main source of pain and further displacement. Pillows or foam blocks are often placed alongside the leg to keep it from rotating.
For the traction to work properly, the patient lies flat on their back with the foot of the bed slightly elevated. That elevation uses body weight as a natural anchor, preventing the patient from slowly sliding toward the foot of the bed. The head of the bed should not be raised more than 20 degrees, because sitting up too much weakens the opposing force and makes the traction ineffective. The entire body needs to stay aligned in a straight line.
When It Is Used
The most common reason for Buck’s traction is to stabilize a hip or femur fracture in the hours or days before surgery. After a fracture, the surrounding muscles go into spasm, pulling the broken bone ends past each other. That shortening is painful. Even a few pounds of steady pull can ease spasm enough to bring pain scores down significantly. In one study of adults with femoral shaft fractures, pain intensity dropped from about 7 out of 10 at admission to 1 or 2 out of 10 after skin traction was applied, and that relief was comparable to what patients experienced with more invasive forms of traction that use pins placed directly into bone.
Beyond preoperative fracture care, Buck’s traction is also used to:
- Relieve low back pain by gently decompressing the lumbar spine
- Maintain leg position after total hip replacement during the early recovery window
- Gradually correct hip or knee contractures where joints have become fixed in a bent position
In children over five years old with femur fractures, a Buck’s boot is preferred over skeletal traction because it avoids the risk of damaging growth plates. It works well when surgery is expected within a day or two.
What the Patient Experiences
If you or someone you know is placed in Buck’s traction, the leg will be wrapped in a soft boot or padded bandage, and you will feel a mild, continuous pull. It should not be painful. The weight is light enough that most people adjust to it quickly. Movement in bed is limited, though. You need to stay mostly flat on your back with the affected leg kept straight, and you will not be able to get out of bed while the traction is in place.
Nursing staff will check the leg frequently, typically every hour for the first 24 hours. These checks assess five things: skin color, temperature, swelling, sensation, and the ability to move the toes and foot. They will also press briefly on a toenail to watch how fast the color returns. If it takes longer than two to three seconds, that suggests blood flow to the foot is not adequate. Any numbness, tingling, or inability to pull the foot upward is reported immediately, because these can signal nerve compression.
Risks and Complications
Because the pulling force passes through the skin, the weight must stay low. Anything above about 10 pounds risks damaging the skin underneath the boot or straps, leading to pressure sores or tissue breakdown. Regular inspection of the skin beneath the traction device is essential.
The nerve most vulnerable during leg traction is the peroneal nerve, which wraps around the outside of the knee just below the fibula in a very shallow position close to the surface. Pressure on this nerve causes numbness on the top of the foot, tingling along the outer shin, and in more serious cases, an inability to lift the foot upward (a condition called foot drop). Peroneal nerve palsy is usually temporary if caught early and the pressure is relieved, but it can become permanent if ignored.
Skin irritation or allergic reactions to adhesive materials can also occur, and prolonged bed rest carries its own set of risks, including blood clots and skin breakdown over bony areas like the heel and sacrum.
Who Should Not Have Buck’s Traction
Certain conditions make skin traction unsafe. The main contraindications include:
- Peripheral arterial disease, because already compromised blood flow to the leg can worsen under sustained pressure
- Skin ulcers, eczema, or open wounds on the lower leg, which would break down further under the boot
- Severe swelling in the leg, which increases the risk of circulation problems
- Allergy to adhesive bandages used in some traction setups
- Existing lower limb deformities that prevent proper alignment of the traction
In these situations, alternative methods of pain control and immobilization are used instead.
How It Compares to Skeletal Traction
The key distinction is where the pulling force is applied. Buck’s traction pulls through the skin, which limits the weight that can safely be used. Skeletal traction uses a metal pin inserted directly into bone (usually the tibia), allowing much heavier weights, often 25 pounds or more. Skeletal traction is reserved for situations where greater force is needed or where surgery will be significantly delayed.
For short-term preoperative use, skin traction and skeletal traction produce equivalent pain relief. Studies comparing the two approaches found no meaningful difference in pain scores at 8, 16, or 24 hours. Skin traction also did not affect surgical blood loss or postoperative outcomes compared to skeletal traction. Given that Buck’s traction is less invasive, less painful to apply, and avoids the infection risk that comes with a pin site, it is generally the preferred option when surgery is planned within a few days. Skeletal traction carries additional risks including pin-site infections, fractures through the pin hole, knee stiffness, and in rare cases, compartment syndrome.