Buck’s traction is a type of skin traction that applies a steady pulling force to an injured leg, most often to manage pain and limit movement before surgery on a hip or thigh bone fracture. It works by strapping the lower limb with foam padding and attaching a system of weights, typically no more than 4.5 kilograms (about 10 pounds), to gently pull the leg into better alignment. It is one of the most common forms of temporary fracture management used in orthopedic care.
How Buck’s Traction Works
The basic principle is straightforward: a continuous pulling force holds the broken bone in a more natural position, which reduces muscle spasms, limits swelling, and eases pain. The pull comes from weights hung off the end of the bed, connected by a rope that runs through a pulley system to the patient’s leg. The leg itself is wrapped or fitted with a foam boot that grips the skin’s surface, transferring the force without any pins or surgical hardware.
The recommended weight is roughly 10 percent of the patient’s total body weight, but it should never exceed 4.5 kilograms. Going heavier risks damaging the skin underneath the wrapping, since the force is transmitted through soft tissue rather than bone. This weight limit is the key distinction between skin traction and skeletal traction, which uses a metal pin drilled directly into bone and can handle much greater loads.
Equipment and Setup
A standard Buck’s traction kit includes a foam boot or padded strap that wraps around the lower leg, a spreader bar (typically about 6 inches wide) that keeps the straps from pressing into the ankle bones, a rope, a pulley mounted at the foot of the bed, and a weight bag. The foam is usually convoluted (egg-crate style) to improve airflow against the skin and reduce pressure buildup. The weights must hang freely and never rest on the floor or the bed frame, since any interruption in the pull defeats the purpose of the setup.
When It Is Used
Buck’s traction is most commonly applied to people with femoral neck fractures, intertrochanteric hip fractures, and subtrochanteric fractures of the thigh bone. In nearly all of these cases, it serves as a temporary measure before surgery rather than a standalone treatment. Its primary job is to immobilize the fractured limb so the patient is more comfortable while waiting for the operating room.
The traction is typically kept in place for hours to a day or two. If skin traction needs to stay on for more than 24 hours, clinicians often switch to a configuration called Hamilton-Russell traction, which provides better control and comfort for longer periods. For injuries requiring extended stabilization, skeletal traction with a pin through the shin bone replaces skin traction entirely, sometimes staying in place for up to two weeks before definitive surgery.
Interestingly, the evidence on whether preoperative traction actually reduces pain better than simply resting the leg on a pillow is mixed. A meta-analysis in the Archives of Bone and Joint Surgery noted that many orthopedic departments continue using it as standard practice despite studies questioning its effectiveness. The main argument in its favor is that it physically immobilizes the broken limb, which at minimum prevents the kind of involuntary movements that cause sharp pain spikes.
Skin Traction vs. Skeletal Traction
Buck’s traction is noninvasive. The force passes through the skin and soft tissue, which limits how much weight you can safely apply. Skeletal traction, by contrast, involves inserting a metal pin directly through bone (usually the upper shin) and can support around 25 pounds or about 17 percent of body weight. Skeletal traction provides far more control over fracture alignment, but it comes with its own risks: pin site infections, fractures at the pin insertion point, and knee stiffness.
For femoral shaft fractures treated within 24 hours, research published in the Journal of Orthopaedic Trauma found no significant difference in surgical reduction time between patients who had preoperative skin traction versus skeletal traction. This suggests that for short waits before surgery, the simpler, less invasive Buck’s traction works just as well.
Potential Complications
Because the force acts on skin rather than bone, the most common concern is pressure damage to the tissue underneath the wrapping. Skin breakdown and pressure sores can develop quickly if the straps are too tight, positioned poorly, or left on too long. Regular skin checks, at least once per nursing shift, are standard practice to catch redness or irritation early.
Nerve injury is another risk. The peroneal nerve runs close to the surface near the outside of the knee, and poorly positioned straps or pads can compress it. Peroneal nerve palsy shows up as numbness or tingling along the outer lower leg and, in more serious cases, an inability to lift the foot upward (a condition called foot drop). This complication is more associated with skeletal traction but can occur with any lower-leg traction setup, particularly in patients with higher body weight.
Before traction is applied, the skin condition and circulation of the affected leg need to be assessed. Existing skin wounds, fragile skin from aging or steroid use, poor circulation, or nerve problems in the limb can all make skin traction unsafe. Any of these findings would typically lead the care team to choose an alternative approach.
What to Expect as a Patient
If you or a family member is placed in Buck’s traction, the leg will be elevated slightly and held in a fixed position by the weight system. Movement in bed is limited, and the affected leg should not be repositioned or adjusted without guidance from the nursing team. The weights need to hang freely at all times, so shifting around in bed or letting the rope catch on the bed frame can interrupt the traction and increase pain.
Staff will periodically check the toes on the affected side for warmth, color, sensation, and the ability to wiggle them. These neurovascular checks confirm that the traction is not compressing blood vessels or nerves. Feeling some pulling or mild discomfort in the leg is normal, but sharp pain, numbness, tingling, or coldness in the foot should be reported immediately.
For most patients, Buck’s traction is a brief chapter in the overall treatment plan. It keeps the fracture stable and pain manageable during what is usually a short wait before surgical repair, which is the definitive treatment for the vast majority of hip and femur fractures.