Skeletal traction is a method of pulling a broken bone back into alignment by inserting a metal pin or wire directly through the bone and attaching it to a system of weights, pulleys, and ropes. It applies a steady, controlled force to the limb, using the skeleton itself as the anchor point. This makes it stronger and more precise than skin traction, which pulls from the surface using adhesive tape or wraps and is limited to lighter loads.
Skeletal traction is most commonly used as a temporary measure, holding a fracture in place when surgery needs to be delayed more than 12 to 24 hours. In some cases, particularly in parts of the world where surgical options are limited, it can serve as the primary treatment for weeks.
How Skeletal Traction Works
The basic idea is straightforward: a sustained pull on a broken bone counteracts the muscle spasms and shortening that happen after a fracture, drawing the bone ends back toward their normal position. The force travels through the pin, through the bone, and into the surrounding soft tissues that are still attached to the fragments. Those soft tissue connections act like guides, helping the pieces settle into better alignment as the pull is maintained.
This mechanism has a limit. When a fracture is severely shattered and the bone fragments have lost their soft tissue attachments, traction loses its ability to guide the pieces back together. In those cases, surgery is the only way to restore the joint surface.
When It’s Used
Skeletal traction is a core tool for managing traumatic injuries to the pelvis and lower extremities. The most common scenarios include femur (thighbone) fractures, where powerful thigh muscles pull the bone ends apart and overlap them, and certain pelvic fractures that need stabilization before the patient can safely undergo surgery. It’s also used for some tibial (shinbone) fractures and, less commonly, for dislocations that resist closed reduction.
For the cervical spine, a specialized form of skeletal traction uses tongs that grip the outer layer of the skull. Gardner-Wells tongs, the most widely used design, allow doctors to gradually apply weight to decompress the spinal cord, realign dislocated vertebrae, and hold the neck stable. This is used for fracture-dislocations of the neck, including unilateral and bilateral facet dislocations. Modern versions are made from titanium and polymers, making them compatible with MRI scanners.
The Hardware: Pins and Wires
Two main types of hardware are used. Steinmann pins are solid metal rods, traditionally 3.5 mm in diameter or thicker, sturdy enough to handle heavy traction loads without bending. Kirschner wires (K-wires) are thinner, typically around 2.0 mm, and are used when a lighter approach is acceptable.
Thicker pins come with tradeoffs. They cause more bleeding at the insertion site, leave larger wounds that take longer to heal, and in rare cases can cause fractures in smaller bones like the calcaneus (heel bone). A comparative study of 65 patients found that using thinner 2.0 mm K-wires with a specially designed tension bow produced equivalent traction results while significantly reducing bleeding, wound size, and healing time compared to traditional 3.5 mm Steinmann pins. Neither group experienced pin loosening, breakage, or bone fractures.
Where Pins Are Placed
The insertion site depends on the fracture being treated. For femur fractures, the pin typically goes into the proximal tibia (the upper part of the shinbone, about 1 cm below and 2 cm behind the bony bump at the front of your knee) or into the distal femur (near the top of the kneecap). For the proximal tibia, the pin enters from the outer side of the leg and passes through both walls of the bone to exit the inner side. For the distal femur, the direction is reversed, entering from the inner thigh.
In both cases, the surgeon uses the wire itself to feel the front and back edges of the bone, centering the pin in the middle to avoid splitting the bone or damaging nearby nerves and blood vessels. For heel bone traction, the pin passes through the calcaneus. Each site is chosen to stay clear of major nerves and arteries, though proximity to these structures is always a concern.
How Much Weight Is Applied
For lower extremity fractures, the standard is roughly 10% of the patient’s body weight. A 70 kg (154 lb) person would typically have about 7 kg (15 lb) of weight hanging from the traction apparatus. Some protocols use a range of 5 to 10% of body weight, adjusted based on the fracture pattern and how well the bone responds.
Skin traction, by comparison, is limited to about 7% of body weight because higher loads damage the skin. This is one of the key reasons skeletal traction exists: it can safely deliver heavier, sustained forces that skin cannot tolerate.
For cervical traction with Gardner-Wells tongs, weight is added incrementally while monitoring the patient’s neurological function. Once the spine is realigned, the weight is typically reduced to about 5 kg to maintain the position.
How Long Traction Lasts
When skeletal traction is used as a bridge to surgery, it may stay in place for days to a couple of weeks while the patient is stabilized, swelling subsides, or an operating room becomes available. When used as definitive treatment (the fracture heals in traction rather than through surgery), the timeline stretches considerably. Historical protocols for femur fractures kept patients in bed for six or more weeks, though this approach has largely fallen out of favor due to complications from prolonged immobility.
Cervical halo traction devices, which are a form of skeletal fixation, are typically worn for about three months until imaging confirms adequate healing. For children and certain upper extremity injuries, traction periods of around three weeks are common before transitioning to a cast or splint.
Complications to Watch For
Pin site infection is the most frequently reported problem. The pin creates a direct pathway from the skin surface into the bone, and the longer it stays in place, the higher the risk. Superficial infections around the pin are common and usually respond to local cleaning and antibiotics. Deep infections are far less common but far more serious. If bacteria reach the bone itself, the result is osteomyelitis, a bone infection that can require months of treatment. In one case series of patients who developed deep pin site infections, more than a quarter needed surgical flap coverage to close the resulting wound.
Other complications include pin loosening (reported in up to 19% of cases with cervical tongs), bleeding at the pin site, and pressure sores from prolonged bed rest. Nerve or blood vessel injury during pin insertion is possible but uncommon when anatomic landmarks are followed carefully. For cervical traction specifically, the most serious risk is perforation of the inner layer of the skull, which can lead to brain abscess in rare cases (0.4 to 0.7%).
Pin Site Care
Keeping the pin sites clean is critical, but there is no single universally agreed-upon protocol. Cleaning frequency ranges from daily to weekly depending on the institution, the stability of the pin in the bone, and how much the surrounding soft tissue moves. Pins placed in areas with thick surrounding muscle and soft tissue are considered at higher risk for infection than those in areas where bone sits close to the skin surface.
Chlorhexidine solution is the most commonly recommended cleaning agent, based on guidelines from the National Association of Orthopaedic Nurses. Some facilities use normal saline, hydrogen peroxide, or alcohol-based solutions. One small study found that antimicrobial gauze dressings reduced pin site infection rates from 4.5% to 1% compared to plain gauze. Whether scabs that form around pins should be removed or left alone remains debated.
Patients and family members are typically taught how to perform pin site care before leaving the hospital, since many people go home or to rehabilitation facilities with pins still in place.
What the Experience Is Like
The pin is inserted under local anesthesia, regional nerve blocks, or sedation. You will feel pressure during insertion, but the procedure itself is relatively brief. Once the traction is set up, the constant pull on your leg or neck feels unusual but should not be sharply painful. Breakthrough pain is managed with medication as needed.
The hardest part for most patients is the enforced immobility. You will be in bed for the duration of traction, which increases the risk of blood clots, skin breakdown, muscle wasting, and respiratory problems like pneumonia. Hospital staff will encourage deep breathing exercises, and you may receive blood-thinning medication to reduce clot risk. Physical therapy typically begins as soon as the fracture is stabilized, even while traction is still in place, focusing on the joints and muscles that can safely be moved.