Weight Computation for Traction
Traction is not a necessary or required element of prehospital or hospital stabilization of suspected femur fractures and is often contraindicated, and when used, weight should be limited to 5-10 pounds (approximately 5-10% of body weight) for lower extremity injuries. 1
Evidence Against Routine Traction Use
The most recent high-quality evidence demonstrates that traction provides no clinical benefit for fracture management:
A randomized trial of 80 patients with hip fractures found no discernible benefit from either skin or skeletal traction during the preoperative period. 2 Patients without traction required no additional analgesic medications compared to those with traction, and the study concluded that traction should not be administered routinely to patients awaiting operation for hip fracture. 2
A 2007 Cochrane systematic review found traction no more effective than placebo, sham, or no treatment for any reported outcome in patients with low back pain of varying duration (with or without sciatica). 1 For sciatica specifically, continuous or intermittent traction was not effective across 8 trials. 1
The 2021 American Academy of Pediatrics position statement explicitly states that traction is not a necessary or required element of prehospital stabilization of suspected femur fractures and is often contraindicated. 1
When Traction Is Still Used: Weight Calculation
Despite limited evidence of efficacy, when traction is applied in clinical practice, the following weight parameters apply:
Standard Weight Guidelines
- For lower extremity skeletal traction (proximal tibia), typical traction weights range from 5-20 pounds, with a mean of 9.8 pounds in contemporary practice. 3
- Traditional teaching suggests 5-10% of body weight for skin traction, though this lacks strong evidence-based support. 4
Body Weight Considerations
When calculating traction weight based on patient body weight, use actual body weight rather than ideal or adjusted body weight. 4 This is the standard approach in orthopedic practice, though no high-quality evidence establishes optimal weight-to-body-weight ratios.
Practical Application
- For a 70 kg (154 lb) patient: 5-10 pounds of traction weight is typical
- For a 100 kg (220 lb) patient: 10-15 pounds of traction weight may be used
- Maximum safe weight for cutaneous (skin) traction: 10-15 pounds to minimize skin complications 3
Critical Safety Considerations
Skin Traction Complications
- Modern foam boot cutaneous traction has a complication rate of only 0.7% (skin wounds) and 0% nerve palsies when properly applied. 3 This is substantially lower than the historical 11% complication rate with adhesive tape and plaster methods. 3
- Average safe duration for cutaneous traction is approximately 21 hours (range 2.3-243.5 hours) with modern foam boots. 3
Common Pitfalls to Avoid
- Do not apply traction routinely to all hip fracture patients, as it provides no analgesic benefit and delays mobilization. 2
- Do not exceed 10-15 pounds for skin traction to prevent pressure sores and skin sloughing. 3
- Do not use traction as definitive treatment for low back pain or sciatica, as it is ineffective. 1
- Ensure patients have intact skin and normal nerve function before application. 3
Monitoring Requirements
- Assess skin integrity at traction application sites every 4-8 hours 4
- Monitor for signs of nerve compression (numbness, tingling, weakness) 4
- Evaluate pain levels regularly, as traction should reduce pain if effective 4
- Check traction setup maintains proper alignment and weight is hanging freely 4, 5
Clinical Bottom Line
The contemporary evidence strongly suggests minimizing or eliminating traction use for most orthopedic injuries. 1, 2 When institutional protocols or specific clinical scenarios require traction, use 5-10 pounds for most adults with lower extremity injuries, ensure modern foam boot application to minimize complications, and limit duration to the shortest time necessary before definitive treatment. 3