If skin traction is likely to be used for more than 24 hours, greater patient comfort and better control of the femoral fracture can be achieved by using Hamilton-Russell skin traction.
A padded sling is placed behind the slightly flexed knee and skin traction applied to the lower leg. The traction cord and pulley system is as illustrated.
The principle of the parallelogram of forces determines that the upward pull of the sling and the longitudinal pull of the skin traction create a resolution of force in the line of the femur, as illustrated.
This configuration of traction also allows control of rotation, by side-to-side adjustment of the pulley above the knee.