Application of traction
Lateral traction is applied to extract the displaced femoral head from the pelvis. This also allows some indirect reduction of the medially displaced fracture fragments by ligamentotaxis. Lateral traction is typically achieved with a Schanz screw applied through the lateral greater trochanter region of the femur. Because the patient is in the lateral position, this typically requires a manual force.
Longitudinal traction is also required to correct proximal displacement. Longitudinal traction can be obtained with a fracture table applied to a distal femoral traction pin (A), a femoral distractor (B), or with manual traction on the affected extremity.
In some surgeon’s experience, the use of a traction table post or other traction frame is helpful during this operation.
Excessive longitudinal or lateral traction may result in the locking of the fracture, inhibiting further reduction maneuvers. Furthermore, the position of the femur may affect reduction and visualization. Commonly, one must reposition the involved extremity and change the vector of traction several times during the course of the operation. Thus, it must be easy to adjust the traction and the limb position intraoperatively.