Rate of skin and nerve complications as a result of cutaneous traction with modern foam boots

• Published in: Injury Vol. 55; no. 8; p. 111687
• Main Authors: Birch, Robert, Miller, Jordan, Surina, Jeffrey, Daubs, Gregory, Gray, Aaron, Nelson, Karen E., Wentz, Brock, Kubiak, Erik N.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.08.2024
• Subjects: Buck traction; Cutaneous traction; Skeletal traction; Skin traction; Traction; Skin traction; Traction; Cutaneous traction; Buck traction; Skeletal traction
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2024.111687

•Historical methods of cutaneous traction use adhesive tape and plaster in immediate contact with the skin, resulting in a complication rate of 11%.•Cutaneous traction with modern foam boots has an overall complication rate of 0.7%.•Modern foam boot traction has a similar complication rate as skeletal traction. Cutaneous traction is used to temporize lower extremity fractures and relies on friction between the skin and surrounding material to apply a longitudinal force. This circumferential compressive force can lead to pressure sores, skin sloughing, or compressive neuropathies. These complications have been reported in up to 11% of patients when the cutaneous traction relies on adhesive tapes, plaster, and rubber bandages being in immediate contact with the skin. The rates of these complications are not well documented when using modern foam boots. A retrospective chart review was performed on all orthopedic trauma patients who suffered pelvic or lower extremity injuries between March 1st, 2020 and April 30th, 2021 at a single Level-1 trauma center. We included all patients with femoral fractures, axially unstable pelvic ring and/or acetabular fractures, and unstable hip dislocations temporized with the use of cutaneous traction. All patients had intact skin and lower extremity nerve function prior to application. There were 138 patients identified with 141 lower extremities. The average patient age was 50.7 (6–100) years. Mean traction weight of 9.8 (5–20) pounds. Average traction duration was 20.9 (2.3–243.5) hours. At the time of traction removal, there was 1 (0.7%) new skin wound and 0 nerve palsies. The new skin wound was a stage one heel pressure sore and did not require further treatment. Cutaneous traction with a modern foam boot was found to have a skin complication rate of 0.7% and a nerve palsy complication rate of 0% for an overall complication rate of 0.7%, which has not been previously established and is lower than historically reported complication rates of 11% when utilizing adhesive and plaster directly on skin. Foam boot Cutaneous traction may be considered a safe option for traction placement.