What is Skeletal Traction?
- It’s a temporary treatment method used in emergency department in some type of lower extremity fractures.
- It’s more powerful and has greater fragment control than skin traction.
- It permits pull up to 15% to 20% of body weight for the lower extremity.
Indications of Skeletal Traction:
- Temporary management of neck of femur fractures.
- Femoral shaft fracture in children (It is mostly a final treatment).
- Undisplaced fracture of acetabulum.
- After reduction of dislocation of the hip.
Choice of thin Kirschner wire (K-wire) versus Steinmann pin
Kirschner wire (K-wire):
- K-wire is more difficult to insert with a hand drill and requires a tension traction bow.
The Steinmann pin:
- Steinmann pin may be either smooth or threaded.
- A smooth pin is stronger but can slide easily through bone.
- A threaded pin is weaker and bends more easily with increasing weights, but it will not slide, and will advance more easily during insertion.
- In general, the largest pin available (5 to 6 mm) is chosen, especially if a threaded pin is selected.
Types of skeletal traction:
Tibial Skeletal Traction
- The pin is placed 2 cm posterior and 1 cm distal to the tibial tubercle.
- It may go more distal in osteopenic bone.
- The pin is placed from lateral to medial to direct the pin away from the common peroneal nerve.
- The skin is released at the pin’s entrance and exit points.
- Optimally, avoid penetrating the anterior compartment.
- A sterile dressing is applied next to the skin. Sharp ends should be protected.
Femoral Skeletal Traction
- This is the method of choice for pelvic, acetabular, and many femoral shaft fractures (especially in knees with ligamentous injuries).
- The pin is placed from medial to lateral (directed away from the neurovascular bundle) at the adductor tubercle, slightly proximal to the femoral epicondyle.
- The location of this pin can be determined from the anteroposterior (AP) knee radiograph using the patella as a landmark.
- One should spread through the soft tissue to bone to avoid injury to the superficial femoral artery
Calcaneal Skeletal Traction
- This is most commonly used with a spanning external fixation for “traveling traction,” or it may be used with a Bohler-Braun frame.
- It is used for irreducible rotational ankle fractures, some pilon fractures, and extremities with multiple ipsilateral long bone fractures or compromised soft tissues.
- The pin is placed from medial to lateral, directed away from the neurovascular bundle, 2 to 2.5 cm posterior and inferior to the medial malleolus.