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:

  1. Temporary management of neck of femur fractures.
  2. Femoral shaft fracture in children (It is mostly a final treatment).
  3. Undisplaced fracture of acetabulum.
  4. 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.