What is Skeletal Traction?

January 6, 2021 || By : Dr. MhmadFarooq || Trauma

What is Skeletal Traction?

  • It’s a temporary treatment method used in emergency department in some 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.

Skeletal Traction indications:

  1. Temporary management of neck of femur fracture.
  2. Femoral shaft fracture in children (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:

  • 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.

Type 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.
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