Femoral Skeletal Traction

Published on 16/03/2015 by admin

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Last modified 16/03/2015

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Chapter 15 Femoral Skeletal Traction

Overview

Femoral traction is accomplished with placement of a pin across the distal femur and attachment to a pulley system secured to the bed.

Indications for use

1. Acetabular fractures
2. Proximal femur fractures

Precautions

1. Do not set up femoral traction until confirming that no skeletal injury is present about the knee.

a. Confirmation that no skeletal injury is present about the knee can be ascertained via a clinical examination in an alert and oriented patient or with radiographs.
b. Note that femoral traction continues to be indicated when a ligamentous injury to the knee is present.

2. The pin must be inserted from the medial aspect to avoid injury to the femoral artery.
3. Ensure that the pin is placed under sterile technique. Do not place pins through or near open wounds.
4. Ensure that the pin is placed perpendicularly to the axis of the limb and in a straight horizontal plane.
5. Place traction weights gently!
6. Once traction has been established, ensure that the traction bow is not in contact with the skin.

a. A pressure ulcer can be created easily by the traction bow.
b. To ensure that the traction bow does not create a pressure ulcer, the bow should be overwrapped in rolled gauze.

7. Apply rubber stoppers or similar end caps to the ends of the pin to prevent injury to the patient or health care workers.

Pearls

1. Close coordination with the operating surgeon is mandatory when placing patients into traction.
2. Insertion of femoral traction can be completed under local anesthetic, but conscious sedation is preferred.
3. If only a local anesthetic is being used, consider increasing the amount and adding bupivacaine.
4. If the patient is going to go to the operating room for definitive fixation shortly after placement of femoral traction, elective intubation prior to placement may be prudent.
5. Before placement of femoral traction, ensure that the patient is on a bed that is capable of having a traction frame attached to it.
6. Placement of a femoral pin is easiest when all the equipment is organized. Having two bedside tables facilitates organization and maintenance of a sterile environment.
7. Having an assistant is not mandatory but is extremely helpful.
8. A hand drill or power drill may be used. We prefer using a power drill, especially in younger patients with good bone stock.

Equipment

1. Sterile technique items:

a. Sterile gloves
b. 4 × 4 inch gauze
c. Antiseptic: Chlorhexidine or Betadine
d. Sterile drapes or blue towels

2. Local anesthesia items:

a. Syringe: 10-mL syringe
b. Needle:

(1) Large-bore, blunt-tipped, drawing-up needle
(2) 2-inch, 21-gauge needle

c. Anesthetic: Lidocaine, 10 mL of 2%

3. Items for insertion of pin:

a. #11 blade scalpel
b. Straight hemostat
c. Centrally threaded Steinmann pin (also known as a Denham nail), 4 × 225 mm or 5 × 225 mm (Figure 15-1)
d. Power drill and battery (Figure 15-2)
e. Jacobs chuck and key (Figure 15-3)

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