Tibial Skeletal Traction

Published on 16/03/2015 by admin

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Last modified 16/03/2015

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Chapter 16 Tibial Skeletal Traction

Overview

Tibial traction is accomplished with placement of a pin across the proximal tibial metadiaphysis and attachment to a pulley system secured to the bed.

Indications for use

Femoral shaft fractures

Precautions

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

a. A clinical examination should be performed to rule out a ligamentous injury.
b. Radiographs should be obtained prior to pin insertion.

2. The pin must be inserted from the lateral aspect to avoid injury to the common peroneal nerve.
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. The Kirschner traction bow must be used with the Kirschner wire because it adds tension to the wire and prevents the wire from bending. Figure 16-1 illustrates the incorrect use of a Böhler’s stirrup, resulting in a wire without tension and significantly increasing the risk of wire breakage.
6. Place traction weights gently!
7. Once traction has been established, ensure that the traction bow is not in contact with 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.

8. Apply rubber stoppers to the ends of the pin to prevent injury to the patient or health care workers.
image

Figure 16-1

Pearls

1. Close coordination with the operating surgeon is mandatory when placing patients into traction.
2. Insertion of tibial 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 tibial traction, elective intubation prior to placement may be prudent.
5. Prior to placement of tibial traction, ensure that the patient is on a bed that is capable of having a traction frame attached to it.
6. Placement of a tibial 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

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