As a general
rule for femoral fractures use 10% body weight.
traction elevate bed 5 cm for every 1 Kg (1 inch per 1 lb)
Knots to attach cord to traction
device (click here)
and how to set up traction (click here)
Maximum traction weight 6.7 Kg
(15lb), remember skin quality.
Generally for paediatric cases
For Adult cases, or where thin
If poor quality skin reduce max
weight to 4.5Kg (10 lb) or consider skeletal traction.
- Steinman pin and Bohler stirrup
- Denham pin, threaded pin engages cortex reducing movement.
- Kirschner wire, on wire tightener
Second and third metacarpals
Distal Tibia and Calcaneus
K wire from medial to
Right angles to logitudinal axis
3 cm distal to tip of olecranon
Deep to subcutaneous border
Avoid ulnar nerve
Screw eye can be used directly
into tip of Olecranon
K wire 2-2.5cm proximal to distal end second metacarpal.
Wire traverses the 2nd and 3rd metacarpals transversely
To lie at right
angles to the longitudinal axis of the radius
Lateral surface of femur
2.5cm below the most prominent part
of the greater trochanter
Midway between anterior and posterior
surfaces of femur
Beware knee stiffness, try not use for longer than 2 to 3 weeks
lateral knee joint capsule reaches 1.25-2cm above knee joint, dont forget the
distal femoral physis in children.
In general, the pin should pass along
or slightly posterior to the midcoronal plane of the femoral shaft. It should
also pass just proximal to the adductor tubercle in order to avoid engagement of
the collateral ligaments. This lies almost at the level of the proximal pole of
the patella in the relaxed and extended knee.
Flex the knee slightly during
insertion to draw the periarticular soft tissues into the position they will
occupy while the limb is in traction, thereby reducing pressure necrosis of the
Line at upper
pole of patella
from anterior to head of fibula.
Where these two points meet insert pin
Just proximal to upper limit of lateral femoral condyle
(3 cm proximal to
lateral joint line)
Contraindicated if the knee ligaments
have been injured.
Insertion point 2cm distal and
posterior to Tibial tuberosity. Dont let the pin creep anteriorly while
inserting the pin.
2cm behind and below Tibial tuberosity
From Lateral to
medial to avoid common peroneal nerve
Ideally, the pin should be inserted as far posterior as
possible while still engaging sound bone. The tendons and neurovascular bundle
passing behind the malleoli and the subtalar joint are to be
Halett et al suggests for a calcaneal pin place it 2 cm below and behind the
lateral malleolus or 3 cm below and behind the medial malleolus BEWARE
et al show no position is completely safe when placing a medial calcaneal pin or
transcalcaneal pin. Ensure you are as far posterior as possible yet still
above ankle joint
Beware see reference below
below and behind lateral malleolus
Below and behind medial malleolus
The medial calcaneus provides a small window for safe percutaneous
Posterior to the halfway point from Point A to B and
posterior to the one-third mark from Point A to C remain the relatively
A more posterior placement in the safe zone is safest.
Careful blunt dissection and the use of cannulas may help to avoid
Click here for
Traction and Orthopaedic Appliances;
John D.M Stewart, Jeffrey P. Hallett
Percutaneous pin placement in the medial
calcaneus: is anywhere safe?
Casey D, McConnell T, Parekh S, Tornetta P 3rd.
J Orthop Trauma. 2004 Sep;18(8 Suppl):S39-42.