Skeletal Traction: Insertion Sites and Technique
Skeletal traction is classified as a functional treatment method. Its main advantages include the ability to continuously monitor the limb visually, preserve joint mobility (which serves as prevention of joint stiffness), as well as improve local blood supply and create ideal conditions for fragment union.
Pin insertion is performed using an electric or hand drill. An important technical requirement: the sharp end of the metal pin must rest against the bone strictly perpendicularly to its longitudinal axis, and the skin is pierced by the pin itself.
Anatomic landmarks depend on the injured segment:
- Femur: the pin is inserted from lateral to medial. Two options are possible: through the supracondylar region (just above the prominent part of the condyles, corresponding to the upper edge of the patella) or through the tibial tuberosity (1.5–2 cm posterior to the most prominent point).
- Tibia: fixation is performed through the calcaneus, 3–4 cm posterior and inferior to the malleolus.
- Humerus: the pin is inserted through the olecranon (2–3 cm distal to its tip and 1–1.5 cm deep into the bone mass).
Weight Calculation, Counter-Traction, and Treatment Periods
Managing a patient on traction requires proper dosage of the load, which is selected individually depending on the degree of displacement, muscle development, and the patient's weight. To create adequate counter-traction, the patient's own body weight is used by elevating the foot of the bed. If a weight of 6 to 10 kg is used, the height is increased by 30 cm; for 11–15 kg, by 70 cm.
Treatment is divided into two main periods:
- Fragment reduction period (1–3 days). The main goal is to eliminate displacement. The load is increased gradually: starting at a baseline of 4–5 kg and adding another 1–2 kg every 2 hours.
- Reparative period (4–6 weeks). This begins after successful reduction and is characterized by the initiation of callus formation. At this stage, the load is radically reduced to 4–5 kg. This is critically important to prevent muscle overstretching and separation (diastasis) of bone fragments.
Rehabilitation and Pin Removal Guidelines
Traction treatment is a prolonged process (up to 2 months). Successful union requires adequate nutrition enriched with protein, as well as minerals—calcium (Ca) and phosphorus (P). To stimulate blood flow, therapeutic exercise (physical therapy), medical massage, and physiotherapy (electrotherapy, balneotherapy, mechanotherapy) are actively used.
Standard Pin Removal Technique:
- The skin and the pin itself are thoroughly treated with an iodine solution.
- The pin is cut with sterile wire cutters flush with the skin.
- The hardware is pulled out by the opposite end.
- The puncture sites are treated with iodine again and covered with a dressing.
If severe pain or signs of inflammation develop around the pin, early removal is indicated. In this case, a strict rule applies: the pin must be cut on the side where there is no inflammation, and pulled out from the side of the infectious focus. This is done to avoid pulling infected tissues through the healthy bone canal.
Osteosynthesis
Osteosynthesis is the surgical joining and rigid retention of bone fragments using various metal implants. Unlike traction, this method requires exposure of the fracture site and open, direct reduction of fragments.
The following basic types of osteosynthesis are distinguished:
- Intramedullary: insertion of metal rods or pins directly inside the bone (into the medullary canal).
- Extramedullary: fixation of fragments outside the bone using metal plates that are rigidly fixed with screws.
- Other methods: local joining of bone fragments using only metal bolts, screws, or surgical wire.
To avoid mistakes when removing an infected pin, remember the principle: "Cut the clean side, pull the dirty side." The metal should be cut from the side of healthy skin and pulled from the side of suppuration to prevent introducing bacteria into the bone canal.
Class and exam questions
Why is the foot of the bed elevated by 30 or 70 cm?
This is necessary to create counter-traction using the patient's own body weight. The elevation height directly depends on the weight of the suspended load (the heavier the load, the higher the elevation).
What macroelements must be included in the diet of a patient with a fracture?
Nutrition must be rich in proteins, and among minerals, calcium (Ca) and phosphorus (P) are of primary importance.
What is the fundamental difference between intramedullary and extramedullary osteosynthesis?
In intramedullary osteosynthesis, the fixing rod is inserted inside the bone (into the medullary canal), whereas in extramedullary osteosynthesis, metal plates are applied externally to the bone and fixed with screws.
What else to study on this topic
- Mechanisms and Stages of Callus Formation
- Prevention of Specific Complications of Skeletal Traction
- Indications and Contraindications for Extramedullary Osteosynthesis
- Types of Physical Therapy in the Post-Fracture Rehabilitation Period
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