Lower Limb Skeletal Traction: Proximal Tibia

Lower limb skeletal traction can be achieved through the proximal tibia, distal tibia, and the calcaneus. Proximal tibial traction is the most frequently used and can be used to reduce and immobilize femoral fractures.

Skeletal traction through the proximal tibia is most commonly achieved under local anesthesia by inserting a pin ~2 cm distal to the tibial tubercle and ~2 cm behind the anterior border of the tibia (measurements are for adults). Ideally, the pin passes through the skin and subcutaneous fat, but will avoid muscle and the common peroneal nerve.

The Steinmann pin (blue bar) is typically used. The pink is usually attached externally to a Böhler-Steinmann stirrup as shown above, which is attached to weights via rope (red arrow) to achieve the desired traction.

The Denham pin can also be used in osteoporotic bone. It is threaded in the middle to engage the cortex and reduce the risk of the pin sliding.

The immediate complication to look for on radiographs is malpositioning of the pin, which can lead to damage to nearby neurovascular bundles. If the traction is maintained for a longer period, radiographs should be inspected for signs of infection. In addition, in cases where the bone is osteoporotic or the applied traction is too heavy, there is a risk of the pin cutting through bone.

References

Cook J, Sankaran B, Wasunna AEO. Chapter 10: Traction. in Surgery at the District Hospital: Obstetrics, Gynaecology, Orthopaedics and Traumatology. WHO(1991).