Bradley R. Merk

1. Ipsilateral pelvic, acetabular, or femoral fracture as a definitive or temporary treatment

2. Preoperative soft tissue relaxation prior to limb lengthening reconstruction

3. Adjunctive aid to fracture reduction in the operative treatment of femoral or acetabular trauma

1. Active local infection

2. Significant local wound contamination

3. Inadequate soft tissue envelope

4. Polyligamentous knee injury or tibia fracture (avoid tibial traction)

1. If necessary, initial stabilization per ATLS protocols.

2. Obtain appropriate biplanar radiographs to allow for the identification and classification of the skeletal injury.

3. Document preoperative neurovascular and soft tissue examination.

1. Supine position

2. Place a bump under the knee to allow for free access to the limb.

3. If available, fluoroscopy may be helpful in minimizing the risk of physeal injury and/or to mark the knee joint axis in the coronal plane.

4. The procedure is generally performed under local anesthesia. The anesthetic is injected into the subcutaneous and subperiosteal tissues on both the medial and lateral sides of the extremity.

5. A minor surgical tray, a threaded Steinmann pin set, a hand drill, a Steinmann pin holder or Kirschner wire bow, and a bolt cutter are required.

1. Don’t be distracted by the obvious injury. Be sure to fully assess the entire skeletal system.

2. If the skeletal injury allows, assess the ligamentous knee integrity prior to placement of a tibial traction pin.

4. In a patient with good bone stock, a power drill may generate excessive heat and result in bone necrosis.

5. The ends of the Steinmann pin should be trimmed with a bolt cutter and capped to avoid inadvertent lacerations to the contralateral limb or healthcare personnel.

6. In older patients with osteopenic bone, consider placing the pins in a more diaphyseal location to improve fixation.

7. If femoral rodding is anticipated, femoral traction pins should be placed anterior in the femur to allow for nail passage. Alternatively, use tibial traction.

1. Minimize injury to soft tissues and/or neurovascular structures by bluntly dissecting to bone.

2. Avoid oblique pin placement in any plane.

3. Avoid inserting the femoral traction pin from lateral to medial because this increases the chance of injury to the superficial femoral artery in the adductor canal.