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Femoral and Tibial Traction Pins


- Anesthesia:
    - skeletal traction can be applied under sedation & local anesthesia;

- Distal Femoral Pins:
    - inserted on medial side to avoid injury to femoral artery on pin exist;
    - flex the knee and thigh on several folded sheets inorder to facilitate pin insertion from the opposite side of the table (medial to
           lateral) and to facilitate obtaining a lateral radiographic view;
    - entry site is just proximal adductor tubercle (proximal  to medial epicondyle and/or growth plate);
           - distal pin placement risks entering joint at intercondylar notch;
           - more proximal pin insertion risks injury to femoral artery at Hunter's canal;
    - flex knee to 90 deg:
           - traction pin must be applied w/ knee at 90 deg of flexion;
           - if leg is in extension while pin is inserted, it will later be difficult to flex the knee because the pin is bound by the IT band;
    - as the short longitudinal incision is made, turn the knife 90 deg (once it is buried under the skin) in order to make a small
           transverse nick in the IT band;
    - place pin perpendiulcar to knee joint, rather than perpendicular to femoral shaft;

- Proximal Tibial Pins:
    - contraindications:
          - ligament injury to ipsilateral knee;
          - should never be used in children;
                - may cause recurvatum injury due to damage of tibial physis;
    - pins are inserted from lateral side to avoid damaging peroneal nerve;
    - pin insertion:
          - proper insertion site: 2.5 cm posterior to & 2.5 cm distal to tibial tubercle;
          - landmark is to place pin one to two fingerbreaths below tibial tuberosity in the midportion of the tibia;
                  - proximal pin placement, places it thru too much cancellous bone, which is weaker;
                  - distal pin placement, while in stronger cortical bone, risks damage to peroneal nerve as it passes anterior after it passes
                           around  fibular neck;
          - make a transverse skin incision about 1 cm in length, placed about 3 cm below lesser tuberosity;
                  - the most common mistake is to make the incision too anterior, which causes the skin to bunch up posteriorly