The Hip: Preservation, Replacement and Revision

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

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 27, 2016 5:29 am