Skeletal tibial
traction is a temporizing measure used preoperatively for
femoral fractures to improve the length and alignment of the limb and provide
pain relief. The goal of this study was to identify possible neurovascular morbidity associated with the use of bedside skeletal tibial
traction to treat femur fractures. All
femoral fractures treated with proximal tibial
traction during a 10-year period at an urban level I trauma center were retrospectively reviewed. The medical record was reviewed to determine whether a pin-related complication had occurred. Records also were reviewed to identify ipsilateral multi-ligamentous
knee injuries that were not diagnosed until after the application of
traction. In total, 303 proximal tibial
traction pins were placed. A total of 7 (2.3%; 95% confidence interval, 0.60%-4.0%) pin-related neurologic complications and zero vascular complications were noted. All complications involved motor and/or sensory deficits in the distribution of the peroneal nerve. Of the 7 complications, 6 resolved fully after surgery and removal of the pin. After
traction placement, 6 (2.0%) ipsilateral multiligamentous
knee injuries were diagnosed. None of these patients had a neurovascular complication. This study suggests that bedside placement of proximal tibial
traction for
femoral fractures is associated with a low incidence of neurovascular complications and that
traction can be safely placed at the bedside by residents. A thorough neurovascular examination should be performed before insertion, and care should be taken to identify the proper starting point and reduce soft tissue
trauma during pin placement. [Orthopedics. 2017; 40(6):e1004-e1008.].