Primary Surgery Vol.2 – Trauma: EQUIPMENT FOR BONE TRACTION

EQUIPMENT FOR BONE TRACTION

•STRAPPING, traction, adhesive, 50 mm $\ensuremath{\times }$ 10 mm, six rolls only. This is elastic across its width, but not along its length. If you don’t have it, use ordinary zinc oxide strapping. ’Elastoplast’, which is elastic in both directions is useless.

•PIN, Denham, (Denham threaded Steinmann pin), stainless steel, 4 mm, tapered, self tapping, with long coarse screw thread, triangular shank, packet of 5, two packs only. This is the ordinary Denham pin, but made with a triangular shank. If possible, buy the kind with a long length of thread which will grip both cortices of the tibia.

•PIN, Steinmann, triangular shank, stainless steel, trocar pointed at one end, (a) 2 $\ensuremath{\times }$ 180 mm, (b) 3 $\ensuremath{\times }$ 180 mm, (c) 4 $\ensuremath{\times }$ 180 mm, six only of each size. The small size is for the olecranon and the larger ones are for the tibia.

•HANDLE, with Jacobs chuck, 4 mm capacity, and key attached by chain, fully cannulated, stainless steel, one only. This is an ordinary drill chuck in a handle. This chuck has three jaws, and although it is intended for Kirschner wire and for pins and nails with triangular shanks, you can use it with square shanks. It will not grip the round section of a pin.

•STIRRUPS, Boehler, for Steinmann pins, with rotating swivel fixation ieces, (a) 102 $\ensuremath{\times }$ 89 mm, three only. (b) 165 $\ensuremath{\times }$ 144 mm, three only. (e) 241 $\ensuremath{\times }$ 152 mm, five only. These stirrups can be used for Steinmann or Denham pins. The small ones are for the calcaneus and the olecranon and the large ones are for the tibia. If you don’t have these stirrups, take a wire coat hanger and bend it to shape, or tie the cords over corks as in E, Fig. 70-14. •PIN MOUNTS, Thomas, stainless steel with rotating collar for Perkins traction, four pairs only. These are much the best mounts for Perkins traction. If you don’t have them, you can make them by cutting a Boehler stirrup and bending the wire. The hooks must rotate freely round the collars.

•STIRRUPS, for wire traction, adjustable, tensioning, Gissane, 216 mm, with two cord hooks, two only. These are for exerting tension on Kirschner wire. They are more expensive than the standard Kirschner wire stirrups, but there are no loose parts to get lost. Use these stirrups for exerting traction on the olecranon in fractures of the humerus, on the metacarpals in fractures of the radius, and on the metatarsals in some fractures of the foot.

•WIRE, Kirschner, plain unthreaded, stainless steel, drill pointed at one end, packet of 5, (a) 0.75 $\ensuremath{\times }$ 254 mm, four packets only. (b) 1 mm $\ensuremath{\times }$ 254 mm, four packets only. (c) 1.5 mm $\ensuremath{\times }$ 254 mm, four packets only. These are the standard Kirschner wires. Unfortunately, Kirschner wire is seldom available in district hospitals at the present time. It is one of the purposes of this system of surgery to promote its use.

•INTRODUCER, for Kirschner wire, Pulvertaft’s, one only. This will make introducing Kirschner wire much easier.

•CUTTERS, Kirschner wire, one only. If you don’t have these, sterilize a pair of ordinary pliers, but take care to oil them carefully afterwards.

•HAND DRILL, for Kirschner wires and drills, 4 mm capacity cannulated throughout, one only. The chuck of this drill has a hole through it so that long Kirschner wires can be passed down it and supported close to the skin. If you don’t have one of these drills, use a small ordinary carpenter’s hand drill and the bits for it and keep them oiled after use. Unfortunately, a carpenter’s drill is not cannulated, so you can use it only with drill bits, not with Kirschner wire. The main use of a drill is to exclude osteomyelitis (7.3). If you don’t have any kind of drill, you may be able to hammer in a Steinmann pin through cancellous, but not through cortical, bone.

•DRILL BITS, twist, bone, 4 mm, six only. Use these to: (1) Drill a hole for a Steinmann pin. (2) Explore for pus in patients with osteomyelitis. Don’t drill so vigourously that the bit becomes too hot, because the heated bone around the bit may die and form a ring sequestrum.

•FORCEPS, wire cutting, compound lever action with pliers jaws, 170 mm. These can cut and bend Kirschner wire up to 1.6 mm diameter.

•CORD, braided, for traction, local purchase. If you don’t have this use a length of bandage.

•PULLEYS, orthopaedic, assorted, ten only. If you don’t have pulleys for Perkins traction, wrap a strip of old X-ray film loosely round the bar of the bed so it can rotate. Hold it there with adhesive strapping and let the traction cord run over it.

•BARS, for overhead traction. These are needed for ’90–90’ traction (Fig. 77-11), for some pelvic fractures (Fig. 76-2), and for humerus fractures in unconscious or supine patients (Fig. 71-16). Make them from welded tubing.

•WEIGHTS, for traction, local manufacture. Use bags of sand, or bricks suspended in stockinette, as in Fig. 70-11; each brick weighs about 3 kg. Or, use lengths of pipe filled with concrete into which a hook has been placed before the concrete sets. For example, 45 cm of 7.5 cm pipe filled with concrete weighs about 7 kg.