70.11 Skeletal traction

Steinmann pins are stainless steel rods 2 to 4 mm in diameter. A Denham pin is similar, except that it has a few large threads on it, which you can screw into the cortex of the bone to stop it slipping from side to side. Denham pins are better than Steinmann pins for Perkins traction (78.4) and for calcaneul traction (81.12). But Steinmann pins have other uses, so you will need both. Insert them with the chuck shown in Fig. 70-12. If you don’t have a chuck, you can, if necessary, hammer in a Steinmann pin, if you follow the instructions below, but you cannot hammer in a Denham pin, because of its threads. If you wish, you can drill a hole for a pin before you insert it. One difficulty is finding the hole after you have drilled it.

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Figure 70.13: SITES FOR SKELETAL TRACTION. Pins can spread or introduce infection, so put them through healthy tissue some distance from a fracture, and not through the fracture site itself where injured tissue is easily infected. After de Palma with kind permission.

These pins are stiff, so you can apply traction to them without tensioning them. You can use: (1) A Boehler’s stirrup (Fig. 70-12) and a single traction cord and weight. (2) Two Thomas pin mounts (swivels) with two traction cords and two weights. (3) If you don’t have either of these, you can put corks on the ends of the pin and tie the cords to them. If you tie the traction cords directly to the ends of a pin, they usually slip off and cause agony as they do so. join the cords together and run them through a pulley attached to a single weight, so as to equalize the pull on either end of the pin as in B, Fig. 70-14.

Pins can spread or introduce infection, so: (1) Put them through healthy tissues some distance from a fracture, and not through a fracture site where the injured tissue is easily infected. You can use them to treat open infected fractures, but the further they are from the site of the infection the better. (2) Keep them still. The pin must stay motionless in the bone, and rotate freely in the stirrup or pin mount. This is why a Denham pin which is firmly screwed into the bone is better than a Steinmann pin. If your pin mounts have set screws, don’t tighten them. (3) Never put a pin through a joint capsule. The most serious complication of skeletal traction is infection of the knee joint, or osteomyelitis, particularly in the calcaneus (7.13). If sequestrectomy does not cure this, it may be necessary to remove the whole calcaneus.

A LOOSE PIN PROMOTES INFECTION