Skeletal Traction: Common sites

1. Olecranon

• Site:

1. 1.25 inches (3 cm) distal to the tip of olecranon
2. just deep to the subcutaneous border of upper end of the ulna.

• Direction: 

1. Medial to lateral
2. at right angles to the longitudinal axis of ulna.

Avoid: Ulnar nerve injury.

2. Second & Third Metacarpals

• Site: 

1. About 1 inch (2-2.5 cm) Proximal to the distal end of Second metacarpal

• Direction: 

1. The wire traverses 2nd and 3rd metacarpals transversely
2. at right angles to the longitudinal axis of the radius.

3. Greater trochanter (upper end of femur)

• Site:

1. On the lateral surface of femur
2. 1 inch below the most prominent part of the greater trochanter
3. midway between anterior and posterior surfaces of the femur 

• Direction: Lateral to medial

A coarse threaded cancellous screw or Screw eye is used.

4. Distal Femur

There are 2 methods to determine the point of insertion at distal femur.

A)  Site:

1. Draw a line posteriorly at the level of upper pole of patella.
2. Draw a 2nd line from below upwards just anterior to the head of fibula.
3. The point of intersection of these two lines is the site of insertion of a Steinmann pin.

B)  Site:

1. About 1.25 inches (3 cm) Proximal to the articulation between the lateral femoral condyle & the lateral tibial plateau. (this corresponds to the upper limit of lateral femoral condyle)

• Direction: Lateral to medial

Avoid: entering the knee joint by puncturing the joint capsule.

5. Proximal Tibia

• Site: 0.75 inch (2 cm) posterior and inferior to the tibial tuberosity.

• Direction: Lateral to medial

Avoid: damage to Common Peroneal Nerve

6. Distal Tibia

• Site:

1. 2 inches (5 cm) above the level of ankle joint
2. midway between anterior and posterior tibial borders

• Direction: Medial to lateral

7. Calcaneum

• Site: 0.75 inch (2 cm) below & behind the Lateral malleolus (this corresponds to a point 1.25 inches below & behind Medial malleolus)

Avoid: entering the subtalar joint.