Int. J. Pharm. Sci. Rev. Res., ISSN: 0976 – 044X, 84(3) - March 2024; Article No.

17, Pages: 114-121 DOI: 10.47583/ijpsrr.2024.v84i03.017

Review Article

A Review on Traction in Orthopedics

Adarsh GS*, Preeti V Kulkarni, Venkatrao H Kulkarni, Venkatesh Biradar
Soniya Education Trust’s College of Pharmacy, Dharwad-580002, India.
*Corresponding author’s E-mail: adarshgsgubbi@gmail.com

Received: 06-01-2024; Revised: 03-03-2024; Accepted: 10-03-2024; Published on: 15-03-2024.

ABSTRACT
Traction in Orthopedic and trauma has been an age-long practice designed to provide a pulling force to achieve the desired purpose.
We aim to write this article to describe indications, applications of various forms of traction, and their relevant complications. In areas
with limited resources for advanced treatment options, traction is still used to fill its traditional roles some roles in orthopedic and
trauma care. Several methods for placing skeletal traction have been described, and it is critical for orthopedic surgeons not only to
be proficient in their application but also to understand the appropriate indications for use.
Keywords: Orthopedic, Trauma, Indications, Skeletal.

INTRODUCTION
Traction in Orthopedics

T raction is the application of a pulling force for

medical purposes, to treat muscle or skeletal
disorders, for example, to reduce a fracture,
stabilize and maintain bone alignment, relieve pain, or
prevent spinal injury. Traction is usually applied to the
arms, legs, spine or the pelvis. It is used to treat fractures,
dislocation, long-duration muscle spasms and to prevent
or correct deformities1.
Traction can be used for either short term, for example at
an accident scene, or in A&E as pain relief or as part of an
interim care plan before surgery. It can also be used for
long, as a part of a non-operative treatment plan. It is
based on simple mechanical principle and is a well- Figure 1: Sites of Skeletal Traction
established treatment in orthopedic settings. To pull (or PROCEDURE
apply) traction effectively, there must be something to
pull against, which is endeavoring to pull or thrust in the Identify and demarcate the superficial landmarks
opposite direction. These two forces are called traction around the proximal tibia. Make note of the medial
and counter traction respectively. and lateral knee joint lines and the four poles of the
patella. The tibial tubercle and the fibular head
Counter traction is the force acting in the opposite should also be identified.
direction to the applied traction. It is usually achieved by
a patient’s body weight and bed adjustment, sometimes
with the use of additional weights1.The pulling force
overcomes muscle spasm and shortening. It can also, in
some circumstances, control movement of the injured
part so enabling bone and soft tissue to heal. Human
tissue is very vulnerable, however, and traction on limbs
must be practiced with caution and discretion1.
Tibial Skeletal Traction
Identify the proper placement of the tibial traction
Skeletal traction is a treatment method for broken bones.
pin 3 . This is generally approximately 2 fingerbreadths
It is a system where a combination of pulleys, pins, and
distal to the tibial tubercle and 2 fingerbreadths
weights are used to promote the healing of fractured
posterior and lateral on the tibia. Mark this trajectory
bones. These are usually in the lower body. In skeletal
on the lateral as well as the medial side where the pin
traction, a pin is placed inside your bone2.
will exit.

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Place pin caps on the tip of either side of the pin to

protect both the patient and staff. Alternatively,
Use the prep solution to clean the leg on both the blood collecting test tubes can be utilized. Place
lateral and medial aspects 4 .Start from the center and Xeroform over the pin sites on the skin. Apply the
work circularly in an outward direction. Don sterile traction bow and wrap the pin sites with Kerlix and
gloves and place sterile towels around the proximal continue to wrap the entire traction bow with Kerlix.
tibia. Keep the knee joint in view in order to not block This acts as a cushion buffer in case the traction bow
out any anatomical landmarks 5 . ever makes contact with the patient’s skin. Cut
traction rope and applies a traction knot. Apply rope
to the traction bow with a hook and then attaches
traction apparatus to the bed. Hang weights from the
hook. Use 5-pound increments. Ensure that the
traction bow is not resting on the patient distal to the
traction pin site. A fully wrapped Kerlix can be placed
directly on the skin at this level to ensure the traction
bow does not come in contact with the patient’s skin
a. Apply local anesthesia around the marked in order to avoid a pressure ulcer.
trajectory of the pin on the lateral as well as the Obtain post-traction radiographs to determine if
medial side where the pin would be expected to exit. more or less weight is needed. While skeletal traction
Place the traction pin on the drill and then place the may be sound daunting at first, understanding
traction pin on the marked skin laterally. Generally, anatomical considerations, being prepared with all
the tip of the traction pin is sharp enough to puncture necessary equipment, and following these clear and
through the skin. A small stab incision could also be concise steps will lead to success 8 .
made with a #11 blade scalpel.
BOHLER BRAUN SPLINT
b. In our practice it has been found that stab
incisions with a scalpel can stretch over time Bohler-Braun is used in the conservative management of
especially with weighted traction, therefore it is not fractures of the lower limb. The splint is cumbersome
generally used 6 . After going through the skin, making it difficult to work within situation where
subcutaneous, and soft tissue, palpate for bone. The compactness of the splint is required. This work is a
proximal tibia is close to the subcutaneous tissues. modification of the splint into a portable version 9.

c. Once on bone, walk the pin slightly anterior and

slightly posterior in order to gauge that the pin is
relatively central on the bone. While the more critical
neurovascular structures are on the posterior aspect
of the tibia, it is also important not to be too anterior
on the tibia to ensure that the pin has adequate depth
when weighted traction is applied. Confirm that the
pin is parallel to the knee joint line. Once confirmed
placement on the tibia, drill full speed and drive the
pin through the bone and through the soft tissue and
skin on the medial side 7 . Even out the amount of the
pin that is outside the skin on both the medial and
lateral sides. This will ensure that there is enough
space on both the medial and lateral sides for the
application of the traction bow and pin caps. Figure 2: BOHLER BRAUN SPLINT

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Structure 2. Pressure sores – heel, ischium and other pressure areas

It consists of an iron frame with a set of 4 pulleys for 3. Pin tract Infection – detect early signs like pain, swelling,
application of mobile traction. It is modified from Braun redness, discharge.
splint which consists of only one pulley for distal tibia or
4. Physiotherapy – ankle mobilization to prevent equinus,
calcaneal skeletal traction.
anti-foot drop splint at nights. Knee and other joints
Bohlers Modification: addition of two more pulleys for mobilized if possible. Static quadriceps to be encouraged
proximal tibia and distal femur traction10.
5. Portable radiograph – biweekly or as and when required
Uses of 4 pulleys in first 2 weeks and then weekly. Accordingly arrange the
weight and direction of traction14.
1st (Lowermost): Tibia and fibula injuries
Tips and Tricks
2nd (Second from bottom): supracondylar fracture femur
1. Pressure from slings, wrappings, etc. or from the leg
3rd (directed away from patient): fracture shaft femur
lying against the side of the frame can cause peroneal
middle third
nerve damage. Make sure leg is not externally rotated,
4th (topmost and directed towards the patient): prevents and check the neurovascular status every two hours.
foot drop11.
2. Make sure the proximal end of the frame does not press
Uses With traction into the perineum. A large dressing or pieces of sheep skin
can be used to pad this area and can be easily changed if
For lower limb injuries with displacement / fragment
soiled15.
overlap: The skeletal fraction is given via a K wire,
Steinman pin, Bohler's pin, etc. 3. Make sure elastic bandages are not tighter at the
proximal rather than the distal end of the femur or lower
In leg fracture: pin through calcaneal tuberosity
leg, otherwise swelling may occur [in skin traction].
In femur fracture: pin through tibial tuberosity in adults,
4. Usually, the patient can turn towards the splint for
just above condyles in children12.
backcare, linen changes, etc. It may be easier if the bed is
Without traction made with two folded sheets, one at the head and another
at the foot underneath the splint. Then, if only one part of
Compound fracture with no overlap, for dressing and
the bed needs changing, the splint will not have to be
wound cafe and possible immobilization, soft tissue injury
moved15.
to leg, rest in case of cellulitis, gangrene, amputation,
etc12. 5. If possible, apply an anti-embolism stocking to the
unaffected leg.
Advantages
6. Passive mobilization of Patella to prevent patella
Mobile traction is especially useful in cases where
femoral adhesions.
transportation is necessary as the traction unit I self-
contained, limb in comfortable position, wound care 7. Chest physiotherapy to prevent lung complications.
possible, multipurpose application. Angle of traction can
8. In cases of supracondylar fractures of femur, provide
be changed by changing the pulleys [no change in
support/padding at the fracture site to prevent
arrangement required). Simultaneous traction through
angulations and avoid padding at the knee joint which
Calcaneal/distal tibia and proximal tibia/distal femur can
might contribute to angulation15.
be given13.
SKIN TRACTION
Disadvantages & complications
Skin traction is used when the soft tissues, such as the
Non ambulatory, Stiffness / contracture
muscles and tendons, need to be repaired. Less force is
Urination and defecation become difficult, common applied during skin traction to avoid irritating or damaging
personal nerve compression the skin and other soft tissues16.
Other complications of recumbence like bed sore, 1. General considerations
hypostatic pneumonia etc13.
• Inadequate pain relief
Precautions or regular monitoring is needed for patients
in traction • Loosening

5 P’s – Pulse/pins and needle; Pressure sores; Pintract • Constriction

infection; Physiotherapy; Portable radiographs • Friction with skin necrosis
1. Pulse and pins and needles - Distal Neurovascular status
sensation, distal pulsation, nailbed circulation, pain on
passive dorsiflexion [sign of compartment syndrome]

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Traction configurations A simple skin-traction kit can be made easily with a roll of
nonelastic adhesive strapping (approximately 3 inches, 8
Straight skin traction is achieved with weight over the end
cm, wide), Foam padding for the malleolar region and
of the bed.
wooden spacer block (suitably drilled for cord
attachment)
Before application of adhesive traction strip, the skin
should be painted with friar’s balsam (tincture of benzoin)
or equivalent, then apply the strip to the lower leg from
the level of the knee to the supramalleolar region. Apply
the strapping to the inner side of the leg, then unroll it a
little further to allow placement of the spacer and the
foam, thereafter apply it to the outer side of the leg. It is
important to ensure that the wooden spacer lies
transversely, i.e., parallel to the sole of the foot18.

Figure 3: Straight Skin Traction

If skin traction is likely to be used for more than 24 hours,
greater patient comfort and better control of the fracture
can be achieved using balanced skin traction (Hamilton-
Russell), which allows for a slightly flexed knee and hip and
elevation of the extremity17.This configuration of traction
and leg support also can be adjusted to control femoral
rotation by directing the upward support medially or
laterally17.
2. Application of skin-traction kit
This photograph shows a commercially available skin-
traction kit.18 Figure 5: Applying procedure of skin traction
To prevent the development of blisters, the skin traction
needs to be applied without folds or creases in the
adhesive material, and the covering bandage should be
nonelastic. Should a crease be inevitable due to the
contour of the limb, the creased area should be lifted and
partially slit transversally, and the edges overlapped.
Once the adhesive strip is satisfactorily in place, ensuring
that the padded lower section overlies the malleoli, an
inelastic bandage is carefully wrapped around the limb
from just above the malleoli to the top of the strip18. Apply
the overlying bandages spirally, overlapping by half.

Figure 4: Skin Traction Kit

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overhead bar medially (internal rotation) or laterally

(external rotation) 21.

Figure 6: Applying procedure of bandage

3. Positioning of the lower extremity
As the proximal fragment position cannot be influenced,
traction has been used to align the distal extremity to align
the fracture. Typically, this requires mild flexion,
abduction, and slight external rotation19.
4. Straight skin traction
With straight skin traction, padding has been added under
the patient’s calf to keep the heel from pressing on the
Figure 8: Balanced skin traction
bed beneath it20.
A simpler alternative to this technique involves two
Note: With any longitudinal traction, the surface of the
separate systems:
bed should be tilted, e.g., with blocks at the foot of the
bed or in Trendelenburg, to counteract the tendency for • A sling suspended from the overhead frame or
the traction weights to pull the patient down the bed. supported with a rope and pulley counterweight to
With the tilted bed, the weight of the patient acts as provide an upward force, which lifts the leg off the bed
countertraction20.
• Longitudinal (distal) traction applied with skin or
skeletal technique22.
The resulting vector force, as illustrated, is oblique (the
vector sum of the upward and distal forces applied by the
two weights).
6. Assessment of reduction
After traction has been set up, an x-ray is taken to check
for acceptable fracture alignment. That is readjusted as
necessary. The skin is assessed, especially bony
prominences for breakdown, as well as neurovascular
status, respiratory status, including rate and patter,
breath and lung sounds, ability to cough and breathe
Figure 7: Straight skin traction deeply. Evaluate muscle strength and tone and mobility in
5. Balanced skin traction affected and unaffected areas 23.
To apply balanced skin traction, a dedicated orthopedic 7. Mobilization in bed
bed or a standard bed in combination with a mobile Assisted active mobilization and chest physiotherapy
Balkan beam frame is needed 21. A padded sling is placed should start from the first day. With the aid of a trapeze
behind the slightly flexed knee and applies skin traction to bar, as shown, patients can lift themselves, and the
the lower leg. The principle of the parallelogram of forces traction system allows mobilization of the knee. The grip
determines that the upward pull of the sling and the or hold on the patient's body must be adequate and
longitudinal pull of the skin traction create a resulting secure. Provision for counter traction must be made.
force in the line of the femur, as illustrated. There must be minimal friction on the cords and pulleys.
This configuration of traction and leg support can also be The line and magnitude of the pull, once correctly
adjusted to control femoral rotation by moving the established, must be maintained24.

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EXTERNAL FIXATION significant damage to skin, muscle, nerves, or blood

vessels.
External fixation is a surgical method of immobilizing
bones to allow a fracture to heal properly. It is used to The external fixation also ensures the ideal compression,
provide stability to bone and soft tissue after a serious extension, or neutralization of bone placement while
break but can also be applied as a procedure to correct allowing for movement of the nearby joints. This not only
bone misalignment, restore limb length, or protect soft aids in setting the bones correctly, but it can also help
tissue after a serious burn or injury25. minimize muscle atrophy and edema (the buildup of
excess fluid) caused by the total immobilization of a
limb27.
External fixation is contraindicated under the following
circumstances:
• Bone-related disorders or deterioration that
makes stabilization less assured.
• Persons who are not able or willing to properly
care for the pins and wires.
• A person with severely compromised immune
systems who are at higher risk of infection.
Other Uses of External Fixation
Figure 9: External Fixations to Repair Broken Bone Beyond the immediate repair of severe or compound
External fixation is accomplished by placing pins or screws fractures, external fixation can be used to treat or repair
into the bone on both sides of the fracture. The pins are other conditions. These include surgeries to correct bone
secured together outside of the skin using a series of malformations that result in the shortening of a limb.
clamps and rods known as the external frame. External External fixation can also be used to retain the integrity of
fixation is performed by an orthopedic surgeon and is bone structures (such as the hand) after a serious burn or
usually done under a general anesthetic. The procedure injury. Without fixation, the exposed or damaged tissue
itself typically follows the following steps: can contract from the accumulation of scar, causing long-
term or even permanent restriction of movement28.
1. Holes are drilled into the undamaged areas of
bones around the fracture. Vacuum-assisted closure

2. Special bolts are screwed into the holes. Vacuum-assisted closure of a wound is a type of therapy
to help wounds heal. It is also known as wound VAC.
3. Outside of the body, rods with ball-and-socket During the treatment, a device decreases air pressure on
joints are joined with the bolts. the wound. This can help the wound heal more quickly.
4. Adjustments can be made to the ball-and-socket
joint to ensure the bone is aligned properly with as little,
if any, shortening of a bone.
The areas of skin that have been pierced by the procedure
need to be cleaned regularly to prevent infection. In some
cases, a cast may need to be applied. The removal of the
bolts and external frame can usually be done in a doctor’s
office with no anesthesia. Fractures have been known to
occur at the drill sites and, as such, extended protection
may be needed after removal of the device26.
Advantages and Considerations of External Fixation
The main advantage of external fixation is that it is quickly
and easily applied. The risk of infection at the site of the
fracture is minimal, although there is a chance
of infection where the rods have been inserted through
the skin. External fixators are often used in severe
traumatic injuries as they allow for rapid stabilization Figure 10: Vacuum-assisted closures
while allowing access to soft tissues that may also need
treatment. This is particularly important when there is The gases in the air around us put pressure on the surface
of our bodies. A wound vacuum device removes this
pressure over the area of the wound. This can help a
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wound heal in several ways. It can gently pull fluid from Proper training in dressing changes can help reduce the
the wound over time. This can reduce swelling, and may risk of these problems. Certain problems can increase risk
help clean the wound and remove bacteria. A wound VAC of complications, such as:
also helps pull the edges of the wound together. And it
• Exposed organs or blood vessels
may stimulate the growth of new tissue that helps the
wound close. • High risk of bleeding from another health problem
A wound vacuum system has several parts. A foam or • Wound infection
gauze dressing is put directly on the wound. An adhesive
film covers and seals the dressing and wound. A drainage • Nearby bone infection
tube leads from under the adhesive film and connects to • Dead wound tissue
a portable vacuum pump. This pump removes air pressure
over the wound. It may do this either constantly. Or it may • Cancer tissue
do it in cycles. The dressing is changed every 24 to 72 • Fragile skin, such as from aging or longtime use of
hours. During the therapy, you’ll need to carry the topical steroids
portable pump everywhere you go.
• Allergy to adhesive
It can gently pull fluid from the wound over time. This
can reduce swelling, and may help clean the wound and • Very poor blood flow to wound
remove bacteria. A wound VAC also helps pull the edges • Wounds close to joints may reopen due to
of the wound together. And it may stimulate the growth movement33.
of new tissue that helps the wound close29.
CONCLUSION
Why one might need vacuum-assisted closure of a
wound? Traction still has some role in current practice particularly
in resource-challenged regions as well as in the developed
One might need this therapy for a recent traumatic world especially as temporary treatment, pre, intra, and
wound/or may need it for a chronic wound. This is a postoperative periods in orthopedics and trauma. We
wound that is not healing properly over time. This can hope this provides an aid for the practitioner when the
happen with wounds linked to diabetes. One may need a need arises, to guide them in application, planning and
wound VAC for having a recent skin graft and for a large decision-making processes when traction is considered.
wound. Large wounds can take a longer time to heal30.
Source of Support: The author(s) received no financial
A wound vacuum system may help wound heal more support for the research, authorship, and/or publication of
quickly by: this article
• Draining excess fluid from the wound Conflict of Interest: The author(s) declared no potential
• Reducing swelling conflicts of interest with respect to the research,
authorship, and/or publication of this article.
• Reducing bacteria in the wound
REFERENCES
• Keeping wound moist and warm
1. Anderson GH, Harper WM, Connolly CD, Badham J, Goodrich N,
• Helping draw together wound edges Gregg PJ. Preoperative skin traction for fractures of the proximal
femur. A randomised prospective trial. The Journal of Bone & Joint
• Increasing blood flow to wound Surgery British Volume. 1993 Sep 1;75(5):794-6.
2. Bhatti AN. Broken bones and bone setters. Medical channel.
• Decreasing redness and swelling (inflammation)
2010;16(1):7-9.
Wound VAC offers some other advantages over other 3. Nielsen E, Walterscheid Z, Beingessner D, Kleweno C. Implementing
types of wound care. It may decrease ones overall an Educational Module for Orthopaedic Residents Placing Skeletal
discomfort. The dressings usually need changing less Traction. JAAOS Global Research & Reviews. 2023 Apr;7(4):18-23.
often. And they may be easier to keep in place31. 4. Coskun Ö, Viskjer S. Chlorhexidine shampooing of dogs the night
before elective surgery: Are human recommendations applicable
What are the risks of vacuum-assisted closure of a to veterinary medicine?. Canadian Journal of Veterinary Research.
wound? 2022 Oct 1;86(4):306-10.

Wound VAC has some rare risks, such as: 5. Zhao Q, Zhu J, Zhu J, Zhou A, Shao H. Bone anatomical landmark
localization with cascaded spatial configuration network.
• Bleeding (which may be severe) Measurement Science and Technology. 2022 Mar 3;33(6):065401.
6. Ernat JJ, Peebles AM, Provencher MT. Lateral Collateral Ligament
• Wound infection
and Proximal Tibiofibular Joint Reconstruction for Tibiofibular
• An abnormal connection between the intestinal Instability. Arthroscopy Techniques. 2022 Feb 1;11(2):e251-6.
tract and the skin (enteric fistula) 32. 7. Lee DH, Son DW, Seo YR, Lee IG. Comparison of femoral tunnel
widening after anterior cruciate ligament reconstruction using
cortical button fixation versus transfemoral cross-pin fixation: a

International Journal of Pharmaceutical Sciences Review and Research

Available online at www.globalresearchonline.net 120
©Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited.
Int. J. Pharm. Sci. Rev. Res., ISSN: 0976 – 044X, 84(3) - March 2024; Article No. 17, Pages: 114-121 DOI: 10.47583/ijpsrr.2024.v84i03.017

systematic review and meta-analysis. Knee Surgery & Related years follow-up. Journal of Orthopedics and Orthopedic Surgery.
Research. 2020 Dec;32:1-8 2021 Jul 13;2(2):50-55.
8. Hwang CJ, Kim DG, Lee CS, Lee DH, Cho JH, Park JW, Baik JM, Lee 21. Yuenyongviwat V, Jiarasrisatien C, Iamthanaporn K, Hongnaparak
KB. Preoperative halo traction for severe scoliosis. Spine. 2020 Sep T, Tangtrakulwanich B. Balanced Suspension versus Pillow on
15;45(18):E1158-65. Preoperative Pain for Proximal Femur Fractures: A Randomized
Controlled Trial. Advances in Orthopedics. 2020 Jul 22;2020.
9. Dhurvas RR, Sengodan VC, Kandasamy K. Skeletal traction for the
management of lower limb fractures: Its relevance today. 22. Kimura S, Tsuchiya A, Ogawa M, Ono M, Suda N, Sekimoto K, Takeo
International Journal of Orthopaedics. 2019;5(1):500-3. M, Tsuji T. Tissue-scale tensional homeostasis in skin regulates
structure and physiological function. Communications Biology.
10. Çamur S, Celik H, Kılınç BE, Oc Y, Özcan MS, Kara A. Outcomes of 2020 Oct 30;3(1):637-43.
diaphyseal femur fractures treated by long-and short-term traction
methods in pre-school children. Medicine Science. 2021. 23. Smetana GW. Postoperative pulmonary complications: an update
on risk assessment and reduction. Cleveland Clinic journal of
11. Levy DM, Meadows MC, Gates DJ. A Novel Traction Frame for medicine. 2009 Nov 4;76(4):S60.
Femur Fracture Management in Developing Countries: Technique
and Outcomes. Journal of Orthopaedic Trauma. 2019 May 24. Izcovich A, Popoff F, Rada G. Early mobilization versus bed rest for
1;33(5):e203-6. deep vein thrombosis. Medwave. 2016 Jun 28;16(Suppl2):60-66.
12. Gadhe S, Ghorpade NA. Treatment of Unstable Diaphyseal Fracture 25. Bible JE, Mir HR. External fixation: principles and applications.
Femur with Femur Intramedullary Interlocking Nailing. JAAOS-Journal of the American Academy of Orthopaedic Surgeons.
International Journal of Contemporary Medical Research. 2015 Nov 1;23(11):683-90.
2020;7(1):A7-11.
26. Mark H, Bergholm J, Nilsson A, Rydevik B, Strömberg L. An external
13. Panchal P. A prospective study of functional and radiological fixation method and device to study fracture healing in rats. Acta
outcomes of treating acetabular fractures with open reduction and Orthopaedica Scandinavica. 2003 Jan 1;74(4):476-82.
internal fixation. 2020.
27. Schuind FA, Burny F, Chao EY. Biomechanical properties and design
14. McGuire JA, Hayanga JA, Thibault D, Zukowski A, Grose B, Woods considerations in upper extremity external fixation. Hand clinics.
K, Schwartzman D, Hayanga HK. Anesthetic Choice for 1993 Nov 1;9(4):543-53.
Cardiovascular Implantable Electronic Device Placement and Lead
Removal: A National Anesthesia Clinical Outcomes Registry 28. Tresley J, Schoenleber SJ, Singer AD, Clifford P. “Ilizarov” external
Analysis. Journal of Cardiothoracic and Vascular Anesthesia.2023 fixation: what the radiologist needs to know. Skeletal radiology.
Jul 29. 2015 Feb;44:179-95.

15. Pisulkar G, Saoji K, Angachekar DU, Dadlani M, Pandey P. 29. Mora R, Pedrotti L, Bertani B, Tuvo G, Maccabruni A. Problems,
Intraoperative periprosthetic fracture of femur in a case of revision Challenge, Complications in Hexapod External Fixation Systems.
total hip replacement: A case report. Medical Science. 2020 Contraindications. In Hexapod External Fixator Systems: Principles
Aug;24:2691-9. and Current Practice in Orthopaedic Surgery. Cham: Springer
International Publishing. 2021 Jun 1 (pp. 239-246).
16. Barreiro G, de Lima VS, Cavazzola LT. Abdominal skin tensile
strength in aesthetic and massive weight loss patients and its role 30. De Bastiani G, Aldegheri R, RenziBrivio L. Dynamic axial fixation: A
in ventral hernia repair. BMC surgery. 2019 Dec;19:1-6. rational alternative for the external fixation of fractures.
International orthopaedics. 1986 Jun;10:95-9.
17. Venturini G, Volpe G, Villani M, Popescu M. Investigation of cooling
solutions for hairpin winding in traction application. In2020 31. Ahmed Z, Husain N, Nour S, Yee SH. Efficacy of vacuum-assisted
International Conference on Electrical Machines (ICEM). closure (VAC) in wound healing. Surgical Science. 2019 Jun
2020;1:1573-1578. 28;10(6):173-215.

18. McCarthy A, Meagher E, Dolan M. An Unorthodox Skin Traction 32. Gläsel S, Jarvers JS, Pieroh P, Heyde CE, Spiegl UJ. Does the use of
Technique for the Initial Management of Distal Femur Fractures in epicutaneous vacuum-assisted closure after revision surgery on the
a High-volume Trauma Centre: A Technical Review. Cureus. 2020 spine reduce further wound revision surgery?. International
Feb 26;12(2):32-36. Orthopaedics. 2023 Mar;47(3):803-11.

19. Obey MR, Berkes MB, McAndrew CM, Miller AN. Lower-extremity 33. Hinterwimmer F, Lazic I, Langer S, Suren C, Charitou F, Hirschmann
skeletal traction following orthopaedic trauma: indications, MT, Matziolis G, Seidl F, Pohlig F, Rueckert D, Burgkart R. Prediction
techniques, and evidence. JBJS reviews. 2019 Nov 1;7(11):e4. of complications and surgery duration in primary TKA with high
accuracy using machine learning with arthroplasty-specific data.
20. Spagnolo R, Porreca D, Vimercati M, Pace F. Polytraumatized Knee Surgery, Sports Traumatology, Arthroscopy. 2023
patient with two columns fracture of the acetabulum and skin Apr;31(4):1323-9.
abrasion, which incision to use with soft tissue: A case report at 15

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