OTA 1997 Posters - Tibia Fractures

*Replacing the Fracture Table with a Portable Distractor

Laurence E. Dahners, MD

Chapel Hill, North Carolina, USA

Purpose: To describe an alternative to the fracture table in indirect reduction. For many years, the fracture table has served as the gold standard for the application of the distraction forces necessary to the indirect reduction of fractures during internal fixation procedures. The fracture table, however, is expensive, often cumbersome, requires intraoperative adjustment by "non-scrubbed" personnel, can be difficult to use in the care of multiply traumatized patients, and is often unsuitable for the morbidly obese patient.

Methods: This technical presentation describes the application of distraction with a sterile device developed by the author which is used "in the surgical field" and applies distraction from a K-wire (or Steinman pin) tensioner to either another K-wire tensioner or a "perineal post."

Results: Multiply traumatized patients who are placed on a radiolucent table for thoracoabdominal procedures have successfully undergone intramedullary nailing using this device without requiring transfer to a fracture table (or alternatively without requiring that surgical team members apply manual distraction during the nailing procedure). Morbidly obese patients have been nailed in a closed fashion with surprisingly little difficulty.

Discussion: This device, in various developmental incarnations, has become preferred over the fracture table by many of the surgeons at the author's institution. The device can also be used to apply distraction for tibial nailing, for indirect reduction and plating, and for hip and ankle arthroscopy.

Conclusion: This device represents a less expensive and often more effective alternative to the fracture table.