Technical notes on a radiolucent distractor for indirect reduction and intramedullary nailing

For many years, the fracture table has served as the gold standard for the application of the distraction forces necessary to indirectly reduce fractures during internal fixation procedures. However, the fracture table is expensive, often is cumbersome, requires intraoperative adjustment by "nonscrubbed" personnel, can be difficult to use in the care of multiply traumatized patients, and often is unsuitable for the morbidly obese patient. This technical note describes the application of distraction with a sterile device that 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." The multiply traumatized patient who is placed on a radiolucent table for thoracoabdominal procedures can undergo 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). Such a device also can be used to apply distraction for tibial nailing, for indirect reduction and plating, and for hip and ankle arthroscopy.