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2Application of traction

Steinmann pin positioning for traction of a distal tibia fracture

A 4 mm Steinmann pin, centrally threaded if available, is inserted from medial to lateral through the calcaneal tuberosity. It is vital to avoid the posterior tibial neurovascular bundle behind the medial malleolus. A 2 mm K-wire may also be used, but it will require a tensioning clamp.

The posterior tibial pulse should be located; if this is not clearly palpable, due to swelling, the pulse of the uninjured leg should be palpated and used as a reference guide to find it at the injured side.