Summary TrakPak® is the all-in-one skeletal traction procedure kit designed to streamline bedside skeletal traction in the emergency department. TrakPak® controls costs, wins back resources for the hospital, and makes staff happy by: Reducing setup delays, allowing providers to administer care faster Eliminating the need for traction beds and bed frames, simplifying patient transfers and further reducing setup delays Eliminating sterile processing for skeletal traction, reducing equipment bottlenecks Moving patients out of the ED faster, improving ED throughput TrakPak® is used at over 65 trauma centers, including industry leaders like Harborview and Shock Trauma, and has proven to save providers over 45 minutes per procedure, on average. Design No Borrowing Costly OR Power Systems TrakPak® includes a custom FDA cleared DEWALT® Pin Driver and pre-sterilized cover, eliminating the need to borrow sterile power systems from the OR. Modern Tension Bow QuikBow® is a single use, modern tension bow QuikBow® is included in every TrakPak®, so it is always brand new, never stripped, and always available when you need it It utilizes spring loaded locking cams, making it easier to use than traditional bows QuikBow® is made from 98% bio-based polymer derived from castor beans, which makes it: Radiolucent, reducing imaging artifacts Sustainable and recyclable. A QuikBow® recycling program is available at no cost. Eliminates Traction Beds, Bed Frames, and Bed Control TrakPak® includes QuikBow® with QuikLine™, which can be used on any patient bed with or without a footboard. Eliminate the need to involve bed control and wait for a traction bed Eliminate the scavenger hunt for traction bed frames Simplify patient transfers and transport Indications Typically indicated for use for Femoral neck shaft fractures Acetabular fractures Pelvic ring fractures Approach Distal femoral or proximal tibial skeletal traction Preparation Collect 1 TrakPak® procedure kit and the Arbutus Surgical Power System Prepare two work surfaces Sterile surface accessory kit, traction wire, and drill cover Non-Sterile surface DEWALT® pin driver Step 1: Organize sterile work surface Open the Accessory kit and organize contents on the sterile work surface Open the sterile traction wire and drill cover and place them on the sterile work surface Step 2: Prepare the Pin Driver Place the SteriGo cover on the drill Place the sterile drill cover over the drill with the white gasket at the head of the drill Grab the drill and unfold the cover to completely surround the drill Remove the white strip and seal the cover by rolling it up Place covered drill on the sterile work surface until ready for use Loading the traction wire in the pin driver Push the blue quick connector of the wire into the drill until it clicks The drill is now ready to drive the wire Do not dispose of the extra wire cap as you will need this during the procedure Note, the wire can remain separate from the drill until ready to drive the pin, if desired Patient Preparation: The patient should be in a supine position with the affected leg extended. The leg should be flexed approximately 20-30° to allow for clearance of the other leg while driving the pin Derotate the leg so the patella is facing upwards to ensure the pin is being driven through the bone while remaining parallel to the floor and joint line Pin Placement Landmarking To avoid key neurovascular structures during pin entry and exit, femoral traction pins should be inserted from medial to lateral, while tibial traction pins should be inserted from lateral to medial. Identify the following landmarks to aid in pin placement: Distal Femur Traction Landmarks Patella Joint line 2cm superior to patella Femoral epicondyle (medial and lateral) 2cm superior/proximal to the medial epicondyle Proximal Tibia Traction Landmarks Patella Joint line Tibial tubercle 2 cm distal to tibial tubercle 2 cm posterior to previous mark Injecting Lidocaine Perform a digital block at the pin entry and exit sites Inject 10cc medially and 10cc laterally with a skin wheal and to the periosteum Inserting the Pin Before driving the pin, locate the center of the bone to ensure bicortical pin placement Insert the pin at the pin entry site determined during landmarking and push the pin to the bone. Using a gentle poking technique, march the pin on the bone to locate the anterior and posterior limits of the bone to find the desired position (either center or anterior ⅓ of bone depending on institutional preference). Angle the pin or diverge, looking to see that the angle between anterior and posterior limits is equally divergent from neutral Ensure the pin is not pushed past the posterior limit to avoid contacting key neurovascular structures For tibial traction, be mindful of the slope of the face of the tibia. Once center of bone is located, remove the pin from the leg and perform a longitudinal skin nick at the desired pin entry site with an 11 blade. Reinsert the pin through the skin nick to the entry site located on the bone. Connect the pin to the pin driver, if not already, and prepare to drive through the bone by ensuring the leg is held securely in the desired position. Have someone hold the leg if needed Ensure the pin is parallel to the floor and joint line and drive the pin through the bone quickly to minimize heat generation A tactile “pop” should be felt when the pin is driven through each cortex, confirming the pin has been placed biocortically For tibial traction, due to the slope of the face of the tibia, begin with the pin perpendicular to the bone, pointing posteriorly. Create a burr on the bone to prevent skiving off the tibia Drop the pin driver to be parallel with the floor and continue driving through the bone Disconnect the pin from the pin driver by pressing the release button at the top of the drill Use the included pin cutters to trim the ends of the pin. Apply a pin cap to each end. Dress the pin sites to protect the tissue by wrapping xeroform around the pin entry and exit sites. Secure the xeroform with gauze. Applying Traction Secure the QuikBow® to the wire Press the spring loaded cams towards the middle of the bow and place the bow on the wire. Release the cams to secure to the wire. Turn the blue handle at the end of the bow to apply tension to the wire. Tighten as much as possible. Secure the BLUE end of the QuikLine™ ropes to the BLUE adaptor on the underside of the bow. Hang the ropes off the end of the bed. Fill the included water bag to the desired weight (approx 15-20lbs) and connect it to the ends of the QuikLine™ ropes hanging off the bed. Adjust the height of the water bag as needed by securing the bag to a higher loop on the QuikLine™ rope Gradually release the water bag to apply traction to the patient Traction is being applied when the bow is lifted off the tibia Technical Specifications Surgical Power Kit 1 FDA cleared DEWALT® drill 2 batteries, 1 charger 1 pin snips TrakPak® Procedure Kit 1 SteriGo® power tool drape 1 SteriTrak® traction pin driving system 2mm x 310mm 1 QuikBow® pin tensioner 1 set of Pin Tip Covers 4 Blue Towels 4 Sticky Drapes 2 10.5ml of ChloraPrep w/ Applicator 1 Roll of Kerlix 1 Traction Rope 2 18ga x 1.5 Needle 2 22ga x 1.5 Needle 1 20cc Syringe 2 Xeroform Pads 1 11 Blade 1 Skin Marking Pen 4 4” x 4” Gauze Pads 2 Specialized Adaptors 1 Water Bag (20lbs)