The hazards of tibial pin replacement in 90--90 skeletal traction.

Tibial pin placement and 90--90 traction may lead to serious knee difficulties. Not only proximal tibial epiphyseal insult, but also serious displacement of the tibia on the femur may occur. In light of these potential complications, distal femoral pin placement should always be preferable for 90--90 traction in treatment of fractured femurs in children.