Risk factors for genitoperineal injury:
(1) prolonged traction against the perineal post (> 120 minutes)
(2) narrow padding
(3) limb positioning that increases the countertraction forces
Complications of prolonged traction:
(1) erectile dysfunction
(2) ischemic scrotal skin necrosis with or without cellulitis
(3) pudendal nerve palsy
(4) urethral injury
Ways to reduce the risk of injury:
(1) use wide padding (>= 10 cm)
(2) keep operative time as short as possible
(3) periodic release of traction during prolonged procedures
(4) using alternative operative strategies to reduce traction periods, such as use of preoperative traction to maintain limb length
(5) selection of limb positioning that reduces the countertraction forces (avoid adduction of the affected limb; use 20 degrees adduction of the affected leg; or use flexion-abduction-external rotation of the contralateral limb with the post placed ipsilateral to this leg)
A male who undergoes orthopedic surgery with traction using a perineal post should be monitored for several days following surgery in order to detect possible complications.
