**1. Introduction**

Both-column fracture of the acetabulum is relatively common among acetabular fractures and is mainly caused by high-energy trauma [1,2]. During open reduction and internal fixation, intraoperative traction of the ipsilateral leg is required in most cases to facilitate fracture reduction and stabilization. In particular, in acetabular fractures associated with central dislocation of the femoral head, adequate reduction in the fracture is challenging without traction. Methods for applying intraoperative traction in pelvic and acetabular surgery are as follows: taking help from a skilled assistant for manual traction, using a universal distractor or external fixator, and using an on-table frame [3–6]; however, there is no consensus on an ideal technique [7]. In general, intraoperative traction is entirely dependent on surgical assistants because it is the simplest and most easily reproducible method, requiring no special equipment. However, it is not easy for humans to perform precise and continuous traction with constant force throughout the operation. Moreover, the surgical assistant can easily be exhausted, and the need for extra operating room personnel is another drawback.

Limb positioners, which were originally designed for upper extremity surgery and arthroscopic procedures, have been increasingly used in lower extremity procedures because they can be easily adjusted intraoperatively [8]. We hypothesized that both-column

**Citation:** Kim, J.-W.; Oh, C.-W.; Park, K.-H.; Hong, W.-K.; Yoon, S.-H.; Lee, G.-S.; Oh, J.-K. Application of an Intraoperative Limb Positioner for Adjustable Traction in Both-Column Fractures of the Acetabulum: A Technical Note with Clinical Outcome. *J. Clin. Med.* **2023**, *12*, 1682. https://doi.org/10.3390/ jcm12041682

Academic Editors: Paul Alfred Grützner and Piettro Regazzoni

Received: 10 January 2023 Revised: 1 February 2023 Accepted: 17 February 2023 Published: 20 February 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

<sup>2</sup> Department of Orthopedic Surgery, School of Medicine, Korea University Guro Hospital, Seoul 10408, Republic of Korea

fractures of the acetabulum can also be effectively managed with intraoperative traction using a limb positioner. Accordingly, we describe our technique, which—to the best of our knowledge—has not yet been reported in patients with both-column fractures of the acetabulum. This study aimed to report on the novel use of a limb positioner as an intraoperative reduction aid for both-column fractures of the acetabulum as well as its clinical outcomes.
