Review of Lower Extremity Traction in Current Orthopaedic Trauma

Matullo, Kristofer S.; Gangavalli, Anup K.; Nwachuku, Chinenye

doi:10.5435/jaaos-d-14-00458

Cited by 27 publications

(24 citation statements)

References 16 publications

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“…In our study, soft tissue injury caused by high-speed power drilling was more frequently noted than hammer injury; resolution of the associated complication was di cult. The heat generated during drilling may have caused soft tissue and bone damage [20]. However, pain may be experienced when the of hammer method is used, despite the administration of local anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Yang¹,

Zhu

Dong³

2020

Preprint

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Background and Objective: Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment. However, early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed. This study aimed to analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.Materials and Methods: A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a level-1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Data regarding the demographic information, Tscherne soft tissue injury, fracture site, entry point placement, and duration of traction were recorded. Procedure-related complications such as movement and sensation disorder, vessel injury, discharge, infection, loosening, and iatrogenic fracture were analyzed.Results: The mean patient age was 42.5 (18–71) years and the mean duration of traction was 7.5 (0–26) days. In total, 19 (4.7%) patients presented with procedure-related complications, including technique-associated complications in 6 patients and nursing-associated complications in 13. Differences in the incidence of complications with respect to sex, affected side, soft tissue injury classification, and fracture sites were not observed. However, the number of complications due to hammer insertions was significantly fewer than those due to drill insertions (2.9% vs. 7.4%).Conclusion: The application of preoperative external traction fixation had been proved to be an ideal alternative treatment for high energy tibial fractures. In this study, we found the incidence of early complications of the fixation is low, and it is not significantly associated with the severity of soft tissue injury and fracture site. Although relatively rough and more likely to cause pain, complications of hammer insertions were significantly fewer than drill insertions. The possible reason was higher probability of heat damage and loosening by drilling.

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Section: Discussionmentioning

confidence: 99%

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Yang¹,

Zhu

Dong³

2020

Preprint

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“…Acute treatment of these specific fractures remains a challenge for trauma surgeons due to multisystem injuries and poor conditions during emergencies [ 1 , 2 ]. Traditionally, acute treatment of PFFs involves lower-limb skin or skeletal traction [ 3 , 4 , 5 ], and then intramedullary nailing is considered to be the definitive treatment in the majority of trauma patients [ 6 , 7 , 8 , 9 , 10 ]. With the extensive use of external fixators in trauma surgery, some literature has described the application of an external fixator to the PFF as the definitive treatment, but it is associated with extensive soft tissue damage, severe open fractures [ 11 , 12 ], and poor general conditions [ 13 , 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients

Qing

Chen

2021

Open Medicine

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Background and aim Acute treatment of young patients with proximal femoral fracture (PFF) remains a challenge for trauma surgeons due to major fracture displacement and heavy pain in clinical practice. Traditional methods have a variety of intrinsic defaults and cannot successfully manage the requirements of young patients. Benefiting from our anatomic research, we explored a new method of external fixation for this specific trauma and evaluated its feasibility and clinical outcomes. Material and methods Twenty-three young multiple-trauma patients with PFF were included in this study. Surgical treatment was applied using an external fixator via the anterior inferior iliac spine (AIIS). Electronic patient records, surgical characteristics, clinical outcomes, and complications were reviewed for each patient. Results The mean surgical time was 30.3 ± 7.3 min. The mean blood loss was 25.3 ± 10.8 mL. No iatrogenic nerve palsy, pin tract infection, failure of external fixation, or bedsores were observed. The postoperative visual analog scale score was significantly lower than the preoperative score (P < 0.01). The mean fracture reduction rate of the femur was 58.1 ± 17.0%, and the mean degree of reduction was 13.5 ± 6.9°. The mean external fixation time was 7.6 ± 4.0 days and intramedullary nailing was performed. The mean hospital, follow-up, and healing times were 28.7 ± 8.7 days, 23.5 ± 7.9 months, and 22.8 ± 5.7 weeks, respectively. The Harris Hip Score indicated excellent or good results in 20 patients. Conclusion Collectively, the results of this study revealed that external fixation via the AIIS is a safe, rapid, and effective method for acute treatment of PFF in young patients.

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“…The use of traction devices to treat spinal injuries was described as early as 3000 to 2500 BC. 2 The practice has since been adopted to treat nearly every fracture of the axial and appendicular skeleton. The treatment of femoral shaft fractures has evolved from the historical non-operative management to the most recent methods of intramedullary nail fixation.…”

Section: Introductionmentioning

confidence: 99%

A comparative evaluation of the efficacy between skeletal traction and skin traction in pre-operative management of femur shaft fractures in Korle Bu Teaching Hospital

Agbley

Holdbrook-Smith

Ahonon

2020

gmj

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Objectives: This study is to compare the outcomes of pre-operative skeletal and skin traction in adult femoral shaft fractures awaiting surgical fixation within two weeks of presentation to the Accident Center of Korle Bu Teaching Hospital.Methods: This study was a clinical trial on 86 recruited patients with closed femoral shaft fractures sustained within 24 hours of presentation grouped into 2 groups. Descriptive and inferential statistics comprising frequency, percentage, Chi-square, independent sample t-test and Mann-Whitney U test were used in analysing the data.Results: Of the total number of patients involved in the study, 74% (n=64) were males and 26% (n=22) were females with a mean age of 39.49 (SD ±15). There was no statistically significant difference in the mean visual analogue scale (VAS) pain assessment between the Skin traction group and Trans-tibia skeletal traction group after traction. With regards to complications, the difference between the Skin traction group and the Skeletal traction group was statistically significant (P=0.001). Moreover, the mean blood loss compared with the open type of reduction in the Transtibia skeletal traction group was significantly less than the Skin traction group (p=0.000).Conclusion: This study has shown that both Skeletal traction and Skin traction were equally effective in controlling pre-operative pain in adult patients with femoral shaft fractures and does not affect intra-operative blood loss and postoperative management. Therefore, pre-operative Skin traction can be considered a useful and cost-effective method of maintaining alignment and pain relief in adult femoral shaft fractures.Keywords: Skin traction, Trans-tibia skeletal, reamed Intramedullary nailing, Intra-operative blood loss, Visual Analogue ScaleFunding: Personal Funding

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Review of Lower Extremity Traction in Current Orthopaedic Trauma

Cited by 27 publications

References 16 publications

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients

A comparative evaluation of the efficacy between skeletal traction and skin traction in pre-operative management of femur shaft fractures in Korle Bu Teaching Hospital

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