Trochanteric Femur Fractures: Application of Skeletal Traction during Surgery Does Not Alter Soft-Tissue Microcirculation

Abstract

Background and Objectives: Wound infections provoked by alterations in microcirculation are major complications in the treatment of trochanteric femur fractures. Surgical fracture fixation on a traction table is the gold standard for treatment, but the effect on tissue microcirculation is unknown. Microcirculation could be impaired by the pull on the soft-tissue or by a release of vasoactive factors. We hypothesized that intraoperative traction impairs soft-tissue microcirculation. Materials and Methods: In 22 patients (14 women, eight men), average age 78 years (range 36–96 ± 14), with trochanteric femur fractures, non-invasive laser-Doppler spectrophotometry was used to assess oxygen saturation, hemoglobin content, and blood flow in the skin and subcutaneous tissue before and after application of traction. Measurements were recorded in nine locations around the greater trochanter at a depth of 2, 8, and 15 mm before and after fracture reduction by traction. Results: No differences were found in any depth with traction compared to without (oxygen saturation: p = 0.751, p = 0.308, and p = 0.955, haemoglobin content: p = 0.651, p = 0.928, and p = 0.926, blood flow: p = 0.829, p = 0.866, and p = 0.411). Conclusion: In this pilot study, the application of traction does not affect skin and subcutaneous microcirculation in the surgery of proximal femur fractures.

Relative lateral wall thickness is an improved predictor for postoperative lateral wall fracture after trochanteric femoral fracture osteosynthesis

“…The incidence is estimated at 6.26 million fractures per year by 2050 worldwide 2 , 3 . Despite advanced treatment options, the 2-year mortality rate after TFF is between 9 and 43% 1 , 4 , 5 . Postoperative complications are frequent and include implant failure, surgical site infection, deep vein thrombosis, and secondary lateral wall fracture (sLWF) 1 , 4 – 7 .…”

“…Despite advanced treatment options, the 2-year mortality rate after TFF is between 9 and 43% 1 , 4 , 5 . Postoperative complications are frequent and include implant failure, surgical site infection, deep vein thrombosis, and secondary lateral wall fracture (sLWF) 1 , 4 – 7 . The gold standard treatment of TFF is closed reduction and internal fixation (CRIF), where the correct implant choice and position after appropriate fracture reduction is paramount to minimize the risk of secondary complications 1 , 5 – 8 .…”