Manual traction vs traction table for intramedullary nailing of intertrochanteric fracture

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 2
72 elderly patients with an unstable intertrochanteric fracture were randomized to receive traction table facilitated intramedullary nailing or manual traction intramedullary nailing. The purpose of this study was to compare the two methods of traction in terms of their surgical, functional, and radiographic outcome. Duration of preparation Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
Why was this study needed now?
Unstable intertrochanteric fractures are a frequent traumatic injury among elderly patients. The most popular treatment currently used by surgeons is indirect reduction and cephalomedullary nailing. The use of a traction table is common in these cases and presents the advantage of requiring fewer assistants. However, set up time and possible complications (ie. vascular, neurological, or dermatological) have been cited drawbacks. Manual application of traction on a normal radiotranslucent table with the help of an assistant has been suggested as an alternative treatment method to reduce preparation time and potential complications. The present study was conducted to compare these two approaches with regards to their perioperative surgical, clinical, and radiographic outcomes.
What was the principal research question?
In the treatment of unstable intertrochanteric fracture, what is the comparative efficacy between manual traction and traction table facilitated intramedullary nailing with regards to surgical, functional, and radiological outcomes as assessed over a 6-month follow-up?
Population: 72 elderly patients, over 60 years of age, with unstable intertrochanteric fracture (AO type 31A2 and 31A3) and scheduled for closed reduction and internal fixation via intramedullary nailing. The Short InterTAN (Smith & Nephew, TN, USA) nail with single distal locking was used in all patients. Postoperative mobilization was recommended for patients as soon as they were able. Full weight-bearing was permitted at 6 weeks postoperatively.
Intervention: Traction table group: patients received anesthesia on a gurney and were transferred to the traction table with both lower extremities attached to the traction table with the foot apparatus. Fracture reduction was performed with manipulation under fluoroscopy with the help of an assistant, and an additional assistant was present if extra manipulation was required. (n=36, 34 completed 6 month follow-up; Mean age: 74.8+/-10.5)
Comparison: Manual traction group: patients were placed on a radiolucent table in a supine position exposing the affected hip. Fracture reduction and maintaining the reduction was performed with longitudinal traction and manipulation with the help of an assistant. Additional assistants were available if necessary. (n=36, 30 completed 6 month follow-up; Mean age: 76.5+/-10.2)
Outcomes: Preoperative outcomes included the duration of preparation from the end of anesthetic administration to incision, duration of surgery from incision to completion of wound closure and dressing, and fluoroscopy time in minutes. Intraoperative outcomes consisted of estimated blood loss, the total duration of anesthesia, and the number of assistants required during the procedure. Postoperative outcomes consisted of anteroposterior and lateral radiographs to measure the quality of reduction and fixation, postoperative duration of hospital stay (days), the Harris Hip Score (HHS), ambulation score, superficial wound infections (%), and radiological malunion (%). The incidence of adverse events was also documented.
Methods: RCT; prospective, multicenter
Time: Outcomes were measured perioperatively. HHS and the ambulation score were both measured at 6 months postoperatively.
What were the important findings?
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How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.