Objectives—1) Determine if distal femoral traction pins result in knee dysfunction in femoral or pelvic fracture patients, and 2) to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures. Design—Prospective cohort trial. Setting—Level I urban trauma center. Patients/Participants—120 adult patients with femoral shaft, acetabular, and unstable pelvic fractures. Intervention—Patients with femoral shaft fractures were placed into distal femoral skeletal traction or a long-leg splint, based on an attending-specific protocol. Pelvic or acetabular fracture patients with instability or intra-articular bone fragments were placed into skeletal traction. Main Outcome Measurements—An initial Lysholm knee survey was administered to assess pre-injury knee pain and function; the survey was repeated at 3- and 6-month follow-up visits. Also, a 10-point visual analog scale (VAS) was used to document pain immediately before, during, and immediately after fracture immobilization with traction or splinting. Results—35 patients (29%) were immobilized with a long-leg splint, and 85 (71%) were immobilized with a distal femoral traction pin. 84 patients (70%) completed 6-month follow-up. Lysholm scores decreased by a mean 9.3 points from pre-injury baseline to 6 months post-injury in the entire cohort (p<0.01); no significant differences were found between the splint and traction pin groups. During application of the immobilization, VAS pain scores were significantly lower in traction patients as compared to splinted patients (mean 1.9 points less, p<0.01). Traction pins caused no infections, neurovascular injuries, or iatrogenic fractures. Conclusions—Distal femoral skeletal traction does not result in detectable knee dysfunction at 6 months post-insertion, and results in less pain during and after immobilization than long-leg splinting.
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Objectives—1) Determine if distal femoral traction pins result in knee dysfunction in femoral or pelvic fracture patients, and 2) to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures. Design—Prospective cohort trial. Setting—Level I urban trauma center. Patients/Participants—120 adult patients with femoral shaft, acetabular, and unstable pelvic fractures. Intervention—Patients with femoral shaft fractures were placed into distal femoral skeletal traction or a long-leg splint, based on an attending-specific protocol. Pelvic or acetabular fracture patients with instability or intra-articular bone fragments were placed into skeletal traction. Main Outcome Measurements—An initial Lysholm knee survey was administered to assess pre-injury knee pain and function; the survey was repeated at 3- and 6-month follow-up visits. Also, a 10-point visual analog scale (VAS) was used to document pain immediately before, during, and immediately after fracture immobilization with traction or splinting. Results—35 patients (29%) were immobilized with a long-leg splint, and 85 (71%) were immobilized with a distal femoral traction pin. 84 patients (70%) completed 6-month follow-up. Lysholm scores decreased by a mean 9.3 points from pre-injury baseline to 6 months post-injury in the entire cohort (p<0.01); no significant differences were found between the splint and traction pin groups. During application of the immobilization, VAS pain scores were significantly lower in traction patients as compared to splinted patients (mean 1.9 points less, p<0.01). Traction pins caused no infections, neurovascular injuries, or iatrogenic fractures. Conclusions—Distal femoral skeletal traction does not result in detectable knee dysfunction at 6 months post-insertion, and results in less pain during and after immobilization than long-leg splinting.
Copyright remains with the authors and publisher.