Stephen, J Bone Joint Surg Am 2002 - Femoral Intramedullary Nailing: Comparison of Fracture-Table and Manual Traction

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Femoral Intramedullary Nailing: Comparison of Fracture-Table and Manual Traction

Stephen, McKee, et al.·J Bone Joint Surg Am·2002·126 citations·RCT

Background

The purpose of this study was to compare manual traction and fracture-table traction for the reduction and nailing of femoral shaft fractures. We evaluated the quality of the reduction, operative time, complications, and functional status of the patient.

Methods

87 consecutive adult patients with a unilateral fracture of the femoral diaphysis that did not extend into the knee joint or proximal to the lesser trochanter were enrolled in the study.
Patients who were transferred to our institution more than 48 hours after injury; those with multiple-system injuries, injury to the ipsilateral lower extremity, or pathological fracture; and those who were unable or unwilling to provide consent or to return for follow-up were excluded.
45 patients were randomized to manual traction and 42, to fracture-table traction; all were treated in the supine position.
The number of surgical assistants, operative and fluoroscopy time, complications, functional scores, and other outcomes were recorded.

Results

There were no significant differences between the groups with respect to age, gender, Glasgow Coma Score, Injury Severity Score, side or mechanism of injury, fracture type, or time from injury to treatment.
Internal malrotation was significantly more common when the fracture table had been used: 12 (29%) of the 42 femora were internally rotated by >10 compared with 3 (7%) of the 45 treated with manual traction (p = 0.007).
Total operative time, from the beginning of the patient positioning to the completion of the skin closure, was decreased from a mean of 139 minutes (range, 100 to 212 minutes) when the fracture table was used to a mean of 119 minutes (range, 65 to 180 minutes) when manual traction was used (p = 0.033).
There was no significant difference between the 2 treatment groups with regard to the number of assistants per case (mean 2; range, zero to 3), fluoroscopy time, other complications including femoral shortening or lengthening, or functional status of the patient at one year.

Conclusions

Compared with fracture-table traction with the patient in a supine position, manual traction for intramedullary nailing of isolated fractures of the femoral shaft is an effective technique that decreases operative time and improves the quality of the reduction.

Copyright remains with the authors and publisher.

Femoral Intramedullary Nailing: Comparison of Fracture-Table and Manual Traction

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Femoral Intramedullary Nailing: Comparison of Fracture-Table and Manual Traction

Stephen, McKee, et al.·J Bone Joint Surg Am·2002·126 citations·RCT

Background

The purpose of this study was to compare manual traction and fracture-table traction for the reduction and nailing of femoral shaft fractures. We evaluated the quality of the reduction, operative time, complications, and functional status of the patient.

Methods

87 consecutive adult patients with a unilateral fracture of the femoral diaphysis that did not extend into the knee joint or proximal to the lesser trochanter were enrolled in the study.
Patients who were transferred to our institution more than 48 hours after injury; those with multiple-system injuries, injury to the ipsilateral lower extremity, or pathological fracture; and those who were unable or unwilling to provide consent or to return for follow-up were excluded.
45 patients were randomized to manual traction and 42, to fracture-table traction; all were treated in the supine position.
The number of surgical assistants, operative and fluoroscopy time, complications, functional scores, and other outcomes were recorded.

Results

There were no significant differences between the groups with respect to age, gender, Glasgow Coma Score, Injury Severity Score, side or mechanism of injury, fracture type, or time from injury to treatment.
Internal malrotation was significantly more common when the fracture table had been used: 12 (29%) of the 42 femora were internally rotated by >10 compared with 3 (7%) of the 45 treated with manual traction (p = 0.007).
Total operative time, from the beginning of the patient positioning to the completion of the skin closure, was decreased from a mean of 139 minutes (range, 100 to 212 minutes) when the fracture table was used to a mean of 119 minutes (range, 65 to 180 minutes) when manual traction was used (p = 0.033).
There was no significant difference between the 2 treatment groups with regard to the number of assistants per case (mean 2; range, zero to 3), fluoroscopy time, other complications including femoral shortening or lengthening, or functional status of the patient at one year.

Conclusions

Compared with fracture-table traction with the patient in a supine position, manual traction for intramedullary nailing of isolated fractures of the femoral shaft is an effective technique that decreases operative time and improves the quality of the reduction.

Copyright remains with the authors and publisher.

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