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.

Daniel Y D Agbley,Henry A Holdbrook-Smith,Yao Ahonon

doi:10.4314/gmj.v54i3.4

Daniel Y D Agbley, Henry A Holdbrook-Smith + Show 1 more

Open Access

https://doi.org/10.4314/gmj.v54i3.4

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Abstract

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. 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. 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). 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 post-operative 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. Personal Funding.

Highlights

Fractures of the femoral shaft are among the most common fractures that orthopaedic surgeons encounter in Korle-Bu Teaching Hospital.[1] traction is an important and basic treatment principle of orthopaedics
Patient selection and Data source In this prospective randomized study, assuming a medium effect size (0.25) among the means of pain levels and its conforming Pearson correlation coefficient (0.3) value of repeated measurements and using a 80% power at 5% level of significance giving non-centrality parameter (10.2) which follows an F-distribution, 86 patients with femoral shaft fractures awaiting surgical fixation who presented to the Accident Centre of the Korle Bu Teaching Hospital from May to December 2017 were recruited
In the Skin traction group, the etiological factors were Road traffic accident (67.4%), fall from a height (18.6%), direct blow (9.4%), sports injury (2.3%) and other forms (2.3%)

Summary

Introduction

Fractures of the femoral shaft are among the most common fractures that orthopaedic surgeons encounter in Korle-Bu Teaching Hospital.[1] traction is an important and basic treatment principle of orthopaedics. The treatment of femoral shaft fractures has evolved from the historical non-operative management to the most recent methods of intramedullary nail fixation.[3,4,5,6] Traction has been the traditional method of treatment of femoral fractures, but this method has proved to have a high rate of malunion and knee stiffness, in recent times surgery has become the ideal treatment for these fractures.[5]. Skeletal traction and skin traction can be used to regain length of the injured limb. Skin traction may be applied by way of adhesive tape, tapes bandaged to the limb or a traction boot[7]. Other possible adverse effects of skin traction are damage to the skin by mechanical shearing, ischaemia to the limb from tight bandages or allergy to adhesive strapping

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