An evaluation of Hamilton-Russelltraction in the pre-operative management of patients with hip fracture

Abstract

Hamilton-Russell traction has been used for many years in the pre-operativemanagement of patients with hip fracture despite a lack of evidence that it relieves pain. In order to evaluate the usefulness of this traction system, 303 patients with fractured neck of femur were randomly allocated to traction ( n =121) and no traction ( n =182) groups. Pain data were collected in the pre-operative period, and pressure sore data were collected in the pre- and post-operative periods. The groups were equivalent in all respects except mental function scores, where it was found that the no traction group had a disproportionate number of patients with very low scores. Analysis of covariance (ANCOVA), which offers the possibility of posthoc statistical control when group equivalence has not been obtained, was used to test for differences in outcome measures. Analysis of the pressure sore data found no difference in global scores between thetraction and no traction groups. Analysis of a small number of specific sites found that patients in traction were less likely to incur pressure damage to the heel on the opposite side to the injury ( P =0.016). During data collection, patients were asked to describe the pain they felt when they were at rest, and when they attempted to move about the bed. On analysis of the data, no difference was found between the traction and no traction groups in pain experienced on movement. However, it was found that patients in the traction group experienced less pain at rest on the day after the injury than those in the no traction group ( P =0.002). Consequently, we recommend that Hamilton-Russell traction should not beroutinely used in the pre-operative treatment of hip fracture patients. However, there is a case for retaining its use in the minority of patients who are unable to receive definitive surgical treatment within 24 hours of the injury.