Treatment of femur shaft fractures using Perkins’ traction at Addis Ababa University: An Ethiopian experience

Abstract

Objectives: To evaluate the outcomes of Perkins’ technique in the treatment of adult femur shaft fractures from October 2007 – May 2009. Faculty of Medicine, Black-Lion Hospital (BLH), Addis Ababa University, Ethiopia, The study also aimed at looking into the spectrum of femur shaft fractures referred to BLH. Design: This was a prospective study. Setting: Addis Ababa University, Black-Lion (‘Tikur Anbessa’) Hospital-BLH, is the country’s highest tertiary level referral and teaching Hospital. The 67- bedded orthopaedic department, only one in the country, runs under-graduate and post-graduate/ residency programmes and receives referred patients from all over the country. Methods: All the 68 consecutive femur shaft fracture adult patients admitted to the department’s wards during the study period were recruited for the study. They were prospectively followed after obtaining their consents. Standard Perkins’ system of traction was applied and the orthopaedic team composed of consultants, residents, physiotherapists and nurses using a Perkins’ format/protocol prepared by the researchers followed patients. A physiotherapist attended each patient individually and as a group with similar patients. Knee and quadriceps exercise was done four times a day and recorded. Variables like patient’s demography, cause of the fracture, characteristics of fracture, duration of traction, thigh circumference, knee range of motion, limb length, pin tract condition, complications were included in the format chart. These were recorded every week and fed into computer. Final outcomes at the end of traction were documented and analyzed. Traction is removed when there is clinical and radiological evidence of fracture union. Physiotherapists give gait training and serial check X-rays were taken at out patient fracture clinics. Results: From the total of 68 consecutive patients admitted with femur shaft fractures and followed, 60 (88.2%) were males and only 8 (11.8%) were females making the fracture over eight times frequent in the male sex. About half of the patients lied in the age range 18-28 years. Road traffic accident was cause of fracture in nearly half (49.2%) patients. The right side was more commonly fractured (40, 58.8%) than the left (28, 41.2%). Two thirds of the fractures (44, 64.7%) were closed. There was one bilateral fracture encountered. Half of the fractures (34, 50%) occurred in the proximal third of the femur. Transverse fracture was the commonest pattern (29, 42.6%), followed by comminuted pattern (18, 26.5%). Only three segmental fractures were admitted. Mean hospital stay was 45 days and in the majority (33, 48.5%), duration of traction was between 30- 40 days and only eight patients were on traction for more than two months. Shortly at the end of traction; circumference of thigh was reduced only in 8 (11.8%) patients, knee range of motion was more than 90 degrees in 7 (10.3%) patients. At a mean follow-up of eight months (range 4-20 months), only one patient ended up with non-union and there was also only one mal-union. Shortening of over 2 cm was noted in 11(16.2%) patients. Over all pin tract infection rate was 11.8 %, eight patients only. Conclusion: Outcomes of conservative treatment of femur shaft fracture using Perkins’ method are safe, easy, effective and very encouraging in a developing set-up like ours. There is an excellent practice of Perkins’ traction at Black Lion Hospital, Addis Ababa. East African Orthopaedic Journal, Vol. 4: March 2010