Preoperative Skeletal Traction Research Articles

Closed intramedullary nailing of femoral shaft fractures. A review of one hundred and twelve cases treated by the Küntscher technique.

Since May 1972, the standard treatment of femoral shaft fractures at the Western General Hospital has been the closed femoral nailing technique of Küntscher. We have found that the use of intraoperative skeletal traction eliminates the need for immediate operation, preoperative skeletal traction, or the use of a distraction apparatus to prevent preoperative shortening. By the use of a cross-pinning technique, the closed femoral nailing method has been extended to include severely comminuted fractures of the femoral shaft and fractures of the distal third of the femur, with effective control of shortening and rotatory deformity. This allows early mobilization and discharge from the hospital for patients with these difficult fractures. One hundred and twelve consecutive traumatic fractures of the femoral shaft treated in this manner united within three to six months. The clinical results in terms of early joint movement, early weight-bearing, and rapid discharge from the hospital have been excellent.

Preoperative skeletal traction in scoliosis

To determine the role of preoperative traction in the treatment of spinal curves, ten patients with curves averaging 81 degrees by the Cobb measurement were studied. Each patient was treated in traction by means of a halo or skull tongs and femoral pins for two to three weeks prior to the surgical correction of the scoliosis with instrumentation. Weights were added to the traction apparatus, 1.8 kilograms a day, to a maximum of 18.1 kilograms. Pretraction supine roentgenograms were compared with supine roentgenograms made at three-day intervals throughout the traction period. Preoperative traction resulted in an average improvement of the curves of 34 degrees, or 41 per cent of the initial curve. Most of the correction was obtained within the first week of traction. Further correction during surgery with Harrington instrumentation yielded 13.5 degrees on the average (16 per cent) so that combined correction averaged 47 degrees, or 57 per cent.