Traction Tables Research Articles

Proximal femoral nailing for unstable trochanteric fractures: lateral decubitus position or traction table? A case-control study of 96 patients.

This study aimed to compare the treatment of unstable intertrochanteric femoral fractures with short proximal femoral nailing in elderly patients in the lateral decubitus position versus the supine position on traction tables. From June 2020 to January 2022, a prospective case-control study was performed on 96 patients who presented with unstable trochanteric fractures treated by internal fixation via short proximal femoral nail (PFN). Patients were divided into two groups: Group A, which included patients who underwent surgery in the lateral position; and Group B, which included those in the supine position. Both groups were subjected to follow-up for 12 months. The mean setup time, surgery time, and blood loss were significantly greater in Group B than in Group A, while the hospital stay and fluoroscopy duration were similar in both groups. Regarding reduction quality and fixation (TAD (tip-apex distance), CDA (collodiaphyseal angle), and Reduction CRQC (change reduction quality criterion)), there were no statistically significant differences between the two groups; moreover, there were no intraoperative or postoperative complications in either group or the Harris hip score (67.65±17.06 in Group A vs. 67.15±17.05 in Group B). The lateral decubitus and supine positions on a traction table are suitable for proximal femoral nailing with comparable outcomes, and surgeons can use either position according to their preferences and resources.

155 Fracture of Pubic Rami During Hip Fracture Fixation - a Rare Case of Traction Table Related Injury

Abstract Background Traction tables form the mainstay of closed reduction techniques for lower limb fracture and in particular hip fractures. They offer a versatile solution to continuous traction required in a variety of operations such as closed intramedullary femoral fixation and hip fixation. Counter traction on the table is provided by the perineal post, this has been associated with significant complications such as neuropraxia, erectile dysfunction, cutaneous necrosis, and urethral injuries. Case presentation We present a case of an elderly and co-morbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intra-operatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table. Conclusions Closed reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed fixation should be accounted for when managing this complex and often frail group of patients.

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review.

The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table (n = 4402) and 100.1 ± 32.6 minutes for traction table (n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard (n = 2992) and 531.7 ± 364.3 mL for traction table (n = 2675). Intra-operative fracture rate was 1.3% for standard table (n = 3940) and 1.7% for traction table (n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.

A case report depicting patient\u2019s installation on the fracture table when an ankle spanning external fixator is already in place

BackgroundFractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table. Moreover, some femoral neck fractures may be treated with total hip arthroplasty using a direct anterior approach and a traction table. Fracture and traction tables both use a boot tightly fitted to the patient’s foot in order to: 1) obtain fracture reduction by traction and adequate rotation exerted on the slightly abducted or adducted extremity; or 2) adequately expose the hip joint using traction, rotation and extension to implant total hip arthroplasty components. In some instances, multiply injured patients may present with both a proximal or diaphyseal femur fracture and a diaphyseal or distal tibia or ankle fracture necessitating an ankle spanning external fixator on the same limb. Frequently, the tibia or ankle fracture has to be treated first, and standard use of the fracture or traction table may be thereafter difficult due to the external fixator construct preventing tight fitting of the boot to the patient’s foot.Case presentationIn order to address this situation, the authors describe a simple technique allowing rigid fixation of the limb with an ankle spanning external fixator to the traction or fracture table, providing accurate control of the position of the lower limb in all planes for adequate fracture reduction and fixation or total hip arthroplasty. The technique is exemplified with a clinical case.ConclusionsThis technique allows an efficient way to: 1) timely stabilize diaphyseal or distal tibia or ankle fractures; and 2) subsequently use all the advantages of a fracture or traction table to adequately reduce and fix proximal or diaphyseal femur fractures, or optimally expose femoral neck fractures for total hip arthroplasty using a direct anterior approach.

Outcomes of Internal Fixation with Compression Hip Screws in Lateral Decubitus Position for Treatment of Femoral Intertrochanteric Fractures.

PurposeInternal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed.Materials and MethodsBetween March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated.ResultsClinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0–5; P<0.05); HHS was 85 (range, 72–90); and mean bone union time was 5.0 (range, 2.0–8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27–14.63) mm; lateral average TAD was 7.26 (range, 1.20–18.43) mm; total average TAD was 14.21 (range, 2.47–28.66) mm; average lag screw sliding was 4.63 (range, 0–44.81) mm; and average angulation was varus 0.72°(range, −7.6°−12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5°ConclusionCHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

An alternative to the orthopaedic traction table (fracture table): A prototype of low cost, easy reproduction and good applicability

Abstract&#x0D; Background: Orthopaedic traction tables are used as an aid in numerous surgical procedures. The present paper aims to present a prototype of an external device of lower limb traction, which is portable, of simple construction, and can be installed on any operating table, with possible application in surgical and teaching practices. We will compare the quality of radiographic images obtained with the help of this prototype (PT) to those images obtained with the aid of the conventional traction table (CT).&#x0D; Materials and methods: Cross-sectional, observational, and double blind study, approved by the Research Ethics Committee. On two occasions 36 randomly selected radiographs of the lower limbs, 18 of which obtained on the CT and the remaining on the PT, were evaluated by nine physicians. These radiographs were obtained from three volunteer and none of them presented musculoskeletal system disorders previously diagnosed in the study. Examiners rated each picture from 1 to 5, according to the quality of the image obtained. The responses were submitted to statistical analysis by SPSS ®, v23. Comparisons were considered significant when p &lt;0.05, with a 95% confidence interval.&#x0D; Results: The average ratings were similar and all significance tests between the averages were higher than 0.9. The intra-observer agreement was 76.13% for the PT and 82.69% for the CT. The inter-observer agreement was low for both models. Due to its lower weight and smaller size compared to the CT and the material used for prototyping, the production cost of the PT is quite affordable.&#x0D; Conclusions: The PT presented in this paper is a good alternative to CT.&#x0D; &#x0D; Keywords: Traction table, Fracture table, Orthopaedic surgery, Orthopaedic prototype, Lower limbs.

Erectile Dysfunction Secondary to Pudendal Nerve Injury Complicating Orthopedic Surgery: Practical Recommandations

Erectile dysfunction (ED) resulting from direct damage of pudendal nerve injury during orthopedic surgery is common and closely associated to the use of traction tables. Prolonged countertraction on the fracture table and the inappropriate placement of the perineal post are the two main contributing factors. Clinical signs are essentially sensitive, such as hypoesthesia of the perineum. Urinary incontinence, ED and hypoesthesia or complete anesthesia of scrotum and glans penis are the main clinical manifestations. Electrophysiological examinations should be considered when symptoms are not regressive and in cases of vesico-sphincter dysfunction and immediate severe ED. No medical treatment has demonstrated its effectiveness. Pudendal nerve decompression was reported to be useful in some cases. Preventive measures should be considered by surgeons to avoid perineal traction injuries. Patients must be clearly informed about this possible neurological complication before an operation on the orthopedic table. J Curr Surg. 2017;7(1-2):1-3 doi: https://doi.org/10.14740/jcs322e

Cervical Traction for Managing Neck Pain: A Survey of Physical Therapists in the United States.

Study Design Cross-sectional survey. Objective To examine the use of traction by physical therapists for patients with neck pain, including how and when traction is used, the delivery modes and parameters, supplemental interventions, and influence of professional demographics on usage. Background Systematic reviews provide little support for traction in managing neck pain. While traction usage among physical therapists in other countries has been described, usage in the United States has not been examined. Methods A random sample of 4000 Orthopaedic Section members of the American Physical Therapy Association were surveyed. Associations among respondents' professional demographics and survey responses were explored with chi-square analyses (α = .05). Results The response rate was 25.5% (n = 1001); 76.6% (n = 767) of respondents reported using traction, and 93.1% reported that they would use traction for a patient presenting with signs of nerve root compression. Common delivery modes included manual methods (92.3%) and mechanical traction tables (88.3%). Using traction is often supplemented with other interventions (exercise, postural education, joint mobilization). A higher proportion of physical therapists with American Board of Physical Therapy Specialties orthopaedic certification reported using traction (88.6%) than did those without specialty certification (73.0%). Conclusion Most respondents reported that their use of cervical traction was consistent with proposed criteria that identify patients who are likely to benefit. They use various traction delivery modes/parameters within comprehensive plans of care incorporating multiple interventions. Professional demographics (clinical specialist credentialing) were associated with traction usage. J Orthop Sports Phys Ther 2017;47(3):200-208. Epub 30 Oct 2016. doi:10.2519/jospt.2017.6914.

The dangers of hemilithotomy positioning on traction tables: case report of a well-leg drop foot after contralateral femoral nailing

BackgroundPostoperative contralateral morbidities after fracture fixation surgery by hemilithotomy positioning on traction table is uncommon. We’d report a case of unexpected common peroneal nerve palsy developed on the contralateral side manifesting with drop foot after a common orthopedic femoral nailing.Case reportA 28-year-old female sustained an unusual common peroneal nerve palsy manifesting contralateral drop foot after prolonged femoral nailing. Although the initial presentations were similar to the notorious well-leg compartment syndrome, a benign course with complete recovery in functions was observed 3 months later. After neurophysiologic exam and review of pertinent literature, this iatrogenic and transient dysfunction was delineated to be position-related neuropraxia.ConclusionPosition adjustment at intervals or complete avoidance of prolonged knee hyperflexion is recommended to prevent contralateral common peroneal nerve morbidity.

Update in Tibia Intramedullary Nailing

Since the first description of modern intramedullary tibia nails by Kuntscher and through the subsequent introduction of the locked nails by Gross and colleagues, infrapatellar access routes have been utilized. The discussion on the correlation between different entry points and the incidence of anterior knee pain has been extensive. Furthermore, nailing of proximal tibia fracture can be complicated by malalignment, typically an apex anterior with valgus angulation, coupled with posterior displacement of the distal fragment. The insertion of an intramedullary nail in the tibia utilizing a lateral suprapatellar percutaneous entry point, with the knee in semiextension, appears to mitigate the establishment of malreduction. Because the suprapatellar route does not directly injure the tendon, it consequently appears to lead to reduced incidence of knee pain. Originally indicated for proximal tibia fractures, this modification of the classical tibial nailing has been proven effective in all tibial locations. It allows for fast setup of the operating room, without the need for cumbersome traction tables; it simplifies the treatment in polytrauma patients with injuries to the soft tissue surrounding the patellar tendon area and it reduces the manipulation of concomitant fractures, such as femur and pelvis.

Scrotum wound caused by orthopaedic traction table in the surgery of femoral neck fracture

Traction table is used during orthopaedic surgeries for treating fractures such as femoral shaft and proximal femoral fractures. In this case, we report a scrotum wound caused by the use of traction table during the treatment of femoral neck fracture. The patient was a 49-year-old male, admitted to the emergency department after a fall. The patient's vital signs at admission were stable. No history of previous illness was reported by the patient. After assessment by emergency physicians, the orthopaedic surgeon was assigned to visit the patient at the earliest. Emergency internal fixation with cannulated screw was opted for by the orthopaedic surgeon. The patient was transferred to the operation room (OR) within 2 hours. Surgery lasted for 2 hours. During the surgery, the patient was kept in supine position on the orthopaedic table. After surgery, the patient was admitted to the orthopaedic ward. Two days after surgery, the patient complained of pain and burning in the scrotums. Orthopaedic nurses assessed the patient's scrotums and found a 5 cm wound and reported to the surgeon (Figure 1A, B). The orthopaedic surgeon assessed the scrotum wound and reported that the wound was related to the traction table. Inappropriate attachment of traction table to the patient's scrotum had caused the wound. Lack of sufficient attention while positioning the patient on the traction table had resulted in his scrotum getting attached to the pudendal post in a severe manner and this had caused skin necrosis and injury. Although traction tables are considered safe by orthopaedic surgeons, using them is not without any risk. Perineal wound, paresthesia of calf, pudendal nerve paresthesia, erectile dysfunction, foot compartment syndrome, rupture of epigastric artery, and external iliac thrombosis are some of the complications caused by traction tables, as reported in the literature 1-6. Considering that traction tables are used frequently in orthopaedic surgeries, operation room nurses should be aware of its complications. Pudendal post should be positioned at the correct site (between genitalia and not injured limb) and covered with sufficient amount of cotton and undercast padding (Webril). The perineal area should be assessed to ensure that it is not pressurised by the pudendal post. Abbas Abdoli Tafti1, Sanaz Sajadi2, & Hossein Rafiei3 1Orthopedic Department, Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran 2Emergency Department, Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran 3Department of Intensive and Critical Care, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran [email protected]

New Tool for Applying Traction During Open Reduction and Internal Fixation of Acetabular Fractures

Open reduction and internal fixation is used to treat complex acetabular fractures. Traction on the femur is necessary to reduce the acetabulum and is accomplished by surgical assistants or with mechanical devices. To overcome the disadvantages of various traction methods, the author designed a simple, novel traction device that can be used on an ordinary orthopedic or radiolucent operating table and has advantages over manual traction and commercial traction tables. The device consists of a horizontal cross-bar supported over the patient by 2 free-standing legs and is constructed from commercially available parts.

Traction Table-related Complications in Orthopaedic Surgery

Traction tables are used in numerous procedures about the hip and femur, including fracture fixation, hip arthroscopy, and less invasive arthroplasty. The use of a traction table is not without risks, however, and significant complications have been described, including injury to the perineal integument and soft tissues, neurologic impairment, and iatrogenic compartment syndrome of the well leg. The orthopaedic surgeon who uses a traction table for the surgical management of femur fracture must be familiar with the associated potential dangers and risks and must develop a plan to avoid traction table-associated complications, such as use of a radiolucent flat-top operating table for obese patients, adequate patient positioning, and the minimum possible surgical time.

Treatment of Distal Femorl Fracture with Retrograde Interlocking Intramedullary Nail

目的 总结股骨逆行交锁髓内钉应用的适应症、优点及其疗效.方法 2001年6月～2006年3月,采用切开复位交锁髓内钉内固定,治疗股骨远段骨折24例,早期行膝关节功能锻炼.结果 22例获随访,全部骨性愈合,功能恢复良好,无膝痛、跛行、膝关节僵直等.结论 股骨逆行交锁髓内钉治疗股骨远段骨折具有明显优势,固定牢固、坚强,功能恢复快,并发症少等优点,手术不需要C臂X线机和骨科手术牵引床,适合基层医院临床应用。

Contralateral sciatic nerve palsy following femoral nailing

The Journal of Bone and Joint Surgery. British volumeVol. 73-B, No. 4 ArticlesFree AccessContralateral sciatic nerve palsy following femoral nailingGR Tait, M DantonGR TaitSearch for more papers by this author, M DantonSearch for more papers by this authorPublished Online:1 Jul 1991https://doi.org/10.1302/0301-620X.73B4.2071664AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByPatient Positioning for Proximal Femur Fracture Fixation: a Review of Best Practices3 July 2021 | Current Reviews in Musculoskeletal Medicine, Vol. 14, No. 4The dangers of hemilithotomy positioning on traction tables: case report of a well-leg drop foot after contralateral femoral nailing14 May 2015 | Patient Safety in Surgery, Vol. 9, No. 1Traction Table-related Complications in Orthopaedic SurgeryAmerican Academy of Orthopaedic Surgeon, Vol. 18, No. 11Reactions to Injury19 November 2010Length of Operative Procedures: Reamed Femoral Intramedullary Nailing Performed With and Without a Fracture TableJournal of Orthopaedic Trauma, Vol. 12, No. 7Neurologic Complications of Pediatric Femoral NailingJournal of Pediatric Orthopaedics, Vol. 16, No. 5Neurologic Complications of Pediatric Femoral NailingJournal of Pediatric Orthopaedics Vol. 73-B, No. 4 Metrics Downloaded 77 times History Published online 1 July 1991 Published in print 1 July 1991 InformationCopyright © 1991, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download