Pozzo BA, Orbezo FG, García FG, Trueba DC

Language: Spanish
References: 12
Page: 189-192
PDF size: 44.12 Kb.

ABSTRACT

Objective. The aim of present study is to investigate the analgesic effect of preoperative skin traction in patients who have recent fracture of the hip. Material and methods. A series of 100 patients who were classified into four groups is reported. Groups were as follows: trochanteric fracture and preop. skin traction, trochanteric fracture with no skin traction, femoral neck fracture and preop. skin traction and femoral neck fracture with no skin traction. Trochanteric fractures were treated by hip-screw bone fixation while femoral neck fractures were treated by partial hip prosthesis, either mono or bipolar. The standard time-span between admision and surgery was lesser than 48 hours in 90 cases (90 %). In the remaining 10, such a period was 6.2 days in average (3 to 10), as concominat diseases required to delay operation. No difference there existed between groups for preoperative period. Skin traction remained on place either in cases of standard or longer periods. Results. No significant preoperative pain control difference was found between any group at 2, 4 or 8 hours after traction application or even 15 minutes before surgery. Analgesic prescription was the same for all groups. No specific transoperative complications appeared in any case in regard to preoperative traction or its absence. No pulmonary embolism ocurred in any case of the whole series. Pressure sores were found in 10 cases of skin traction while no case of sores ocurred in non-traction patients. Finally, nursing care was somewhat more difficult in the groups of skin traction patients. Conclusion. There is no reason to perform skin preoperative traction as a routine in patients awaiting for hip fracture surgery, since it does not provide significant pain relief, or other advantage for patients and for the hospital.

REFERENCES

1. Anderson G, Harper W, Connolly C, Badham J, Goodrich N, Gregg P. Preoperative skin traction for fractures of the proximal femur. The Journal of Bone and Joint Surgery (Br) 1993; 75-B: 794-796.

2. Benson L. Orthopaedic Pearls 1999, F.A. Davis. 105-113.

3. Billsten M, Besjakov J, Hyddmark U, Johnell O, Sernbo I. Enquiry in Sweden on the use of traction preoperatively in patients with hip fracture and a radiological study on the effect of the traction on ten displaced cervical hip fractures. Acta Orthop Scand 1996; 67(270): 35.

4. Canale TC. Cirugía Ortopédica. 9na Edición 1998; Harcourt Brace, volumen tres: 2182.

5. Donahoo C, Dimon J. Orthopedic Nursing 1977; Little Brown and Company: 161-175.

6. Garden RS. Low-angle fixation in fractures of the femoral neck. The Journal of Bone and Joint Surgery 1961; 43B(4): 647-663.

7. Hart R, Rittenberry T, Uehara D. Handbook of Orthopaedic Emergencies 1999; Lippincott-Raven 108-109.

8. Jerre R, Doshe A, Karlsson J. Preoperative skin traction in patients with hip fractures is not useful. Clinical Orthopaedics and Related Research 2000; 378: 169-173.

9. Koval K. Preoperative skin traction was not useful for hip fractures. The Journal of Bone and Joint Surgery, Incorporated 2001; 83-A: 303.

10. Rosen J, Chen F, Hiebert R, Koval K. Efficacy of preoperative skin traction in hip fracture patients: A prospective, randomized study. Journal of Orthopaedic Trauma 2001; 15(2): 81-85.

11. Resch S, Thormgren K. Preoperative traction for hip fracture. A randomized comparison between skin and skeletal traction in 78 patients. Acta Orthop Scand 1988; 69(3): 277-279.

12. Stromqvist B, Nilsson L, Egund N, Thorngren K, Wingstrand H. Intracapsular pressures in undisplaced fractures of the femoral neck. The Journal of Bone and Joint Surgery (Br) 1998; 70B: 192-194.