A prospective study of pain reduction and knee dysfunction comparing femoral skeletal traction and splinting in adult trauma patients.
Academic Article
Overview
abstract
OBJECTIVES: To determine if distal femoral traction pins result in knee dysfunction in patients with femoral or pelvic fracture, and to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures. DESIGN: Prospective cohort trial. SETTING: Level I urban trauma center. PATIENTS/PARTICIPANTS: One hundred twenty adult patients with femoral shaft, acetabular, and unstable pelvic fractures. INTERVENTION: Patients with femoral shaft fractures were placed into distal femoral skeletal traction or a long-leg splint, based on an attending-specific protocol. Patients with pelvic or acetabular fractures with instability or intraarticular bone fragments were placed into skeletal traction. MAIN OUTCOME MEASUREMENTS: An initial Lysholm knee survey was administered to assess preinjury knee pain and function; the survey was repeated at 3- and 6-month follow-up visits. Also, a 10-point visual analog scale was used to document pain immediately before, during, and immediately after fracture immobilization with traction or splinting. RESULTS: Thirty-five patients (29%) were immobilized with a long-leg splint, and 85 (71%) were immobilized with a distal femoral traction pin. Eighty-four patients (70%) completed a 6-month follow-up. Lysholm scores decreased by a mean 9.3 points from preinjury baseline to 6 months postinjury in the entire cohort (P < 0.01); no significant differences were found between the splint and traction pin groups. During application of immobilization, visual analog scale pain scores were significantly lower in traction patients as compared with splinted patients (mean, 1.9 points less, P < 0.01). Traction pins caused no infections, neurovascular injuries, or iatrogenic fractures. CONCLUSIONS: Distal femoral skeletal traction does not result in detectable knee dysfunction at 6 months after insertion, and results in less pain during and after immobilization than long-leg splinting. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
