Traction Pins Offer No Advantage in Closed Femur Fractures

NAPLES, FLA. – Preoperative traction pinning did not reduce the need for transfusion or adjunctive reduction of closed, mid-shaft femur fractures in a retrospective analysis of 255 trauma patients.

In all, 44.6% of the 56 patients who received preoperative invasive traction pinning required red blood cell transfusion, compared with 43.7% of the 199 patients managed with noninvasive stabilization including splinting, Hare traction, and Buck’s traction.

The proportion of patients transfused was similar between the invasive and noninvasive groups at all three time points: preoperative (6 patients vs. 15 patients), intraoperative (10 patients vs. 28 patients), and postoperative (23 patients vs. 74 patients), Dr. Douglas Stoddard and his colleagues reported in a poster at the annual meeting of the Eastern Association for the Surgery of Trauma.

Adjunctive reduction was needed in 21% or 27.5% of the invasive traction group vs. 65% or 32.7% of the noninvasive group, which again was not significantly different. Length of hospital stay was also similar at 10.5 days vs. 8.9 days, respectively.

Preoperative management of closed mid-shaft femur fractures varies among trauma and orthopedic patients. It has been suggested that invasive pin traction might allow for better reduction and stabilization of the fracture relative to noninvasive stabilization, but studies in pediatric trauma patients have failed to demonstrate a benefit.

The current analysis included adult patients who underwent orthopedic repair within 48 hours of admission. Preoperative fracture stabilization was at the discretion of the orthopedic surgeon. There were no differences in age, injury severity score, or mechanism of injury between groups.

Invasive traction did not positively affect weight-bearing status or discharge destination, according to Dr. Stoddard of the Madigan Army Medical Center in Tacoma, Wash. Full weight-bearing status was achieved by 21.4% of the invasive group vs. 21.1% of the noninvasive group, partial weight by 19.6% vs. 27.1% and nonweight bearing by 59% vs. 52%. In the invasive group, 29 patients were discharged home, 25 to a rehabilitation facility and 2 died, vs. 114 patients, 81 patients, and 4 patients respectively, for the same outcomes in the noninvasive group.

The study was limited by its retrospective design, lack of information on self-reported pain, and inability to ascertain if the traction was applied adequately to reduce the fracture. Also, the data were uncontrolled for severity of fracture and concomitant injuries, the authors note.

Future directions for research on this topic include a prospective study verifying the findings and assessing differences in pain between the two groups.

The authors reported no conflicts of interest.