Preoperative traction in patients with hip fractures. Preoperative skin traction or pillow nursing in hip fractures: a prospective, randomized study in 123 patients. Preoperative skin traction for fractures of the proximal femur. A randomised prospective trial. Preoperative skin traction in patients with hip fractures is not useful. Skin traction and placebo effect in the preoperative pain control of patients with collum and intertrochanteric femur fractures. Preoperative traction for hip fractures in the elderly: a clinical trial. Why are we still using pre-operative skin traction for hip fractures? Efficacy of preoperative skin traction in hip fracture patients: a prospective, randomized study. Preoperative traction for hip fracture: a randomized comparison between skin and skeletal traction in 78 patients.
A series of 80 patients with cervical, trochanteric or subtrochanteric hip fractures were randomized to either treatment without traction, skin traction, or skeletal traction during the 1883 h between admission and operation. The institution of skin or skeletal traction was not particularly painful for the patient, but we found no indication that either was of discernible benefit. The number of analgesic medications needed was no higher in patients without traction. We conclude that traction should not be administered routinely to patients awaiting operation for hip fracture. To study the influence on pain and handling of different preoperative immobilization procedures for hip fractures.
                123 consecutive patients with displaced cervical and trochanteric hip fractures were randomized to skin traction, placement in a special foam pillow (Lasse pillow), and comfortable placement with an ordinary pillow under the hip from admission to operation. The effect on pain alleviation was evaluated with a Visual Analogue Scale and by the number of doses of analgesics administered. The processing time through the emergency department, X-ray department and to the ward as well as time to operation was registered.
                No clinically significant difference in the VAS pain evaluation was found. There was no difference in the total consumption of analgesics in the emergency department or on the ward and no effect of immobilization type on the processing time or time to operation. Fracture type did not affect the outcome. Approximately one third of the patients found placement on a regular pillow or the application of skin traction uncomfortable as opposed to only one of 19 of the patients lying in the special Lasse pillow. There was no other difference in processing time with regard to different forms of pillow nursing and skin traction.
                The most convenient immobilization should be chosen as there is no significant difference concerning pain and handling time. Increased attention to analgesic medication and rapid handling to be operated are of importance to promote the rehabilitation process. We report the results of a randomised trial to determine the effects of skin traction on 252 patients awaiting surgery for fractures of the proximal femur. They were allocated randomly to be nursed free in bed or to receive Hamilton-Russell skin traction. No differences were found between the groups in terms of pain suffered, analgesia required, frequency of pressure sores or ease of operation. The application of skin traction to patients with fractures of the upper femur is time-consuming and we recommend therefore that its routine use should be discontinued. One hundred twenty patients with cervical or trochanteric hip fractures were allocated randomly to groups receiving either skin traction or no special treatment while awaiting surgery. No differences were found between the groups in terms of pain experienced, the need for supplementary analgesics, or complications during the hospital stay. In addition, the repositioning and percentage of united fractures after 4 months did not differ significantly between the groups. The application of skin traction offered no benefits, and thus routine use of preoperative skin traction in patients with hip fractures is not recommended. Proximal femur fractures are one of the most common injuries necessitating operative treatment. The aim of this prospective study was to evaluate and compare the possible effects of the preoperative application of a skin traction device, with or without weights, on pain relief in patients with acute proximal femur fracture.
                This study included 108 pre-operative patients with hip fractures. The subjects were randomly divided into three groups, and the following treatments were administered: Group 1, skin traction with 2 kg of weights; Group 2, skin traction without weights; and Group 3, pillow placement under the affected limb.
                Pain was assessed using the visual analog scale (VAS). No significant differences were observed in the scores of the three groups before the pain relief treatment. All three modes of treatment resulted in significant pain reduction in subjects. Patients treated without a weight-loaded skin traction kit had better pain relief compared to the other two groups; this outcome was statistically significant.
                This study indicates that pillow placement under an injured limb can be safely used instead of traction, which has no significant benefit. However, an external device, such as a skin traction kit without weight, may be used in patients with persistent pain; this external device may have an additive placebo effect, as was proven in this study. A consecutive series of 100 patients with femoral neck fractures were assessed by a mental test score on admission. The 67 scoring within the normal range were randomly assigned to skin traction or no traction between admission and operation. Using pain assessment scales and records of analgesic consumption, there was found to be little difference between the two groups. The conclusion was that skin traction offered no benefits in pain control for the patient and therefore should not be used routinely. We performed a prospective randomised trial to evaluate the efficacy of pre-operative skin traction for proximal femoral fractures in 311 patients. We found a significant difference in pain score on the evening of admission and the first morning after admission between the groups with traction compared the group without. However, there was no corresponding increase in analgesic requirement during this period. The peak pain score pattern also was different in our population. No other objective benefit can be shown from using skin traction, and its routine use should be abandoned. To compare the analgesic benefit of preoperative skin traction with the placement of a pillow under the injured extremity in patients with hip fractures.
                Prospective, randomized clinical study.
                University-affiliated teaching institution.
                One hundred consecutive patients with hip fractures admitted to the authors' institution who met inclusion criteria were enrolled. Fifty-five patients had femoral neck fractures, and forty-five patients had intertrochanteric fractures. The average patient age was seventy-eight years.
                All patients were preoperatively randomized into two intervention groups. One group underwent placement of five pounds of skin traction on the injured extremity, whereas the second underwent placement of a pillow under the injured extremity. Fifty patients were enrolled in each intervention group.
                With respect to immediate postintervention pain levels, patients treated with a pillow showed a trend toward better pain relief, as compared with patients treated with skin traction; however, this was not statistically significant. On the morning after admission, patients treated with a pillow had a statistically significant greater reduction in pain (p = 0.04). These patients also requested a statistically significant lower amount of pain medication (p < 0.01).
                The authors think that preoperative skin traction in patients with hip fractures does not provide significant pain relief, as compared with pillow placement under the injured extremity, and thus should not be routinely performed in this patient population for analgesia. 153 consecutive patients with displaced cervical and trochanteric hip fractures were considered for inclusion in this study. 75 were excluded because of senile confusion and the remaining 78 were randomized to skeletal or skin traction preoperatively. The effect on pain alleviation was evaluated with a Visual Analogue Scale (VAS) and by the number of doses of analgesics administered. The processing time through the emergency department, radiographic department and to the ward, as well as time to operation, was registered. No significant difference in the VAS pain evaluation was found. There was a small significant increase in consumption of analgesics of no clinical importance in patients with skin traction, and no effect of traction type on the processing time or time to operation. Fracture type did not affect the outcome. Since half of the patients found the application of skeletal traction painful, compared to one fifth with skin traction, skeletal traction should not be routinely used to alleviate pain preoperatively in these patients.