Methods
fracture, postoperative delirium, intertrochanteric fractures, pain
SECONDARY, COMPLICATIONS
This randomized controlled trial is designed, conducted, and written based on the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement [Patients who consented to the study (192 patients) were then randomized to two groups by a medical student (S.KH.) who used random allocation software with an allocation ratio of one [The whole procedure was explained to the patients to obtain written consent. Because skin traction is impossible to hide from both the patients and the medical staff, patients and medical staff were not blinded to the study. However, as traction was removed before the patients’ entrance to the operating room, the surgeon (M.M.) was blinded and was unaware of the group to which the patient was allocated before the surgery. One surgeon (M.M.) for all the patients performed the surgery. Two different surgeries were performed for the patients: extramedullary fixation (dynamic hip screw) and intramedullary nail (Gamma nail) fixation. Also, all the patients were followed up (measuring VAS scores and documenting morphine dosage and any complications) by one orthopedic resident (M.S.) and one trained nurse (T.R.) to reduce the potential performance bias. The data analyst of the study was also blinded by not mentioning which group of the patients underwent skin-traction application. Patients were excluded from the study if they refused to continue the trial at any stage. After undergoing surgery, thirty-eight patients experienced postoperative delirium. These patients were also excluded from the study as their altered level of consciousness could affect their reported VAS scores. In the end, the data of seventy-eight patients in group A and seventy-six patients in group B were entered for the final statistical analysis (Fig. 
CONSORT flow diagram depicting the number of patients allocated to each group of patients at different study stepsTable 
The comparison of patients’ characteristics between the two groups70 ± 10.2(40–92)70 ± 9.8(40–91)71 ± 10.6(46–92)6.8 ± 2.3(1.0-13.3)7.1 ± 2.4(1.0-13.3)6.5 ± 2.2(1–12)5.6 ± 1.4(2–9)5.6 ± 1.3(3–9)5.6 ± 1.5(2–9)
Bar chart comparison between the two groups regarding gender. In group 
Bar chart comparison between the two groups regarding the fracture side. In group The severity of the pain was measured based on VAS scores in patients within the first hour of diagnosis before skin traction application, two hours before the operation (after skin traction application and before patients’ transfer to the operating theater), and 24 h after the procedure. The study’s primary outcome was the effect of skin traction application on the VAS score of patients with intertrochanteric fractures. The secondary outcome of this study was the effect of skin traction on the mean administered intravenous morphine dosage for these patients per day.The sample size was calculated to be at least 42 in each group using the confidence interval of 95% and the power of study of 90% using the following formula [Where α = 0.05, β is the conventional multiplier for power (90% in our study). ZStatistical analysis was done using SPSS version 26, Chicago. Independent samples t-test, chi-square test, and repeated measures Analysis of Variance (ANOVA) tests were used for the statistical analysis. A 