OTA 2012 Posters

Scientific Poster #15 Hip/Femur OTA-2012

Preoperative Traction in Trochanteric Fractures Treated With a Gamma3 Nail: Determination of the Impact in 347 Cases

Rainer H. Burgkart, MD, PhD1; Erik Wilde, MD2; Andreas Paech, MD2;
Johannes Kiene, MD2; Christian Juergens, MD2,3; Arndt P. Schulz, MD, PhD2,3; 1Clinic for Orthopaedics and Traumatology, Technische Universität München,
München, Germany;
2University Hospital SH, Campus Lübeck, Lübeck, Germany;
3BG Trauma Hospital, Hamburg, Germany

Background/Purpose: Following a hip fracture, traction may be applied to the injured limb before surgery with an aim to reduce pain and facilitate the surgical procedure. There is evidence, however, that the preoperative pain is not positively influenced by this procedure. So far there is no evidence that skin traction facilitates the surgical procedure; on the other hand, it is well recognized that skin traction can be responsible for vascular and neurologic complications as well as infections. The rationale of this study was to evaluate if skin traction has an impact on the postoperative result and complication rate. Patient population in this study is derived from the international prospective Gamma3 follow-up study of Schulz et al. The aim was to evaluate the effects of traction after trochanteric fracture, hypothesizing that there is no measurable effect.

Methods: The study design of the Gamma3 study has been described in detail elsewhere. In brief, it is designed as an international prospective clinical follow-up evaluation. The presented data of 347 patients were collected in April 2011. Data are derived from 5 centers. In 56.6% of all cases a preoperative traction had been used. There was no significant difference in terms of subject age (P = 0.06). There were more female patients who received preoperative traction than male subjects: 60.3% of all female subjects received this kind of preoperative preparation, while 49.0% of all men received the same treatment; these findings were not significant (P = 0.091). There was also no significant difference with respect to body mass index (P = 0.114).

Results: There was no detectable statistical difference regarding the parameters of pain, device-related complications, medical complications, or mobility at 4 months (all P >0.05). Regarding total surgery time, subjects with preoperative traction had highly significant lower total surgery times (P <0.001); the same applied for the skin-to-skin time (P <0.001). To elucidate this, we stratified results according to the OTA classification and the types of implant (long/short nail). Apart from the subtrochanteric fracture types (P = 0.338), results showed significantly shorter procedure times for subjects with preoperative traction (all P <0.05).

Conclusion: In our prospective trial we could show that there appears to be no benefit of traction for pain, complications, or outcome. From the evidence available, the routine use of traction prior to surgery for a hip fracture does not appear to have any benefit apart from procedure time.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.