title: A prospective, randomized clinical trial comparing tibial nailing using fracture table traction versus manual traction.
abstract: OBJECTIVE
  We sought to determine the effectiveness of intramedullary tibial nailing using manual traction with the leg draped free versus standard fracture table positioning and traction.
  
  
  METHODS
  Prospective, randomized clinical trial.
  
  
  METHODS
  Eighty-five tibial shaft fractures (in seventy-nine patients) treated by intramedullary nailing were randomized either to manual traction with the leg draped free or to standard fracture table traction applied through a boot attachment.
  
  
  RESULTS
  We found that manual traction provided results, in terms of intraoperative parameters and quality of fracture reduction, similar to those with standard fracture table traction. Manual traction significantly reduced positioning time (twelve minutes versus twenty-five minutes, p = 0.002) and also allowed for multiple simultaneous or sequential procedures in polytrauma patients without the need for re-positioning or re-draping. This saved a further thirty-two minutes (mean) in 37 percent of cases treated by manual traction.
  
  
  CONCLUSIONS
  Manual traction for intramedullary nailing of the tibia is an effective technique that can save a significant amount of time without sacrificing the quality of reduction or fixation of tibial shaft fractures. It is especially useful in polytrauma patients with multiple lower-extremity injuries.
authors.affiliation: Department of Surgery, St. Michael's Hospital and the University of Toronto, Ontario, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: McKee
authors.forename: E H
authors.initials: EH
authors.lastname: Schemitsch
authors.forename: J P
authors.initials: JP
authors.lastname: Waddell
authors.forename: D
authors.initials: D
authors.lastname: Yoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome