title: Preoperative skeletal versus cutaneous traction for femoral shaft fractures treated within 24 hours.
abstract: OBJECTIVE
  To compare the advantages and disadvantages of preoperative cutaneous traction versus skeletal traction in adults with diaphyseal femur fractures amenable to fixation within 24 hours.
  
  
  METHODS
  Randomized prospective trial.
  
  
  METHODS
  Level I trauma center in a major metropolitan area.
  
  
  METHODS
  Sixty-five patients with 66 femur fractures were prospectively enrolled and randomized to a traction group from July 2009 to July 2010.
  
  
  METHODS
  Time of application for on call physicians/practitioners, pain relief after application of traction; time of reduction in the operating room theater, and evaluation of pain medication consumption before stabilization.
  
  
  RESULTS
  Thirty-seven patients received cutaneous femoral traction, whereas 29 patients received skeletal traction. There was a significant reduction in time of application for the cutaneous traction (24.30 ± 24.74 minutes) compared with skeletal traction (57.10 ± 33.60 minutes) (P ≤ 0.001). There was no statistically significant difference in visual analog scale (VAS) scores when compared with pretraction application pain assessment and posttraction pain assessment between the cutaneous and skeletal traction groups with a decrease in the VAS of (0.56 ± 3.73 and 0.54 ± 2.76), respectively (P = 0.99). There was no difference in pain medication requirements between groups (0.12 ± 0.17 mg/kg for cutaneous versus 0.09 ± 0.14 mg/kg for skeletal, P = 0.39). There was no significant difference in reduction time of the fracture (skin incision or opening reamer to guide wire passage) in the operating room between cutaneous traction versus skeletal traction (P = 0.59).
  
  
  CONCLUSIONS
  Use of cutaneous traction for diaphyseal femur fractures when compared with skeletal traction results in a statistically significant reduction in time of application to the on call practitioner with no complications or detrimental change in operative time and no difference in VAS pain scores or narcotic usage.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Even
authors.forename: Justin E
authors.initials: JE
authors.lastname: Richards
authors.forename: Colin G
authors.initials: CG
authors.lastname: Crosby
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kregor
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Mitchell
authors.forename: Alex A
authors.initials: AA
authors.lastname: Jahangir
authors.forename: Marc A
authors.initials: MA
authors.lastname: Tressler
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D011300:Preoperative Care; D013997:Time Factors; D014143:Traction / Q000379:methods*; D055815:Young Adult