title: A prospective study of pain reduction and knee dysfunction comparing femoral skeletal traction and splinting in adult trauma patients.
abstract: OBJECTIVE
  To determine if distal femoral traction pins result in knee dysfunction in patients with femoral or pelvic fracture, and to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures.
  
  
  METHODS
  Prospective cohort trial.
  
  
  METHODS
  Level I urban trauma center.
  
  
  METHODS
  One hundred twenty adult patients with femoral shaft, acetabular, and unstable pelvic fractures.
  
  
  METHODS
  Patients with femoral shaft fractures were placed into distal femoral skeletal traction or a long-leg splint, based on an attending-specific protocol. Patients with pelvic or acetabular fractures with instability or intraarticular bone fragments were placed into skeletal traction.
  
  
  METHODS
  An initial Lysholm knee survey was administered to assess preinjury knee pain and function; the survey was repeated at 3- and 6-month follow-up visits. Also, a 10-point visual analog scale was used to document pain immediately before, during, and immediately after fracture immobilization with traction or splinting.
  
  
  RESULTS
  Thirty-five patients (29%) were immobilized with a long-leg splint, and 85 (71%) were immobilized with a distal femoral traction pin. Eighty-four patients (70%) completed a 6-month follow-up. Lysholm scores decreased by a mean 9.3 points from preinjury baseline to 6 months postinjury in the entire cohort (P < 0.01); no significant differences were found between the splint and traction pin groups. During application of immobilization, visual analog scale pain scores were significantly lower in traction patients as compared with splinted patients (mean, 1.9 points less, P < 0.01). Traction pins caused no infections, neurovascular injuries, or iatrogenic fractures.
  
  
  CONCLUSIONS
  Distal femoral skeletal traction does not result in detectable knee dysfunction at 6 months after insertion, and results in less pain during and after immobilization than long-leg splinting.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
authors: David B
authors: DB
authors: Bumpass
authors: William M
authors: WM
authors: Ricci
authors: Christopher M
authors: CM
authors: McAndrew
authors: Michael J
authors: MJ
authors: Gardner
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000209:etiology; D005260:Female; D005264:Femoral Fractures / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries / Q000601:surgery*; D011446:Prospective Studies; D013165:Splints; D014143:Traction; D055815:Young Adult