title: The use of traction for treating femoral shaft fractures in low- and middle-income countries: a systematic review.
abstract: The use of traction for treatment of femoral shaft fractures remains common in low- and middle-income countries (LMICs). The objective of this study is to systematically review the literature on outcomes of traction as definitive treatment for adult femoral shaft fractures in LMICs.
  
  
  
  Using the recommended PRISMA methods for systematic reviews, MEDLINE, EMBASE, LILACS, and AJOL were searched for relevant publications. Results were limited to studies occurring in LMICs as defined by the World Bank. Data on time spent in traction (TT), length of stay (LOS), time to partial weight bearing (PWB), complication incidences, and a total complication incidence were recorded.
  
  
  
  Of the 693 initial results, nine were eligible for analysis giving a total of 455 unique patients with a mean age of 32.9 years (range: 0 to 96). The average time spent in traction was 52.8 days (range: 19.8 to 122.5), the average length of stay was 55.4 days (range: 45 to 140), and the average time to partial weight bearing was 52.2 days (range: 42 to 60 days). There were a total of 91 malunions, 25 un-united fractures, 60 infections, 45 other complications, giving a total of 221 complications in 455 patients.
  
  
  
  The use of traction in treating femoral shaft fractures is associated with a high incidence of complications and prolonged course of treatment. Although operative stabilization may be a better alternative, comparative studies are needed to assess whether this can be achieved in a safe and cost-effective manner for widespread application in LMICs.
authors.affiliation: Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA. erik.kramer@yale.edu.|Orthopaedic Trauma Institute, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA. erik.kramer@yale.edu.
authors.forename: Erik James
authors.initials: EJ
authors.lastname: Kramer
authors.affiliation: Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.|Orthopaedic Trauma Institute, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA.
authors.forename: David
authors.initials: D
authors.lastname: Shearer
authors.affiliation: Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.|Orthopaedic Trauma Institute, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA.
authors.forename: Saam
authors.initials: S
authors.lastname: Morshed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur / Q000601:surgery; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D014143:Traction / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Developing countries; Femur fracture; Orthopaedics; Traction