Abstract
Background The use of invasive traction (INV-T) to
stabilize femur fractures prior to fixation (open reduction
and internal fixation, ORIF) remains controversial. Some
centers have utilized noninvasive traction (NINV-T) or
splinting preoperatively. It is possible that INV-T decreases
hemorrhage. However, the use of INV-T in pediatric
patients and for femoral neck fractures in adults is associated
with worsened outcomes. We hypothesized that
there is no difference in the need for transfusion between
those who receive INV-T and NINV-T.
Methods A retrospective study was performed at two
level I and one level II trauma center from January 2006 to
December 2009. Patients C18 years with a closed diaphyseal
femur fracture who underwent ORIF within 48 h of
arrival were included. Patients were grouped by method of
preoperative fracture stabilization. Primary endpoint was
need for transfusion. A power analysis found that 94
patients were needed to detect a 25 % difference with 80 %
power.
Results Fifty-six (22 %) received INV-T and 199 (78 %)
received NINV-T stabilization. No significant differences
were found between groups in terms of age, injury severity
score, or ORIF method. There was no significant difference
between the two groups in the hemoglobin value on arrival,
preoperative hemoglobin value, or the difference between
admission and preoperative hemoglobin values. We did not
find a significant difference in the need for red blood cell
transfusion between the two groups. There was no difference
in length of stay or discharge destination.
Conclusion INV-T is not associated with improved outcomes
in adult patients with closed mid-shaft femoral
fractures who are operated upon within 48 h of arrival.
Keywords Femur fracture Traction