Skeletal Versus Cutaneous Traction For Treatment of Femur Fractures

Diaphyseal femur fractures are a common occurrence in busy level one trauma centers and even
in the age of damage control orthopaedics most of these fractures are fixed definitively
within 24 hours. The historical method of temporizing these fractures has been to place a
distal femoral or proximal tibial skeletal traction pin. However, in the pediatric
population skeletal traction is not utilized due to concern for physeal injury and cutaneous
traction has been the gold standard for decades. Reasons for skeletal traction in adults
are not well defined and there are no clinical studies showing that skeletal traction
provides better outcomes in time of reduction in the operating theater or better pain
control than cutaneous traction. With the ever increasing amount of high energy trauma seen
by junior residents in the emergency department time constraints have become a large factor
in patient care. Long delays for sedation and equipment procurement make stabilizing a
diaphyseal femur fracture a time consuming experience. The purpose of this study is to
determine whether differences exist between skeletal and cutaneous femoral traction in terms
of: 1) time in patient consultation and fracture stabilization; 2) cost and risk to the
patient due to lack of conscious sedation; 3) pain scores prior to surgery; 4) time of
reduction of the diaphyseal femur fraction during surgical fixation; and 5) pain relief
after traction application.

Inclusion Criteria:

- Patient willing to consent

- 18 years of age or older

- Sustained a diaphyseal femur fracture, open or closed

- English competent

- Isolated fracture on that extremity

Exclusion Criteria:

- Pathologic fracture

- Sedated patient

- Polytrauma to same extremity

- Unable or not willing to consent