Comparative Study Of Pain Relief Between Using Traction And Pillow Support In Proximal Femur Fractures

INTRODUCTION: There is always confusion regarding preoperative stabilization modality for proximal femur fractures to achieve pain relief. Objectives: The aim of this study was to study the effects of skeletal traction and pillow support on pain in patients with proximal femur fractures. Patients and Methods: A total of 50 patients contributed in this randomized clinical trial. Patients were randomly allotted into two equal groups: the skeletal traction and pillow support groups. The severity of pain was recorded at admission and 30 minutes, 24, 48 hours after traction/pillow support application using Visual Analogue Scale (VAS). Results: The severity of pain was significantly decreased in skeletal traction group and pillow support group only at the end of the first day after traction application. The number of pain complaints which needs analgesics was the same between the two groups. Conclusions: even though skeletal traction and pillow support had no effect on analgesic consumption, both have significantly decreased the pain at the end of the first day. The application of skeletal traction and pillow support both are recommended in patients with proximal femur fractures.

Clinical analysis of vertebral pedicle bone graft after posterior pedicle screw fixation in the treatment of tho-racolumbar fracture / 中国基层医药

Objective To analyze the clinical effects of vertebral pedicle bone graft after posterior pedicle screw fixation in the treatment of thoracolumbar fractures .Methods 80 cases with thoracolumbar fractures were ran-domly divided into the study group ( 40 cases ) and control group ( 40 cases ) .The study group used simple pedicle screw fixation , posterior reduction , and the control group adopted conventional inter vertebral internal fixation .The operation time,hemorrhage were compared between the two groups .The clinical effects of posterior transpedicular in-strumentation of bone graft and vertebral pedicle screw in fractured vertebra in the treatment of thoracolumbar fractures were analyzed.Results The operation time of study group was (110.0 ±14.9)min,which was longer than that of the control group[(91.0 ±13.7)min](t=5.93,P0.05).At the end of the follow-up after the operation,the anterior vertebral height,Cobbangle,VAS scores in the study group were (91.3 ±1.7)%,(11.2 ±1.9)°,(2.5 ±0.2)%,which were better than (86.6 ±2.3)%,(14.5 ±1.1)°,(3.5 ±0.9)% in the control group (t =5.25,3.24,6.17,all P <0.05). Conclusion Vertebral pedicle bone graft posterior pedicle screw fixation in the treatment of thoracolumbar fractures can effectively correct the kyphosis ,reconstruct vertebral height ,increase the stability of the vertebral body ,reduce and prevent postoperative vertebral height lost ,loosening and fracture fixation complications .

Clinical study of skeletal traction through olecranon of ulna treatment on the irreducible humeral supracondylar fracture in children / 中国综合临床

Objective To explore the clinical results and complications of the traditional skeletal traction through olecranon on treating the irreducible humeral supracondylar fracture in children with of ulna.Methods Ninety-eight children patients of humeral supracondylar fracture with failure of reduction manipulation were selected as our subjects.The towel clamp-skeletal traction through olecranon of ulna was applied as the additional treatment methods.Meanwhile 5-24 months' follow-up were performed.Results According to Flynn elbow joint function evaluation standard.The curative effect was as followed.71 patients (74.7％) got the excellent outcome,17 patients (17.9％) for good outcome and 7 patients for improved utcome(7.3％).Therefore,the ratio of excellent operation reached to 92.6％.Conclusion The towel clampskeletal traction through olecranon of ulna might be an effective method to treat reliable fixation regarding of its high curing rate and simple process of performance.

The Incidence of Infection in Interlocking Intramedullary Nailing after Skeletal Traction of Distal Femur

PURPOSE: The insertion site of K-wire for skeletal traction is proximal part of tibia or distal part of femur. However, people prefer proximal tibia over distal femur due to lower risk of infection rate when change to interlocking IM nailing is needed. We evaluated the infection rate of interlocking IM nailing. MATERIALS AND METHODS: Fourty-seven patients were included in this study who underwent interlocking IM nailing due to femur shaft fracture. Traction was applied at the distal femur in 19 cases and proximal tibia in 10 cases before interlocking IM nailing. No skeletal traction was applied to the remaining 18 cases. Thirty-eight patients were male and 9 were female. The average age at the time of surgery was 36.7 years old (range, 15~17 years). The average traction period was 9.5 days (range, 3~33 days) and the average followed-up period was 17.2 months. RESULTS: In the distal femoral traction group, 8 cases of superficial pin tract infection developed, but no case of deep infection such as osteomyelitis occurred. In the proximal tibia traction group, 2 cases of superficial pin tract infection developed, but no case of deep infection occurred. In the group that received no skeletal traction before interlocking IM nailing, no case of infection developed. CONCLUSION: In femur shaft fracture, the distal femoral skeletal traction followed by interlocking IM nailing of femur, compared to proximal tibia skeletal traction, did not increase the risk of deep infection such as osteomyelitis.

A Skeletal Traction on the Radiolucent Table in Closed Intramedullary nailing of Femoral Fracture

PURPOSE: To evaluate the clinical results of femoral shaft fracture treated by Intramedullary (IM) nailing through skeletal traction compared with manual traction on a radiolucent table. MATERIALS AND METHODS: Thirty cases with femoral shaft fracture treated with closed IM nailing from January 2000 to June 2002 were divided into two groups; fifteen fractures reduced by manual traction (Group A) and fifteen fractures reduced by skeletal traction (Group B) on a radiolucent table. The number of people participated in the operations, operation and radiation exposure time, and post-operative complications were evaluated. RESULTS: The number of people participated in the operations was five in Group A and four in Group B. The average operation time was 116 minutes and 82 minutes (p<0.001). The radiation exposure time was 2.8 minutes and 1.2 minutes (p<0.001). However, there was no significant difference in the post-operative complications such as shortening or lengthening of bone between two groups. CONCLUSION: There was no significant difference in the operative outcome between two groups. However, skeletal traction has positive effects of reducing the operation time, radiation exposure time, and number of people participating in the operations. Also, regarding the consistent traction power, skeletal traction is the better treatment modality in maintaining the alignment and length of femoral bone than manual traction.

Arthrolysis and skeletal traction in treatment of knee ankylosis / 中华创伤骨科杂志

Objective To sum up a new surgical method to treat knee ankylosis with skeletal traction following arthrolysis. Methods Skeletal traction through supracondyle of femur or through patella was applied for 48 patients with knee ankylosis after dissection of both intra and extra articular adhesion and quadricepsplasty. Results The follow up period ranged from 3 to 36 months. The flexion angles of the knee joint increased 70?to 105?in 34 patients. Conclusion Skeletal traction following arthrolysis to treat knee ankylosis can prolong the length of quadriceps,increase the flexion angle of the knee joint step by step and facilitate early functional recovery after operation.

Treatment of comminuted tibia and fibula fractures with one arm external fixator with skeletal traction of calcaneus / 中华创伤骨科杂志

Object To report the one arm external fixator with skeletal traction of calcanus in treatment of comminuted fractures of tibia and fibula. Method 186 cases of fractures of tibia and fibula were treated by the one arm external fixator with skeletal traction of calcaneus. 42 cases were open fractures, and 142 cases were closed fractures.185 cases were followed up. Results 183 cases of fracture united, and the average healing time was 6 months. By Johner Wrichs score 113 were rated as excellent, 69 good, 2 poor. The infection rate was 17.5%. Conclusion It is convenient and effective to use one arm external fixator with skeletal traction of calcaneus to treat comminuted tibia and fibula fractures.

A Clinical Study of the Femur Shaft Fracture in Children Treated by 90 / 대한정형외과학회잡지

Authors has analyzed 75 cases of the femoral shaft fractures in children, treated by 90-90 skeletal traction methods at Jung Ang Gil General Hospital during last six years, from March 1982 to April 1988. The results were as follows :1. The 90-90 Skeletal traction can be widely applicable to the age group ranging from 3 to 13 years, while other traction methods have a certain age limits. 2. Maintenance of initial reduction snd correction of angular and rotational deformity of femoral shaft fracture were easily achieved. In addition, later angular deformity can also be easily corrected. In angular deformity and instability type, the correction and maintenance of deformity and instability were helped by use of 2 cast slabs. 3. Follow-up observation as well as wound care of open fracture and associated soft tissue injury were relatively easy. 4. The period of immobilization necessory after fracture was not longer than the other methods of treatment, and during treatment, evaluation of bony alignment and union was possible by direct palpation and inspection with out the help of X-ray. 5. The limitation of knee motion as well as circulatory and neurogenic complication were not found. Therefore, these results revealed that 90-90 skeletal traction was the easy, safe and effective method in treatment of femoral shaft fractures in childeren.

The Treatment of Supracondylar Fracture of the Humerus in Children / 대한정형외과학회잡지

Supracondylar fracture of the humerus is the most common fracture of the elbow in children For period of 4 years from Jan. 1980 to Dec. 1983, 54 children with dispaced supracondylar fracture of the humerus were classified by direction of displacement of distal fragment and treated by immediate closed reduction after lateral skeletal traction. 32 cases of these were followed up for more than 6 months. The results were obtained as follows.: 1) The most common incidence (79.6%) was 5 to 12 years of age and male and female ratio was 2.4 : l. The left humerus was involved in 35 cases (64.8%). 2) Of all fracture, extension type was 96.3% and flexion type 3.7%. 3) Under the exact anteroposteier and lateral views, fractures were classified by displaced direction of distal fragment. Immediate closed reduction was done by using thick and strong periosteal hinge after lateral skeletal traction. The more accurate anatomical reduction was obtained by maintenance of reduction state and further correction during lateral skeletal traction, and complications such as VIC, loss of reduction were lessened probably. 4) For follow up study of 32 cases, final result were analized according to Mitchells classification. Excellent results were obtained 23 cases (71.9%) Good results were 8 cases (25.0%) Unsatisfactory result was 1 case (3.1 %) 5) In 2 cases of treatment failure, the brachialis muscle was buttonholed by metaphyseal spike of the proximal fragment. 6) During lateral skeletal traction, superficial infection was developed through pin tract in 4 cases. These were treated by the administration of antibiotics and there were no complication such as osteomyelitis.

The Treatment of Supracondylar Fracture of the Humerus in Children / 대한정형외과학회잡지

Supracondylar fracture of the Humerus is the most common fracture of the elbow in children and frequently there are accompanying complications. A total of 78 children with supracondylar fracture of the humerus were treated at the Wallace Memorial Baptist Hospital, Busan, Korea, during a recent 5 year period. Of these, 33 patients were treated by lateral skeletal traction through olecranon pin and 14 of these were followed up for more than 6 months. 1. The average age was 7.2 years and the male and female ratio was 2.4:1. The left humerus was involved in 49 patients (62.5%). 2. Of all fractures, 94.4% were the extension type and 5.6% were the flexion type. 3. Satisfactory results wire obtained in 31 of 33 cases who were treated by lateral skeletal traction. Among these, 14 cases were followed up for more than 6 months. Final results were analyzed according to Mitchells classification; excellent results were obtained in 11 cases (78.6%), good results in 3 cases (21.4%) and there were no unsatisfactory results. 4. In 11 cases in which immediate closed reduction or Dunlops traction followed by closed reduction was unsuccessful, satisfactory results were obtained in 10 of 1 1 cases by using lateral skeletal traction. Therefore, we think that it is possible to treat most of the manual reduction failure patients by lateral skeletal traction. 5. There were two treatment failures using lateral skeletal traction. In one case, the brachialis muscle was buttonholed by the proximal fragment, and in the other case, the patient was treated 8 days after injury and marked hematoma formation between the fracture fragment was noted. 6. During treatment by lateral skeletal traction, infection developed through the pin tract in 2 cases. These were treated by the administration of antibiotics and there were no complications such as osteomyelitis nor did this effect the final results. 7. Incomplete radial nerve palsy developed in 3 cases. However, in all cases recovery was spontaneous with 4 weeks. 8. The average hospital stay for patients treated by lateral skeletal traction was 14.2 days. Prologed hospitalization is ane of the chief disadvantages of lateral skeletal traction. However, if we can minimized the number of hospital days by early cast immobiiization when the fracture is stable, lateral skeletal traction will prove to be a good method which can be expected to yield unlformly satisfactory results which are not surpassed by any other method of treatment. Since this method has been instituted at this hospital, very few patients have undergone open reduction because of fracture malalignment.