A prospective, randomized clinical trial comparing tibial nailing using fracture table traction versus manual traction

Objective: We sought to determine the effectiveness of intramedullary tibia l nailing using manual traction with the leg draped free versus standard fr acture table positioning and traction, Study Design: Prospective, randomized clinical trial. Methods: Eighty-five tibial shaft fractures (in seventy-nine patients) trea ted by intramedullary nailing were randomized either to manual traction wit h the leg draped free or to standard fracture table traction applied throug h a boot attachment. Results: We found that manual traction provided results, in terms of intrao perative parameters and quality of fracture reduction, similar to those wit h standard fracture table traction. Manual traction significantly reduced p ositioning time (twelve minutes versus twenty-five minutes, p = 0.002) and also allowed for multiple simultaneous or sequential procedures in polytrau ma patients without the need for re-positioning or re-draping. This saved a further thirty-two minutes (mean) in 37 percent of cases treated by manual traction. Conclusion: Manual traction for intramedullary nailing of the tibia is an e ffective technique that can save a significant amount of time without sacri ficing the quality of reduction or fixation of tibial shaft fractures. It i s especially useful in polytrauma patients with multiple lower-extremity in juries.